Postpartum Flashcards
What is lochia?
Post-partum vaginal discharge
From shedding of the decidua
What are the three types of lochia?
Lochia rubra: blood red, 1-4 days postpartum
Lochia serosa: 2-3 weeks postpartum
Lochia alba: 1-2 weeks postpartum
When is the uterus back to its pre-pregnancy size?
6-8 weeks
What is the most common causative agent in mastitis?
Staphylococcus aureus
If systemic symptoms are present, how is mastitis treated?
Flu/dicloxacillin
1st line if frequent breastfeeding
What is the most important risk factor for postpartum endometritis?
Caesarean section
Which organisms cause postpartum endometritis?
Polymicrobial invasion of the normal vaginal flora
- Gardnerella vaginalis*
- Staphylococcus epidermidis*
Group B Streptococcus
Ureaplasma urealyticum
How does postpartum endometritis present?
Lower abdominal pain, uterine tenderness
Chills, fever, malaise
Foul-smelling lochia
What causes ovarian vein thrombosis?
- Hypercoagulable state (pregnancy)
- Vascular damage (childbirth)
- Venous stasis
(During pregnancy, the ovarian vessels dilate to compensate for the increased blood flow. After birth, the blood flow suddenly decreases while the veins are still dilated)
Where does ovarian vein thrombosis usually occur?
90% on the right side
What are the 3 most common causes of secondary PPH?
- Retained products of conception
- Subinvolution of the placental site
- Infection (endometritis)
What is the definition of a secondary PPH?
Any significant uterine bleeding occurring between 24 hours and 12 weeks postpartum
What is the first-line investigation for secondary PPH?
Pelvic US with colour and spectral flow Doppler
- Retained PoC = vascularity*
- Blood clot = lack of vascularity*
- Hypoechoic tortuous vessels = subinvolution of the placental site*
What are four causes of primary PPH?
- Tone
- Tissue
- Trauma
- Thrombin
When is the peak incidence of mastitis?
2-4 weeks postpartum
What is the definition of indirect maternal mortality?
Deaths due to pre-existing disease but where disease progression was influenced by pregnancy e.g., maternal heart disease aggravated by the pregnancy
What is the safety of antidepressant use while breastfeeding?
The risks are negligible
The potential benefits of medications far outweigh the mild potential risks to the child
How prevalent is post-partum depression?
10% of new mothers
Most common complication of the post-partum period
How is post-partum psychosis treated?
Psychiatric hospitalisation
Atypical antipsychotics
What is the most common cause of postpartum fever?
Endometritis caused by Group A streptococcus
What is the most common cause of maternal death in Australia?
- Non-obstetric haemorrhage (intracranial or a ruptured splenic artery aneurysm)
- Pre-existing cardiovascular disease*
- Indirect maternal mortality is a greater contributor than direct*
When does post-partum blues normally occur?
Within 3-7 days, peaking at 5 days
What are the risk factors for uterine atony?
Grand multiparity
Nulliparity
Macrosomia
Polyhydraminois
Fibroid uterus
Prolonged labour
Previous PPH
Antepartum haemorrhage
What does active management of the third stage of labour involve?
Use of oxytocic drugs prophylactically
Controlled cord traction to deliver the placenta (Brandt-Andrews method)
Clamping and cutting the umbilical cord
What is a severe PPH?
Blood loss of >1000mL OR any amount of blood loss that causes signs of haemodynamic compromise (shock)
What is a massive PPH?
Any amount of pregnancy/post-partum blood loss that causes signs of severe shock
OR
is life threatening
OR
is like to result in the need for a massive blood transfusion
What scoring system can be used to assess postnatal depression?
Edinburgh Postnatal Depression Scale
When are antibiotics for mastitis indicated?
Systemic symptoms - flu-like symptoms, fever, malaise, chills
Symptoms or signs that have not resolved after 24-48 hours of increased breastfeeding and expressing of milk
Helps prevent abscess formation
What is the definition of premature menopause?
Menopause in a woman < 40 years
What blood test might you do to confirm menopause?
Serum FSH levels will show markedly raised concentrations
Prior to menopause, what is the main type of oestrogen circulating the body?
Oestradiol
What are the side effects of HRT?
Nausea
Fluid retention
Hirsutism
Leg cramps
Breast discomfort
How long postpartum is the uterus no longer abdominally palpable?
2 weeks
What proportion of women with baby blues will develop post partum depression?
1/5
What is the leading cause of post-partum mortality in Australia?
Suicide
Which medications can be used as galactagogues (increase maternal milk production)?
Metoclopramide
Domperidone
How does the uterine height descend following pregnancy?
Umbilical following delivery
1cm descent/day thereafter
Which of the following is contraindicated while breastfeeding?
A. Heparin
B. Lithium
C. Penicillin
D. Warfarin
E. Carbamazepine
Lithium
Which drugs are contraindicated while breastfeeding?
Antineoplastics
Leukopenia
Lithium
Oral retinoids
Amiodarone
Gold salts
