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MBBS VI: O&G > Postnatal care > Flashcards

Postnatal care Flashcards

1
Q

Define post partum hemorrhage

A

Cumulative blood loss >1000ml or bleeding associated with SS of hypovolemia within 24 hours of birth regardless of the delivery route

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2
Q

Define primary PPH vs secondary PPH

A

Primary PPH: occuring in the 1st 24 hours after delivery
Secondary PPH: PPH occurring after 24 hours to 12 weeks after delivery

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3
Q

What are the causes of PPH (4Ts)?

A

Tone (uterine atony): most common cause of PPH. Refers to lack of contraction of uterus after delivery
Trauma (lower genital tract injuries): vulva tear, vaginal tear/cervical tear. Uterine tear or rupture. Maternal factors: previous surgery with scarred uterus/previous trauma/obstructed labor/uterine hyperstimulation. Uterine inversion. 1st degree= fundus at external os, 2nd degree = fundus into vagina, 3rd degree= fundus out of vagina
Tissue (RPOG)
Thrombin (coagulopathy): acute coagulopathy can be caused by preeclampsia, HELLP syndrome, placental abruption, DIC or amniotic fluid embolism

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4
Q

What is the normal physiological mechanism that limits post partum blood loss?

A
  • Contraction of myometrium: compresses the blood vessels supplying the placental bed and causes mechanical haemostasis
  • Local decidual hemostatic factors: release of tissue factor (TF), type 1 plasminogen activator inhibitor, systemic coagulation factors (platelet, circulating clotting factors)
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5
Q

What is immediate action for PPH?

A
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6
Q

How to identify the cause of PPH and treatment?

A
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7
Q

In PPH what is the treatment of uterine atony?

A
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8
Q

In PPH what is the treatment of retained placenta?

A
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9
Q

In PPH what is the treatment of lower genital tract bleeding?

A

 Surgical repair or hemostasis for genital tract injury
 Incision and drainage (I&D) for vulval hematoma

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10
Q

In PPH what is the treatment of uterine inversion?

A
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11
Q

What are other methods to stop bleeding in PPH apart from 1st line Mx for each cause?

A
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12
Q

Who are high risk patients for PPH?

A
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13
Q

How is active management of 3rd stage of labor done for prevention of PPH?

A
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14
Q

What are the complications of PPH?

A
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15
Q

What is the physiological changes during puerperium?

A
  • Uterine involution: return to non pregnant size and condition within 6 weeks
  • Lochia: uterine discharge that follows delivery and lasts for 3-4 weeks puerperium. Lochia contains serous exudate, RBCs, WBCs, decidua, epithelial cells and bacteria. Lochia rubia = blood stained fluid that lasts for the first few days. Lochia serosa = increasingly watery and pinkish brown (appears 3-4 days after delivery and lasts for 2-3 weeks), lochia alba = yellowish white (mixed with RBC –> appears 10 days after delivery)
  • Breast engorgement: Breasts become full, red, hard and sore due to increased blood flow before milk secretion commences
  • Lactation and colustrum: rapid increase in estrogen and progesteroen after delivery remove inhibition on milk production. Insulin and serum growth factors cause cell proliferation at the end of ducts, which under the influence of prolactin and cortisol, differentiate to form alveoli. Maintenance of lactation by regular removal of milk and stimulation of nipple which triggers prolactin release from anterior pituitary gland (stimulates milk production), oxytocin release from posterior pituitary gland (stimulates milk ejection)
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16
Q

What is the physiology of milk production and milk ejection post pregnancy?

A
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17
Q

What is the difference between colostrum and mature milk?

A
18
Q

Define postpartum fever?

A

Oral temp >38 on any 2 of the first 10 days postpartum exclusive of the first 24 hours (low grade fever during this period is common and often resolves spontaneously)

19
Q

What are infectious causes of postpartum fever?

A
20
Q

What are non infectious causes of postpartum fever?

A
21
Q

What is Mx of puerperal fever?

A
22
Q

What is postpartum blues, depression, psychosis?

A
23
Q

What is WHO recommendation for breastfeeding?

A

Exclusive breastfeeding recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary food up to 2 years of age or beyond

24
Q

What are the breast milk contents?

A
25
Q

What is the difference between foremilk and hindmilk?

A
26
Q

What is the physiology of mammary growth and development during puberty?

A
  • Estrogen stimulates milk duct proliferation
  • Progesterone stimulates alveolar development
27
Q

What is the physiology of mammary growth and development during pregnancy?

A
  • Estrogen and progesterone further stimulate alveolar hypertrophy but inhibits milk production
  • Prolactin and human placental lactogen stimulates milk production and secretory activity
28
Q

What are the different stages of lactation?

A
29
Q

How to establish lactation?

A
30
Q

What are the steps to successful breastfeeding?

A
31
Q

What are the different positions of breastfeeding?

A
32
Q

How to determine the frequency and duration for breastfeeding?

A
33
Q

What are the contraindications of breastfeeding?

A
34
Q

What are the infant benefits of breastfeeding?

A
  • Nutritional value: best composition with high bioavailability –> rich in lactose and fat, rich in taurine and cysteine, rich in LC-PUFA and MCT. Amount of iron, calcium and vit D is relatively low in breastmilk compared with formula milk and thus supplementation may be required
  • Easily digested and absorable: contains more whey protein (easier to digest) and less casein protein. Colostrium (whey: casein = 90:10), mature milk (whey: casein = 60:40)
  • GI function: stimulation of GI growth and motility
  • Prevention of atopy (allergy)
  • Prevention of infection: direct acting antimicrobial agents, antiinflammatory agents and immunomodulating agents. Prevention of infections including GE, UTI, respiratory diseases, recurrent ear infection
  • Antimicrobial activity
35
Q

Long term infant benefits of breastfeeding?

A
36
Q

What are the maternal benefits during lactation?

A
37
Q

What are the maternal long term benefits of breastfeeding?

A
38
Q

What are disadv of breastfeeding?

A
39
Q

What are the complications of breastfeeding?

A
40
Q

What is the issue of bottle feeding and formula milk?

A

MBBS VI: O&G (109 decks)

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