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O&G > Postpartum > Flashcards

Postpartum Flashcards

1
Q

What is lochia?

A

Post-partum vaginal discharge

From shedding of the decidua

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2
Q

What are the three types of lochia?

A

Lochia rubra: blood red, 1-4 days postpartum

Lochia serosa: 2-3 weeks postpartum

Lochia alba: 1-2 weeks postpartum

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3
Q

When is the uterus back to its pre-pregnancy size?

A

6-8 weeks

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4
Q

What is the most common causative agent in mastitis?

A

Staphylococcus aureus

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5
Q

If systemic symptoms are present, how is mastitis treated?

A

Flu/dicloxacillin

1st line if frequent breastfeeding

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6
Q

What is the most important risk factor for postpartum endometritis?

A

Caesarean section

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7
Q

Which organisms cause postpartum endometritis?

A

Polymicrobial invasion of the normal vaginal flora

  • Gardnerella vaginalis*
  • Staphylococcus epidermidis*

Group B Streptococcus

Ureaplasma urealyticum

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8
Q

How does postpartum endometritis present?

A

Lower abdominal pain, uterine tenderness

Chills, fever, malaise

Foul-smelling lochia

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9
Q

What causes ovarian vein thrombosis?

A
  1. Hypercoagulable state (pregnancy)
  2. Vascular damage (childbirth)
  3. 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)

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10
Q

Where does ovarian vein thrombosis usually occur?

A

90% on the right side

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11
Q

What are the 3 most common causes of secondary PPH?

A
  1. Retained products of conception
  2. Subinvolution of the placental site
  3. Infection (endometritis)
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12
Q

What is the definition of a secondary PPH?

A

Any significant uterine bleeding occurring between 24 hours and 12 weeks postpartum

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13
Q

What is the first-line investigation for secondary PPH?

A

Pelvic US with colour and spectral flow Doppler

  • Retained PoC = vascularity*
  • Blood clot = lack of vascularity*
  • Hypoechoic tortuous vessels = subinvolution of the placental site*
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14
Q

What are four causes of primary PPH?

A
  1. Tone
  2. Tissue
  3. Trauma
  4. Thrombin
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15
Q

When is the peak incidence of mastitis?

A

2-4 weeks postpartum

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16
Q

What is the definition of indirect maternal mortality?

A

Deaths due to pre-existing disease but where disease progression was influenced by pregnancy e.g., maternal heart disease aggravated by the pregnancy

17
Q

What is the safety of antidepressant use while breastfeeding?

A

The risks are negligible

The potential benefits of medications far outweigh the mild potential risks to the child

18
Q

How prevalent is post-partum depression?

A

10% of new mothers

Most common complication of the post-partum period

19
Q

How is post-partum psychosis treated?

A

Psychiatric hospitalisation

Atypical antipsychotics

20
Q

What is the most common cause of postpartum fever?

A

Endometritis caused by Group A streptococcus

21
Q

What is the most common cause of maternal death in Australia?

A
  1. Non-obstetric haemorrhage (intracranial or a ruptured splenic artery aneurysm)

    1. Pre-existing cardiovascular disease*
  • Indirect maternal mortality is a greater contributor than direct*
22
Q

When does post-partum blues normally occur?

A

Within 3-7 days, peaking at 5 days

23
Q

What are the risk factors for uterine atony?

A

Grand multiparity

Nulliparity

Macrosomia

Polyhydraminois

Fibroid uterus

Prolonged labour

Previous PPH

Antepartum haemorrhage

24
Q

What does active management of the third stage of labour involve?

A

Use of oxytocic drugs prophylactically

Controlled cord traction to deliver the placenta (Brandt-Andrews method)

Clamping and cutting the umbilical cord

25
Q

What is a severe PPH?

A

Blood loss of >1000mL OR any amount of blood loss that causes signs of haemodynamic compromise (shock)

26
Q

What is a massive PPH?

A

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

27
Q

What scoring system can be used to assess postnatal depression?

A

Edinburgh Postnatal Depression Scale

28
Q

When are antibiotics for mastitis indicated?

A

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

29
Q

What is the definition of premature menopause?

A

Menopause in a woman < 40 years

30
Q

What blood test might you do to confirm menopause?

A

Serum FSH levels will show markedly raised concentrations

31
Q

Prior to menopause, what is the main type of oestrogen circulating the body?

A

Oestradiol

32
Q

What are the side effects of HRT?

A

Nausea

Fluid retention

Hirsutism

Leg cramps

Breast discomfort

33
Q

How long postpartum is the uterus no longer abdominally palpable?

A

2 weeks

34
Q

What proportion of women with baby blues will develop post partum depression?

A

1/5

35
Q

What is the leading cause of post-partum mortality in Australia?

A

Suicide

36
Q

Which medications can be used as galactagogues (increase maternal milk production)?

A

Metoclopramide

Domperidone

37
Q

How does the uterine height descend following pregnancy?

A

Umbilical following delivery

1cm descent/day thereafter

38
Q

Which of the following is contraindicated while breastfeeding?

A. Heparin

B. Lithium

C. Penicillin

D. Warfarin

E. Carbamazepine

A

Lithium

39
Q

Which drugs are contraindicated while breastfeeding?

A

Antineoplastics

Leukopenia

Lithium

Oral retinoids

Amiodarone

Gold salts

O&G (13 decks)

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