Post-Partum Complications Flashcards
PPH is defined as a blood loss greater than what after delivery?
500ml
What is meant by a primary PPH?
PPH in the first 24 hours after delivery
What is meant by secondary PPH?
PPH between 24 hours after delivery and 12 weeks post-natally
What amount of blood loss would be classified as a minor PPH?
500-1000ml
What amount of blood loss would be classified as a moderate PPH?
> 1000 - 2000ml
What amount of blood loss would be classified as a severe PPH?
> 2000ml
Primary PPH is most likely caused by one of the four T’s- what are these?
Tone, trauma, tissue, thrombin
What is the most common cause of a primary PPH?
Uterine atony
What are the two main causes of secondary PPH?
Retained products or infection (endometritis)
The risk of PPH is reduced by 60% with the use of what intervention?
Active management of the third stage of labour
Loss of more than 1000mls of blood from PPH causes what presentation?
Maternal collapse
Minor PPH can cause what clinical signs?
Tachycardia, tachypnoea and hypotension
Severe PPH can result in hypoperfusion of end organs- what is most common?
AKI
The aim of management of PPH is to treat the underlying cause while administering adequate resuscitation with what?
Fluids and blood products
For women with severe PPH, what other blood product is transfused alongside red blood cells? At what ratio is this transfused?
FFP, at a 1: 1 ratio with RBCs
What is the non-medical treatment for uterine atony causing PPH?
Rubbing up the abdomen and bimanual uterine compression
When uterine atony is suspected as the underlying cause of PPH, drugs that make the uterus contract are given. Give some examples of these?
Syntocinon, Syntometrine, misoprostol
How is PPH caused by trauma treated?
Repair perineal trauma
How is PPH caused by retained products treated?
Remove retained products in theatre
What measures can be used to temporarily control bleeding from a PPH before the woman is taken to theatre?
Haemostatic ballon, uterine compression suture
If bleeding from a PPH persists despite all interventions, what is the management?
Hysterectomy
If a woman is diagnosed with a post-natal infection, what management is required for the baby?
Septic screen and potentially prophylactic antibiotics
Puerperal sepsis is described as a systemic infection within how long after birth?
6 weeks
What is the commonest organism causing puerperal sepsis caused by perineal infection or endometritis?
Group A strep
What is the commonest organism causing puerperal sepsis caused by mastitis or wound infections?
Staph aureus
Prophylactic antibiotics are given before a C-section to reduce the risk of which infections?
Endometritis and wound infections
Offensive smelling bloody discharge and abdominal pain after delivery suggests that what complication has developed?
Endometritis
In women with puerperal sepsis, broad spectrum IV antibiotics are given within one hour of presentation to hospital. What combination of antibiotics is most commonly used?
Co-amoxiclav and metronidazole
Why does pregnancy cause reduced blood flow, contributing to the increased risk of VTE?
Compression of the iliac veins by the gravid uterus
What medication is given to women who are deemed high-risk of developing VTE both during and after pregnancy?
LMWH
Pregnant women are more likely to develop pelvic DVT. This causes what symptom?
Lower abdominal pain
What investigation is carried out first in women with signs and symptoms of DVT or PE?
Lower limb Doppler
If a lower limb Doppler is negative but a PE is still suspected, what is the next investigation to order?
CXR
After a CXR for a woman with a suspected PE, one of which two investigations can be used next?
V/Q scan or CTPA
What are the advantages of using CTPA over V/Q scan in pregnancy?
More accurate and less radiation to the foetus
What is the disadvantage of using CTPA over V/Q scan in pregnancy?
Increased risk of breast cancer in the mother
What blood tests must be done before treatment with LMWH, as the results are used to determine the dose?
FBC (for platelet count), U&Es and LFTs
Why is a measurement of D-Dimer an unhelpful test in pregnancy?
D-Dimer is always increased in pregnancy
When should LMWH be given in a pregnant women with suspected VTE?
ASAP (i.e. don’t wait for investigation results)
What medication is used to treat VTE in pregnancy?
LMWH
What medication is used to treat VTE in the post-natal period, even in breastfeeding women?
Warfarin
How are women with a massive PE causing maternal collapse treated?
Unfractionated heparin or thrombolysis with IV streptokinase
For women who have a DVT in pregnancy/post-natally, what should be given to them to help prevent post-thrombotic syndrome?
Anti-embolism stockings
How long should anti-embolism stockings be worn for after treatment for VTE?
2 years
After delivery, maternal shortness of breath and hypoxia followed by maternal collapse should point you to what diagnosis?
Amniotic fluid embolism
In a collapsed woman after delivery, if there is no evidence of bleeding what diagnosis should be considered?
Amniotic fluid embolism
How is an amniotic fluid embolism treated?
Supportive care
Symptoms of tearfulness, irritability, low mood and anxiety shortly after giving birth are usually diagnosed as what?
Baby blues
How long do symptoms of the baby blues usually last for?
A few days
Is treatment required for the baby blues?
No
When does post-natal depression typically present?
2-8 weeks after delivery
How are mild cases of post-natal depression treated?
Counselling
How are severe cases of post-natal depression treated?
Anti-depressants
What are the two main risk factors for post-natal depression?
Pre-existing mental health problems and previous post-natal depresion
How soon does post-natal psychosis usually develop?
Within hours of childbirth
How is post-natal psychosis treated?
Admission to a mother and baby unit, and anti-depressants, mood stabilisers and anti-psychotics
