Post partum problems Flashcards
Define peuperium
Time from delivery until 6 weeks
What changes occur by the end of peuperium
Uterus will have involuted (back to original size and position)
Most physiological changes returned to pre pregnant state
What is the difference between direct and indirect maternal deaths
Direct= death related to pregnancy and its complication Indirect= death because of pre-existing medical condition worsened by pregnancy
How many maternal deaths happened in 2012-14
8.5 per 100,000 maternities
What % of maternal deaths happened during pregnancy
2/3
What % of maternal deaths are due to direct complication of pregnancy such as bleeding
1/3
What is PPH?
Primary vs Secondary?
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
What 4 t’s cause primary post partum haemorrhage? What % of all PPH are caused by each T?
Tone- 70%
Tissue-20%
Trauma-9%
Thrombin-1%
What is meant by tone and tissue in terms of causing post partum haemorrhage
Tone- poor uterine tone (hasn’t contracted properly) leads to PPH
Tissue- part of placenta/ membrane retained in the patient
Name 4 predisposing factors to PPH?
Placenta praevia Multiple pregnancy Pre-eclampsia Previous PPH Obesity Maternal age Antepartum haemorrhage in this pregnancy
Name 4 intrapartum risk factors of PPH
Emergency C section Elective C section Retained placenta Episiotomy Operative vaginal delivery Labour >12 hours >4kg baby
What is the most common cause of post partum haemorrhage
Uterine atony
How to treat/ manage uterine atony
Initially, bimanual uterine massage and compression
Oxytocic agents: syntometrine, syntocinon, prostaglandins
What is syntocinon
Synthetic oxytonin which stimulates contraction of uterus
What does ergometrine do
Causes vasoconstriction so helps reduce blood loss
What is EUA
Examination under anaesthetic
4 surgical treatment options for PPH
EUA
Check placenta
Suture any tears
Insert intrauterine balloon
How does uterine artery embolisation work?
Pellets are inserted via femoral artery to reduce blood flow to the uterus
Used especially if a tear has extended into pelvis/ broad ligament
What is the vascular approach to treating primary PPH
Bilateral ligations of the uterine arteries/ internal iliac arteries
What are the 2 most common causes of secondary PPH
Infection (endometritis)
Tissue (retained products of conception)
What investigations are done to diagnose secondary PPH
FBC Blood cultures High/ low vaginal swab MSU Ultrasound may be used
How is secondary PPH usually treated
Broad spectrum IV antibiotics
Why are pregnant women predisposed to thromboembolic disease
Main protective physiological change against PPH is increased clotting factos and reducing anticoagulants
Name 4 pre-existing risk factors for thromboembolic disaease
Previous VTE Age> 35 Obesity Gross varicose veins Paraplegia Sickle cell disease Inflammatory diseases
Define parity
Number of times a woman has given birth to a foetus of 24 weeks or above (alive or dead)
Name 4 pregnancy related risk factors for thromboembolic disease
Surgical procedures Dehydration Sepsis Pre-eclampsia Excessive blood loss Prolonged labour Immobility after delivery
Symptoms of cerebral vein thrombosis?
Headaches
Seizures
What pharmacological treatment is recommended for thromboembolic disease
LMWH 1mg/kg
Warfarinise
What % of women who died between 6 weeks and 1 year of pregnancy died from mental health related causes
25
What are the ‘signs/ symptoms and features’ of postpartum blues
Tearfulness, lability, reactivity
Predominantly happy
Unrelated to environmental stressors/ psychiatric history
When does post partum blues peaks
3-5 days post delivery
What are the symptoms of peureperal psychosis
Loss of contact with reality Hallucinations Severe thought disturbance Abnormal behaviour Mania, depressive or atypical psychosis
How does the depression seen in peureperal psychosis differ from that seen in postnatal depression
Greater severity of symptoms
Confusion, delusion and stupor also accompany
What are the features of atypical psychoses
Confusion/ perplexity Catatonic features Thought disorder Auditory hallucinations Delusions
What is pre-eclampsia
Hypertension with proteinuria and after 20 weeks of pregnancy
What is eclampsia
Pre-eclampsia and convulsions
What is gestational hypertension
Late onset hypertension without proteinuria
When should antihypertensive treatments be reduced
BP< 130/80mmHg
When should antihypertensives be started
Blood pressure> 149/99
Why are women with pre-eclampsia required to carry out urinary reagent strip test at postnatal review
To check to see if proteinuria has persisted- if it has consider referring to kidney specialist
How are the fits associated with eclampsia controlled
Loading dose of 4g MgS04 infused over 20 minutes
Maintence dose 102mgSO4/hr
Cardiac causes of maternal deaths?
SADS
Aortic dissection
Acute coronary syndrome
Cardiomyopathy
