Post partum problems

Question 1

Define peuperium

Answer 1

Time from delivery until 6 weeks

Question 2

What changes occur by the end of peuperium

Answer 2

Uterus will have involuted (back to original size and position)
Most physiological changes returned to pre pregnant state

Question 3

What is the difference between direct and indirect maternal deaths

Answer 3

Direct= death related to pregnancy and its complication
Indirect= death because of pre-existing medical condition worsened by pregnancy

Question 4

How many maternal deaths happened in 2012-14

Answer 4

8.5 per 100,000 maternities

Question 5

What % of maternal deaths happened during pregnancy

Answer 5

2/3

Question 6

What % of maternal deaths are due to direct complication of pregnancy such as bleeding

Answer 6

1/3

Question 7

What is PPH?

Primary vs Secondary?

Answer 7

Post partum haemorrhage: excessive bleeding following delivery
Primary= >500ml blood loss from genital tract within 24 hours of delivery
Secondary= abnormal bleeding from genital tract 24 hours to 6 weeks

Question 8

What 4 t’s cause primary post partum haemorrhage? What % of all PPH are caused by each T?

Answer 8

Tone- 70%
Tissue-20%
Trauma-9%
Thrombin-1%

Question 9

What is meant by tone and tissue in terms of causing post partum haemorrhage

Answer 9

Tone- poor uterine tone (hasn’t contracted properly) leads to PPH
Tissue- part of placenta/ membrane retained in the patient

Question 10

Name 4 predisposing factors to PPH?

Answer 10

Placenta praevia
Multiple pregnancy
Pre-eclampsia
Previous PPH
Obesity
Maternal age
Antepartum haemorrhage in this pregnancy

Question 11

Name 4 intrapartum risk factors of PPH

Answer 11

Emergency C section
Elective C section
Retained placenta
Episiotomy
Operative vaginal delivery
Labour >12 hours
>4kg baby

Question 12

What is the most common cause of post partum haemorrhage

Answer 12

Uterine atony

Question 13

How to treat/ manage uterine atony

Answer 13

Initially, bimanual uterine massage and compression

Oxytocic agents: syntometrine, syntocinon, prostaglandins

Question 14

What is syntocinon

Answer 14

Synthetic oxytonin which stimulates contraction of uterus

Question 15

What does ergometrine do

Answer 15

Causes vasoconstriction so helps reduce blood loss

Question 16

What is EUA

Answer 16

Examination under anaesthetic

Question 17

4 surgical treatment options for PPH

Answer 17

EUA
Check placenta
Suture any tears
Insert intrauterine balloon

Question 18

How does uterine artery embolisation work?

Answer 18

Pellets are inserted via femoral artery to reduce blood flow to the uterus
Used especially if a tear has extended into pelvis/ broad ligament

Question 19

What is the vascular approach to treating primary PPH

Answer 19

Bilateral ligations of the uterine arteries/ internal iliac arteries

Question 20

What are the 2 most common causes of secondary PPH

Answer 20

Infection (endometritis)

Tissue (retained products of conception)

Question 21

What investigations are done to diagnose secondary PPH

Answer 21

FBC
Blood cultures
High/ low vaginal swab
MSU
Ultrasound may be used

Question 22

How is secondary PPH usually treated

Answer 22

Broad spectrum IV antibiotics

Question 23

Why are pregnant women predisposed to thromboembolic disease

Answer 23

Main protective physiological change against PPH is increased clotting factos and reducing anticoagulants

Question 24

Name 4 pre-existing risk factors for thromboembolic disaease

Answer 24

Previous VTE
Age> 35
Obesity
Gross varicose veins
Paraplegia
Sickle cell disease
Inflammatory diseases

Question 25

Define parity

Answer 25

Number of times a woman has given birth to a foetus of 24 weeks or above (alive or dead)

Question 26

Name 4 pregnancy related risk factors for thromboembolic disease

Answer 26

``` Surgical procedures Dehydration Sepsis Pre-eclampsia Excessive blood loss Prolonged labour Immobility after delivery ```

Question 27

Symptoms of cerebral vein thrombosis?

Answer 27

Headaches | Seizures

Question 28

What pharmacological treatment is recommended for thromboembolic disease

Answer 28

LMWH 1mg/kg | Warfarinise

Question 29

What % of women who died between 6 weeks and 1 year of pregnancy died from mental health related causes

Answer 29

25

Question 30

What are the 'signs/ symptoms and features' of postpartum blues

Answer 30

Tearfulness, lability, reactivity Predominantly happy Unrelated to environmental stressors/ psychiatric history

Question 31

When does post partum blues peaks

Answer 31

3-5 days post delivery

Question 32

What are the symptoms of peureperal psychosis

Answer 32

``` Loss of contact with reality Hallucinations Severe thought disturbance Abnormal behaviour Mania, depressive or atypical psychosis ```

Question 33

How does the depression seen in peureperal psychosis differ from that seen in postnatal depression

Answer 33

Greater severity of symptoms | Confusion, delusion and stupor also accompany

Question 34

What are the features of atypical psychoses

Answer 34

``` Confusion/ perplexity Catatonic features Thought disorder Auditory hallucinations Delusions ```

Question 35

What is pre-eclampsia

Answer 35

Hypertension with proteinuria and after 20 weeks of pregnancy

Question 36

What is eclampsia

Answer 36

Pre-eclampsia and convulsions

Question 37

What is gestational hypertension

Answer 37

Late onset hypertension without proteinuria

Question 38

When should antihypertensive treatments be reduced

Answer 38

BP< 130/80mmHg

Question 39

When should antihypertensives be started

Answer 39

Blood pressure> 149/99

Question 40

Why are women with pre-eclampsia required to carry out urinary reagent strip test at postnatal review

Answer 40

To check to see if proteinuria has persisted- if it has consider referring to kidney specialist

Question 41

How are the fits associated with eclampsia controlled

Answer 41

Loading dose of 4g MgS04 infused over 20 minutes | Maintence dose 102mgSO4/hr

Question 42

Cardiac causes of maternal deaths?

Answer 42

SADS Aortic dissection Acute coronary syndrome Cardiomyopathy