Post-partum care and complications Flashcards
Whats meant by the term puerparium?
Period of 6 weeks after childbirth where the mothers reproductive organs return to pre-pregnant state
What are the main aspects of immediate post-partum care?
- 15-60 minute observations
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Ensure that:
- Uterus remains contracted
- Prophylactic antibiotics if needed
- Appropriate thrombopropphylaxis
- Monitoring of spinal/epidural anaesthesia
What care takes place on the post natal ward?
- 4 hourly observation
- Ensure no abnormal bleeding
- Observe
- for infection
- Thrombiprophylaxis
- Ensure fit for discharge (usually 2 day stay)
What care takes place in the community?
- Initially day visits by community midwife
- After day 10 health visitor
- Ensure no abnormal bleeding, observe for infection
What common problems occur in the postnatal period?
- Medical problems
- PPH
- Venous thrombosis
- Sepsis
- Perineal trauma
- Postnatal psychiatric disorders
- Suicide (baby blues)
- Post natal depression
- Peurperal psychosis
At what point do all women receive a post-natal check by the GP?
6 weeks after birth
What hormonal changes take place in the mother puerparium?
- B-HCG levels fall rapidly
- Human placental lactogen levels fall rapidly
- Pre-pregnant levels of oestrogen and progesterone reached 7 days post birth
What changes occur in the uterus post-partum?
Rapid involution - returns to pelvis and is no longer felt in the abdomen
What changes occur in the vagina post-partum?
- Initially swollen, but rapidly regains tone
- Vascularity and oedema decrease
- Rugae reappear - less prominent than nulliparous
What changes occur in the cervix poat-partum?
Os closes gradually after delivery - almost completely closed at day 10-14 post labour
What CVS changes occur in the post-partum/peurperium period?
- Cardiac output initially increases - return of blood from contracted uterus
- Plasma volume decreases - due to diuresis
- HR decreases - decreases CO in combination with decreased plasma voluem
What changes occur in the breast in the peurperium period?
Days 2-4
- Breasts become encorged
- Vascularity increases
- Areolar pigmentation increases
- Lobules enlarge
What is lochia?
Sloughed-off necrotic decidual layer mixed with blood - initially red and becomes paler as bleeding is reduced. It may last for up to 3-6 weeks
What is a primary post-partum haemorrhage?
Blood loss of >/= 500 ml from the genital tract occuring within the 24 hrs of delivery
What is regarded as secondary post-partum haemorrhage?
Excessive loss (>/= 500 ml) of blood between 24 h and 6 weeks of delivery
What are causes of primary PPH?
4 T’s - Tone, tissue, trauma, thrombin
- Uterine atony
- Genital tract trauma
- Coagulation disorders
- Large placenta
- Abnormal placental site
- Retained placenta
- Uterine inversion
- Uterine rupture
What is the most common cause of primary PPH?
Uterine atony (90%)
What is uterine atony?
Failure of uterus to contract effectively after delivery, which can lead to an acute hemorrhage, as the uterine blood vessels are not sufficiently compressed
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What can cause uterine atony?
- Overdistended uterus
- Prolonged labour
- Infection
- Retained tissue
- Failure to actively manage 3rd stage labour
- Placental abruption