Postpartum

Question 1

What is peurperal pyrexia

Answer 1

> 38ºC in the first 14 days following delivery

Question 2

Causes puerperal pyrexia

Answer 2

endometritis: most common cause
urinary tract infection
wound infections (perineal tears + caesarean section)
mastitis
venous thromboembolism

Question 3

Management puerperal pyrexia

Answer 3

if endometritis is suspected the patient should be referred to hospital for intravenous antibiotics (clindamycin and gentamicin until afebrile for greater than 24 hours)

Question 4

when should lochia settle

Answer 4

6 weeks

Question 5

What should be avoided during lochia

Answer 5

tampons

Question 6

Presentation post partum endometritis

Answer 6

Foul-smelling discharge or lochia
Bleeding that gets heavier or does not improve with time
Lower abdominal or pelvic pain
Fever
Sepsis

Question 7

Investigations post partum endometritis

Answer 7

Vaginal swabs (including chlamydia and gonorrhoea if there are risk factors)
Urine culture and sensitivities
USS to rule out RPOC

Question 8

Risk factor RPOC

Answer 8

placenta accreta

Question 9

Invetsigation for RPOC

Answer 9

USS

Question 10

Management RPOC

Answer 10

evacuation of retained products with curagette

Question 11

Complications of surgery to remove RPOC?

Answer 11

ashermans
endometritis

Question 12

Management post partum anaemia

Answer 12

Hb under 100 g/l – start oral iron (e.g. ferrous sulphate 200mg three times daily for three months)

Hb under 90 g/l – consider an iron infusion in addition to oral iron (e.g. Monofer, CosmoFer or Ferinject)

Hb under 70 g/l – blood transfusion in addition to oral iron

Question 13

Contraindication to iron infusion

Answer 13

active infection, many pathogens “feed on iron”

Question 14

Scoring post natal depression

Answer 14

Edinburgh scale

There are ten questions, with a total score out of 30 points. A score of 10 or more suggests postnatal depression.

Question 15

Most common pathogen mastitis

Answer 15

staph aureus

Question 16

Management candidia of nipple

Answer 16

Topical miconazole 2% after each breastfeed
Treatment for the baby (e.g. miconazole gel or nystatin)

Question 17

typical history nipple candidia

Answer 17

after a course of antibiotics

Sore nipples bilaterally, particularly after feeding
Nipple tenderness and itching
Cracked, flaky or shiny areola
Symptoms in the baby, such as white patches in the mouth and on the tongue, or candidal nappy rash

Question 18

Management postpartum thyroiditis

Answer 18

Thyrotoxicosis: symptomatic control, such as propranolol (a non-selective beta-blocker)
Hypothyroidism: levothyroxine

Question 19

Blood results hypo and hyper thyroid

Answer 19

Hypo: High TSH, Low T3 and T4
Hyper: Low TSH, High T3 and T4