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Obs & Gynae (Obs) > Post-Partum Complications > Flashcards

Post-Partum Complications Flashcards

1
Q

PPH is defined as a blood loss greater than what after delivery?

A

500ml

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2
Q

What is meant by a primary PPH?

A

PPH in the first 24 hours after delivery

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3
Q

What is meant by secondary PPH?

A

PPH between 24 hours after delivery and 12 weeks post-natally

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4
Q

What amount of blood loss would be classified as a minor PPH?

A

500-1000ml

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5
Q

What amount of blood loss would be classified as a moderate PPH?

A

> 1000 - 2000ml

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6
Q

What amount of blood loss would be classified as a severe PPH?

A

> 2000ml

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7
Q

Primary PPH is most likely caused by one of the four T’s- what are these?

A

Tone, trauma, tissue, thrombin

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8
Q

What is the most common cause of a primary PPH?

A

Uterine atony

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9
Q

What are the two main causes of secondary PPH?

A

Retained products or infection (endometritis)

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10
Q

The risk of PPH is reduced by 60% with the use of what intervention?

A

Active management of the third stage of labour

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11
Q

Loss of more than 1000mls of blood from PPH causes what presentation?

A

Maternal collapse

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12
Q

Minor PPH can cause what clinical signs?

A

Tachycardia, tachypnoea and hypotension

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13
Q

Severe PPH can result in hypoperfusion of end organs- what is most common?

A

AKI

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14
Q

The aim of management of PPH is to treat the underlying cause while administering adequate resuscitation with what?

A

Fluids and blood products

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15
Q

For women with severe PPH, what other blood product is transfused alongside red blood cells? At what ratio is this transfused?

A

FFP, at a 1: 1 ratio with RBCs

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16
Q

What is the non-medical treatment for uterine atony causing PPH?

A

Rubbing up the abdomen and bimanual uterine compression

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17
Q

When uterine atony is suspected as the underlying cause of PPH, drugs that make the uterus contract are given. Give some examples of these?

A

Syntocinon, Syntometrine, misoprostol

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18
Q

How is PPH caused by trauma treated?

A

Repair perineal trauma

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19
Q

How is PPH caused by retained products treated?

A

Remove retained products in theatre

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20
Q

What measures can be used to temporarily control bleeding from a PPH before the woman is taken to theatre?

A

Haemostatic ballon, uterine compression suture

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21
Q

If bleeding from a PPH persists despite all interventions, what is the management?

A

Hysterectomy

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22
Q

If a woman is diagnosed with a post-natal infection, what management is required for the baby?

A

Septic screen and potentially prophylactic antibiotics

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23
Q

Puerperal sepsis is described as a systemic infection within how long after birth?

A

6 weeks

24
Q

What is the commonest organism causing puerperal sepsis caused by perineal infection or endometritis?

A

Group A strep

25
Q

What is the commonest organism causing puerperal sepsis caused by mastitis or wound infections?

A

Staph aureus

26
Q

Prophylactic antibiotics are given before a C-section to reduce the risk of which infections?

A

Endometritis and wound infections

27
Q

Offensive smelling bloody discharge and abdominal pain after delivery suggests that what complication has developed?

A

Endometritis

28
Q

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?

A

Co-amoxiclav and metronidazole

29
Q

Why does pregnancy cause reduced blood flow, contributing to the increased risk of VTE?

A

Compression of the iliac veins by the gravid uterus

30
Q

What medication is given to women who are deemed high-risk of developing VTE both during and after pregnancy?

A

LMWH

31
Q

Pregnant women are more likely to develop pelvic DVT. This causes what symptom?

A

Lower abdominal pain

32
Q

What investigation is carried out first in women with signs and symptoms of DVT or PE?

A

Lower limb Doppler

33
Q

If a lower limb Doppler is negative but a PE is still suspected, what is the next investigation to order?

A

CXR

34
Q

After a CXR for a woman with a suspected PE, one of which two investigations can be used next?

A

V/Q scan or CTPA

35
Q

What are the advantages of using CTPA over V/Q scan in pregnancy?

A

More accurate and less radiation to the foetus

36
Q

What is the disadvantage of using CTPA over V/Q scan in pregnancy?

A

Increased risk of breast cancer in the mother

37
Q

What blood tests must be done before treatment with LMWH, as the results are used to determine the dose?

A

FBC (for platelet count), U&Es and LFTs

38
Q

Why is a measurement of D-Dimer an unhelpful test in pregnancy?

A

D-Dimer is always increased in pregnancy

39
Q

When should LMWH be given in a pregnant women with suspected VTE?

A

ASAP (i.e. don’t wait for investigation results)

40
Q

What medication is used to treat VTE in pregnancy?

A

LMWH

41
Q

What medication is used to treat VTE in the post-natal period, even in breastfeeding women?

A

Warfarin

42
Q

How are women with a massive PE causing maternal collapse treated?

A

Unfractionated heparin or thrombolysis with IV streptokinase

43
Q

For women who have a DVT in pregnancy/post-natally, what should be given to them to help prevent post-thrombotic syndrome?

A

Anti-embolism stockings

44
Q

How long should anti-embolism stockings be worn for after treatment for VTE?

A

2 years

45
Q

After delivery, maternal shortness of breath and hypoxia followed by maternal collapse should point you to what diagnosis?

A

Amniotic fluid embolism

46
Q

In a collapsed woman after delivery, if there is no evidence of bleeding what diagnosis should be considered?

A

Amniotic fluid embolism

47
Q

How is an amniotic fluid embolism treated?

A

Supportive care

48
Q

Symptoms of tearfulness, irritability, low mood and anxiety shortly after giving birth are usually diagnosed as what?

A

Baby blues

49
Q

How long do symptoms of the baby blues usually last for?

A

A few days

50
Q

Is treatment required for the baby blues?

A

No

51
Q

When does post-natal depression typically present?

A

2-8 weeks after delivery

52
Q

How are mild cases of post-natal depression treated?

A

Counselling

53
Q

How are severe cases of post-natal depression treated?

A

Anti-depressants

54
Q

What are the two main risk factors for post-natal depression?

A

Pre-existing mental health problems and previous post-natal depresion

55
Q

How soon does post-natal psychosis usually develop?

A

Within hours of childbirth

56
Q

How is post-natal psychosis treated?

A

Admission to a mother and baby unit, and anti-depressants, mood stabilisers and anti-psychotics

Obs & Gynae (Obs) (10 decks)

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