Post-partum

Question 1

Define early vs late PPH

Answer 1

Early - blood loss of greater than 500mL within 24 hours of delivery

Late - blood loss of greater than 500 mL after 24h and up to 6/52 postpartum

Question 2

What are the most common causes of early PPH?

Answer 2

The 4 Ts

1. Tone (atony)
2. Tissue (retained placenta, clots)
3. Trauma (laceration, inversion)
4. Thrombin (coagulopathy)

Question 3

What are the most common causes of late PPH?

Answer 3

Retained products +/- endometritis

Question 4

List 5 risk factors for endomeritis

Answer 4

1. C/S
2. Intrapartum chorioamnionitis
3. Prolonged labour
4. Prolonged ROM
5. Multiple vaginal examinations

Question 5

How is endometritis treated?

Answer 5

Oral antibiotics if well - cephazolin/metronidazole

Question 6

List 6 broad causes of postpartum pyrexia

Answer 6

B-5W

Breast: engorgement, mastitis
Wind: atelectasis, pneumonia
Water: UTI
Wound: Episiotomy, C/S site infection
Walking: DVT, thrombophlebitis
Womb: endometritis

Question 7

What is the difference between postpartum blues and postpartum depression?

Answer 7

Postpartum blues - 85% of new mothers, onset day 3-10, self-limited, should resolve by 2 weeks

Postpartum depression: major depression occurring in a woman within 6 months of childbirth. Suspect if the ‘blues’ last beyond 2 weeks, or if the symptoms in the first two weeks are severe (e.g. extreme disinterest in the baby, suicidal or homicidal/infanticide ideation). Rarely assoc. with postpartum psychosis

Question 8

Describe the different degrees of vaginal tears/lacerations.

Answer 8

First degree: involves skin and vaginal mucosa but not underlying fascia and muscle

Second degree: involves fascia and muscles of the perineal body but no the anal sphincter

Third degree: involve the anal sphincter but does not extend through it

Fourth degree: extends through the anal sphincter into the rectal mucosa