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HD 2 > Post partum problems > Flashcards

Post partum problems Flashcards

1
Q

Define peuperium

A

Time from delivery until 6 weeks

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2
Q

What changes occur by the end of peuperium

A

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

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3
Q

What is the difference between direct and indirect maternal deaths

A 
Direct= death related to pregnancy and its complication
Indirect= death because of pre-existing medical condition worsened by pregnancy
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4
Q

How many maternal deaths happened in 2012-14

A

8.5 per 100,000 maternities

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5
Q

What % of maternal deaths happened during pregnancy

A

2/3

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6
Q

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

A

1/3

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7
Q

What is PPH?

Primary vs Secondary?

A

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

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8
Q

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

A

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

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9
Q

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

A

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

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10
Q

Name 4 predisposing factors to PPH?

A 
Placenta praevia
Multiple pregnancy
Pre-eclampsia
Previous PPH
Obesity
Maternal age
Antepartum haemorrhage in this pregnancy
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11
Q

Name 4 intrapartum risk factors of PPH

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

What is the most common cause of post partum haemorrhage

A

Uterine atony

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13
Q

How to treat/ manage uterine atony

A

Initially, bimanual uterine massage and compression

Oxytocic agents: syntometrine, syntocinon, prostaglandins

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14
Q

What is syntocinon

A

Synthetic oxytonin which stimulates contraction of uterus

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15
Q

What does ergometrine do

A

Causes vasoconstriction so helps reduce blood loss

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16
Q

What is EUA

A

Examination under anaesthetic

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17
Q

4 surgical treatment options for PPH

A

EUA
Check placenta
Suture any tears
Insert intrauterine balloon

18
Q

How does uterine artery embolisation work?

A

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

19
Q

What is the vascular approach to treating primary PPH

A

Bilateral ligations of the uterine arteries/ internal iliac arteries

20
Q

What are the 2 most common causes of secondary PPH

A

Infection (endometritis)

Tissue (retained products of conception)

21
Q

What investigations are done to diagnose secondary PPH

A 
FBC
Blood cultures
High/ low vaginal swab
MSU
Ultrasound may be used
22
Q

How is secondary PPH usually treated

A

Broad spectrum IV antibiotics

23
Q

Why are pregnant women predisposed to thromboembolic disease

A

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

24
Q

Name 4 pre-existing risk factors for thromboembolic disaease

A 
Previous VTE
Age> 35
Obesity
Gross varicose veins
Paraplegia
Sickle cell disease
Inflammatory diseases
25
Q

Define parity

A

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

26
Q

Name 4 pregnancy related risk factors for thromboembolic disease

A 
Surgical procedures
Dehydration
Sepsis
Pre-eclampsia
Excessive blood loss
Prolonged labour
Immobility after delivery
27
Q

Symptoms of cerebral vein thrombosis?

A

Headaches

Seizures

28
Q

What pharmacological treatment is recommended for thromboembolic disease

A

LMWH 1mg/kg

Warfarinise

29
Q

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

A

25

30
Q

What are the ‘signs/ symptoms and features’ of postpartum blues

A

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

31
Q

When does post partum blues peaks

A

3-5 days post delivery

32
Q

What are the symptoms of peureperal psychosis

A 
Loss of contact with reality
Hallucinations
Severe thought disturbance
Abnormal behaviour
Mania, depressive or atypical psychosis
33
Q

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

A

Greater severity of symptoms

Confusion, delusion and stupor also accompany

34
Q

What are the features of atypical psychoses

A 
Confusion/ perplexity
Catatonic features
Thought disorder
Auditory hallucinations
Delusions
35
Q

What is pre-eclampsia

A

Hypertension with proteinuria and after 20 weeks of pregnancy

36
Q

What is eclampsia

A

Pre-eclampsia and convulsions

37
Q

What is gestational hypertension

A

Late onset hypertension without proteinuria

38
Q

When should antihypertensive treatments be reduced

A

BP< 130/80mmHg

39
Q

When should antihypertensives be started

A

Blood pressure> 149/99

40
Q

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

A

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

41
Q

How are the fits associated with eclampsia controlled

A

Loading dose of 4g MgS04 infused over 20 minutes

Maintence dose 102mgSO4/hr

42
Q

Cardiac causes of maternal deaths?

A

SADS
Aortic dissection
Acute coronary syndrome
Cardiomyopathy

HD 2 (26 decks)

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