Post-Partum Problems

Question 1

what is puerperium?

Answer 1

a period of repair & recovery after birth where tissues return to their non-pregnant state

~ 6 weeks

Question 2

how does women’s discharge change after birth?

Answer 2

3- 4 days: fresh, red
4-14 days: brownish-red, watery
10-20 days: yellow

Question 3

by what stage of pregnancy are the breasts fully adapted to produce milk?

Answer 3

5th/6th month

Question 4

what is colostrum?

Answer 4

a thick, yellow-ish substance

1st milk a breastfed baby receives and is more protein and vitamin rich than milk to come

essential for early immunological protection

Question 5

what initiates lactation?

Answer 5

expulsion of the placenta

and decrease in oestrogen and progesterone

Question 6

what is the let-down reflex?

Answer 6

mechanism of milk release from breast during feeding

oxytocin stimulates myoepithelial cells, which surround breast alveoli, and in response to oxytocin, contract to squeeze milk out of the breast

Question 7

how is prolactin release maintained?

Answer 7

via positive feedback:

suckling by infant promotes prolactin production by stimulating nipple mechanoreceptors

Question 8

what are stimulus for oxytocin release?

Answer 8

sucking
alcohol
baby cry

Question 9

what is the most prevalent causative organism of mastitis?

Answer 9

staph aureus

Question 10

what are causes of non-infectious mastitis?

Answer 10

duct ectasia (a blocked lactiferous duct)

foreign body

Question 11

what does the MAIDS mneomic stand for?

Answer 11

Milk stasis - decreased milk output?
Abscess - tender lump?
Inflammation - pain, warmth, swelling?
Discharge - purulent?
Systemic - fever, malaise?

Question 12

what is the current antibiotics for lactational mastitis?

Answer 12

flucloxacillin 500mg PO 6 hourly

or augmentin 635mg 8 hourly for 7 days

Question 13

what is the time definition for primary vs secondary PPH?

Answer 13

Primary - bleeding within 24 hours

secondary - bleeding 24 hours to 6 weeks post-delivery

Question 14

how much blood loss is required to define PPH?

Answer 14

> 500ml blood loss

Question 15

what are the four T causes of PPH?

Answer 15

Tone - uterine atony
Trauma - vaginal tear, rupture, cervical laceration
Tissue - retained products
Thrombin - coagulopathy

Question 16

what are antenatal risk factors of PPH?

Answer 16

Placental problems (praevia/accreta etc)

PMH - retained placenta, C-section, PPH

Multiple pregnancies
polyhydramnios
obesity
fetal macrosomia

Question 17

what are intrapartum RF of PPH?

Answer 17

Operative vaginal delivery
Induced labour - syntocinon use
Retained placenta
C-section
Labour >12 hours
perineal tear

Question 18

how would u manage a PPH?

Answer 18

call for help asap
assess/stop bleeding / fluid replace

ABCDE - this is an emergency

Question 19

how many first time mothers will experience a vaginal tear?

Answer 19

9 in 10

Question 20

what are some perinatal psychiatric red flags?

Answer 20

recent change in mental state/new symptoms
new thoughts/acts of violent self-harm
new & persistent expressions of incompetency as a mother or estrangement from their baby

Question 21

what mothers are at risk?

Answer 21

young, single
domestic issues
lack of support
substance abuse
unplanned/unwanted pregnancy
pre-existing mental health problem

Question 22

what are the baby blues?

Answer 22

a brief period of emotional stability where mothers can become tearful, irritable, anxious & confused

tend to arise 3 days post-natally, usually lasts ~ 1 week

Question 23

what is puerperal psychosis?

Answer 23

early symptoms: sleep disturbance, confusion, irrational ideas

later symptoms: mania, delusions, hallucinations

presents 2 weeks post-natally, requires admission to mother-and-baby unit

Question 24

when does postnatal depression tend to begin?

Answer 24

2-6 weeks postnatally

can last weeks/months/over a year