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MRCOG part 2 > Post Partum Care > Flashcards

Post Partum Care Flashcards

1
Q

Brexanolone is

A

Allopregnanolone
Given IV
Modulator of GABA-a receptors
Used to treat postnatal depression

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2
Q

Zuranolone is

A

Allopregnanolone
Neuroactive steroid
GABA-A receptor modulator

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3
Q

Pain management after c/s

A

Intrathecal diamorphine max 300 mcg or 3mg via epidural OR

Intrathecal morphine 100mcg + 15mcg fentanyl or 3mg morphine via epidural

Oral morphine sulfate, paracetamol and ibuprofen +/- dihydrocodeine
Tramadol or oxycodone if not sufficient

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4
Q

C/S wound care

A

Negative pressure wound therapy if BMI >35

Remove dressing 6 to 24 hours after

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5
Q

Risk of stress incontinence after c/s

A

4%

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6
Q

PPH target parameters

A

Hb >80 g/l
Plts >50 x 10(9)/l
PT and APTT <1.5 x normal
Fib > 2g/l

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7
Q

Use of FFP in PPH

A

1 unit for every 4 units RBC (15ml/kg) if PPH ongoing

> 15ml/kg if PT/APPT >1.5 x normal

Use immediately after thawing

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8
Q

Incidence of primary minor PPH

A

18% deliveries

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9
Q

Incidence of primary major PPH

A

1-5%

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10
Q

Define secondary PPH

A

Excessive vaginal bleeding 24h to 12 weeks postpartum

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11
Q

Incidence of secondary PPH in high income countries

A

0.47 - 1.44%

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12
Q

Active management of third stage reduces PPH by

A

RR 0.34
66%

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13
Q

Prevention of PPH for women without risk factors

A

Oxytocin 10 units IM for SVD
5 units slow IV for c/s

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14
Q

Prevention of primary PPH in women with risk factors

A

Syntometrine for SVD
Oxytocin + consider TXA for C/S

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15
Q

MDT for major PPH

A

Midwife in charge
Band 6 midwife
Obs reg
Anaesthetic reg
On call clinical haematologist
Porters

Alert consultant obstetrician, anaesthetist and blood lab

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16
Q

Resuscitation for minor PPH without shock

A

IV access
FBC, coag, G&S
HR, RR, BP every 15 mins
Warmed crystalloid infusion

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17
Q

Resuscitation for major PPH with ongoing bleeding or signs of shock

A

Assess airway
Start 15L oxygen
Continuous HR, RR, BP (use ECG)
Temp every 15 minutes
2 x cannulae
Cross match 4 units, FBC, coag, U&E, LFT
Keep warm and lie flat
Give blood if signs of shock or Hb <70 with ongoing bleeding
Give 2L warm crystalloid then 1.5L warm colloid pending blood
Catheter
HDU/ICU care
Consider art line

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18
Q

Use of cryoprecipitate

A

2 pools if fib <2 g/L
If no clotting result then: 2 pools cryo + 1 platelet for every 8 units RBC

19
Q

Dose of syntometrine

A

5 units oxytocin
500 micrograms ergometrine

20
Q

Dose carboprost

A

250 micrograms repeated every 15 minutes up to 2mg (8 x doses)

21
Q

Side effects of carboprost

A

Bronchospams
Hypertension
Vasodilation
Increased risk infection

22
Q

Dose of misoprostol

A

800 micrograms SUBLINGUAL
(Can be oral or rectal)

23
Q

Oxytocin dose for fluid restricted women

A

30 units in 26 crystalloid
10ml/hr through syringe driver

24
Q

Surgical management of PPH

A

1st line - balloon tamponade
2nd line - brace suture
3rd line vascular ligation
4th line - hysterectomy

25
Q

Incidence of retained placenta

A

3%

26
Q

Risk of secondary PPH after retained placenta

A

1-2%
Occurs 8-14 days later due to sloughing of placental site

27
Q

Placement of brace suture

A

3cm above and below incision line

28
Q

Effectiveness of brace suture

A

75% prevention hysterectomy

29
Q

Stepwise uterine devasculariation

A

One uterine artery, then both
One ovarian artery, then both

30
Q

Effectiveness of stepwise uterine devascularisation

A

100% avoidance hysterectomy

31
Q

Internal iliac artery ligation risks

A

Ureteric injury

32
Q

Success of internal iliac artery ligation

A

61% avoidance of hysterectomy

33
Q

Effectiveness of Selective arterial occlusion (interventional radiology)

A

86.5% arrested bleeding

34
Q

Protamine sulphate is used for ____

A

Reversal of unfractionated heparin or LMWH (partial effect)

35
Q

Side effects of protamine sulphate

A

Bronchospasm
Anaphylaxis

36
Q

Protamine sulphate protocol

A

5mg/min for 5 minutes
Max dose 50mg over 10 minutes

37
Q

Management of women who decline blood products

A

Advanced directive
Counsel without partner/family
Active 3rd stage
Consider cell salvage for both c/s and SVD
Prophylactic interventional radiology on high risk (PAS)
Consider alternatives (inc EPO)

38
Q

Causes of secondary PPH

A

Endometritis
RPOC
Abnormal involution of placental site
Pseudoanuerysms and AV malformation

39
Q

How many secondary PPHs present with massive haemorrhage?

A

10%

40
Q

When does secondary PPH present

A

19% in first 7 days
41% day 8-14
23% days 15-21
12% days 22-28

41
Q

Risk of uterine perforation with SEVAC postpartum

A

1.5%

42
Q

Commonest organism causing c/s wound infection

A

Staph aureus

43
Q

Risk of nec fash after c/s

A

1.8 in 1000

MRCOG part 2 (22 decks)

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