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Repro > Post-partum Care & Emergency Obstetrics > Flashcards

Post-partum Care & Emergency Obstetrics Flashcards

1
Q

What do we call the first 6 wks following delivery?

A

The Peurperium

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2
Q

Who sees the mother during the Peurperium? [2]

A

Midwife for the 1st 9-10 days
Then Health Visitor

Go to GP for 6wk postnatal check

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3
Q

What do the midwife and health visitor do when seeing the new mum? [3]

A

Observe for signs of abnormal bleeding and infection (wound, breast or endometritis)

Debrief the events of the birth especially if there was an emergency CS

Also discussing family planning

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4
Q

What are the common and fairly normal problems in the Peurperium? [3]

A
  • Feeding problems
  • Bonding issues
  • Social problems e.g. the partner, other children or financial
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5
Q

What are the major dangers to the mother in the Post-partum period? [5]

A 
Post-Partum Haemorrhage
VTE
Sepsis
Post-natal Hypertensive disorders
Psychiatric Disorders
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6
Q

What are the types of PPH? How are they distinguished [2]

A

Primary - >500ml within 24hrs

Secondary = >500ml after 24 hrs to the 6wk boundary

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7
Q

What causes primary PPH? [4]

A

Tone - e.g. Atonic Uterus
Trauma - e.g. tears or ruptures
Tissue - Retained
Thrombin - e.g. can’t clot

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8
Q

What causes secondary PPH? [3]

A

Retained Tissue
Endometritis
Tears/trauma

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9
Q

How do we reduce risk of a VTE? [2]

How might a VTE present in the Peurperium [3]

A

A proper risk assessment and if necessary thromboprophylaxis

Presentation

  • Unilateral Leg Swelling and/or pain
  • SOB or Chest pain
  • Unexplained Tachycardia
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10
Q

How can we test for a VTE? [3]

What test do we normally use that cannot be used in pregnant women - state why

A

ECG
Doppler US
CXR +/- VQ scan

D-dimer isn’t useful in pregnant or post-partum women because they’re already hypercoagulable

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11
Q

How do we treat a VTE in pregnancy? What VTE treatment is contraindicated pregnancy but can be given in breastfeeding

A

LMWH

Warfarin can be used when breastfeeding but not during pregnancy

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12
Q

Sepsis is the leading cause of direct maternal death in the UK, how do we test for it if suspicious? [4]

A

Blood Culture
MSSU
Wound Swab
Lower Vaginal Swab (LVS)

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13
Q

How do we manage a suspected case of post-partum sepsis? [4]

A
  • Promopt IV abx
  • Antipyretics
  • IV fluids
  • Refer to hospital
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14
Q

What are the major psych disorders in post-partum women? [3]

A
  • Baby blues
  • Postnatal Depression
  • Peurperal Psychosis
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15
Q

What is the baby blues caused by?
Typical onset?
Natural history?

A

Hormonal changes cause the blues in many mothers 1-3 days PN.
Doesn’t affect function and doesn’t require treatment

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16
Q

What is postnatal depression?

It does require specific treatment unlike baby blues [2]

A

Classic depressive symptoms that do affect function and bonding
Look for a history or family history of affective disorder

17
Q

How do we handle Peurperal Psychosis? [2]

What to look for?

A

Much more serious, women can be a danger to themselves and babies.

So inpatient psych care is required

Look for a history/FH of affective disorder, bipolar or pyschosis

18
Q

Lochia
What is it?
When should it stop?
What to do if it doesn’t stop?

A
  • Passage of blood
  • Mucous and tissue
  • Occurs during childbirth
  • Expect to cease 4-6w
  • Continued vaginal discharge after 6w could indicate retained POC
  • Do USS in this case
19
Q 
Breastfeeding contraindications [2]
Drugs unsafe in pregnancy:
Antibiotics [4]
Psychiatric drugs [2]
Antiplatelets [1]
Endocrine [2]
DMARDs [2]
Anti-arrhythmic [1]
A

HIV
Galactosaemia - baby unable to metabolism galactose

  • Antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
  • Psychiatric drugs: lithium, benzodiazepines
  • Anti-platelet: aspirin
  • Endocrine: carbimazole, sulphonylureas
  • DMARDs: methotrexate, cytotoxics
  • Anti-arrhythmic: amiodarone
20
Q 
Amniotic fluid embolism
Presentation [3]
Ax [2]
Complication
Mx
A

Presentation:
- Can occur suddenly during L&D
- Sudden development of acute respiratory distress and cardiovascular collapse
- In a patient in labour or who has recently delivered
Ax: amniotic fluid enters maternal circulation, triggering syndrome similar to anaphylaxis and septic shock
Cx: DIC
Mx: effective resus

21
Q 
Cord prolapse
Ax
Px [2]
Signs and symptoms [3]
Prognosis
A

Ax: umbilical cord descends ahead of presenting part of fetus
Px: leads to cord compression and cord spasm leading to fetal hypoxia and irreversible damage or death
Sy/Si:
- abnormal fetal HR
- cord palpable vaginally
- cord visible beyond level of introitus
Pro: if treated early fetal mortality LOW

22
Q

Cord prolapse

Risk factors [7]

A

Risk factors:

  • artificial rupture of membranes, prematurity
  • multiparity, polyhydramnios, twins
  • cephalopelvic disproportion
  • abnormal presentations (especially transverse lie)
  • placenta praevia
  • long umbilical cord
  • high fetal station
23
Q

Cord prolapse Management [5]

A

Management:
• Elevate presenting part of fetus: catheterise and fill bladder
• Tocolytics
• Push cord into vagina: (NOT to uterus) to keep warm
• Maternal position: onto all fours
• Delivery: immediate CS (if fully dilated and head low can do instrumental delivery)

24
Q

Placenta accreta
Ax [3]
RF [3]
Mx

A 
Px:
- Attachment of placenta to myometrium due to defective decidua basalis
- placenta doesnt separate properly 
- leading to PPH risk 
RF: 
- previous CS, placenta praevia, PID
Definitive mx is hysterectomy
25
Q

Shoulder dystocia
Ax
Px
Complications [4]

A

Inability to deliver body of fetus using gentle downward traction but head is already delivered
- Impaction of anterior shoulder on maternal pubic symphysis

Complications:

  • PPH
  • Perineal tears
  • Brachial plexus injury
  • Neonatal death (asphyxiation)
26
Q

Shoulder dystocia
Risk factors [3]
Mx [3]

A

Risk factors:

  • Macrosomia, high maternal BMI, DM
  • Prolonged labour
  • Assisted vaginal delivery

Mx:

  • Call for senior help: obstetrician, pediatrician, anaesthetist
  • McRoberts manoeuvre
  • Generous episiotomy
27
Q

PPH risk factors

What is one complication of PPH?

A 
Previous PPH
Prolonged labour
Pre-eclampsia
Advanced maternal age
Polyhydramnios
Emergency CS
Placenta praevia, accreta
Macrosomia
Ritrodrine (tocolytic)

Cx: Sheehan’s syndrome

28
Q

PPH management
Immediate [4]
Medical mx 3 options
Surgical options [4]

A 
ABCDE
Peripheral 14G cannula
Bimanual uterine compression to stimulate contractions
Initial medical mx
- IV syntocinon 10 units
- OR IV ergometrine 500mcg
- OR IM carboprost

Intrauterine balloon tamponade
B-Lynch suture
UAE
Hysterectomy in severe uncontrolled hemorrhage

Repro (34 decks)

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