Postnatal

Question 1

What period of time is puerperium? What risks are associated with this?

Answer 1

6 week period following delivery, when the body returns to prepregnant state

Maternal morbidity and mortality highest

Question 2

What changes happen to genital tract during purperium?

Answer 2

• blood vessels are occluded by uterus contraction
• contractions and after pains may be felt for 4 days
• internal os closed by 3 days
• lochia bloodstained for one month, then yellow or white
• menstruation starts at 6 weeks, longer if delayed by lactation

Question 3

What should be checked daily during puerperium?

Answer 3

uterine involution

lochia

bp

temp

pulse

perineal wound

Question 4

What two hormones regulate lactation? What are their function

Answer 4

Prolactin from anterior pituitary > stimulate milk secretion

Oxytocin from posterior pituitary > ejection in response to sucking and releases more prolactin

*oestrogen and progesterone antagonize prolactin

Question 5

What is colostrum?

Answer 5

yellow, fat-laden, protein, minerals passed for first 3 days before milk

Question 6

What are the advantages of breastfeeding?

Answer 6

protection against infection

bonding

protection against cancer for mother

cost saving

cannot overfeed

Question 7

What postnatal contraception should be used? When should it be started?

Answer 7

start 4-6 weeks after delivery

COCP - suppresses lactation, C.I. in breastfeeding

POP and Intrauterine device are safe

Question 8

What is primary postpartum haemorrhage?

Answer 8

> 500ml < 24h after delivery

> 1000ml after C-section

Question 9

What are the causes of primary postpartum haemorrhage?

Answer 9

4Ts

Tone

Tissue

Trauma

Thrombin

Question 10

What are some risk factors for the ‘Tone’ cause of PPH?

Answer 10

prolonged labour

grandmultiparity

overdistension of uterus (polyhydramnios, mult. preg., fibroids)

Question 11

What can be done to avoid PPH? What is a disadvantage of this?

Answer 11

oxytocin in 3rd stage of labour

causes N&V

Question 12

How would you manage PPH?

Answer 12

Resuscitation

Oxytocin (syntocinon) problem with uterus

Prostaglandin IM (carboprost)

if this fails > evacuation under anaestheic

Rusch balloon to stop bleeding

Question 13

What is a secondary PPH? Cause?

Answer 13

excessive blood loss between 24 hrs and 12(or 6 weeks)

Endometritis with or without retained placental tissue

Question 14

What is postpartum pyrexia? Whats the most common cause? most common organisms?

Answer 14

> /38 in first 14 days

genital tract sepsis after C-section

group A strep, E.coli

Question 15

how does postpartum pyrexia present?

Answer 15

offensive lochia, uterus enlarged and tender