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GOSH > Postpartum > Flashcards

Postpartum Flashcards

1
Q

Definition of a primary and secondary PPH?

When is a PPH major?

A 
Primary= Blood loss >500mls within 24 hours of delivery
Secondary= Between 24hrs to 6 weeks 
Major= >1000mls loss
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2
Q

What are the 4 T’s of PPH

A

Tone
Tissue
Trauma
Thrombin

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3
Q

Antenatal RF for PPH

A

Previous PPH/Retained products, High BMI, Para>4, APH, Uterine overdistension, Uterine abnormalities, Mat age >35

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4
Q

Intrapartum RF for Iol

A

IoL, Prolonged, oxytocin, C-section, Precipitate labour, Operative delivery

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5
Q

Causes of a hypotonic PPH

A 
Overdistension- TWINS
Prolonged, Induction
Infection
Multiple pregnancy
Retained tissue 
Rarely placental abruption
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6
Q

Tissue causes of PPH

A

Retained placenta

Abnormal placental sight- Praevia, Accreta

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7
Q

Trauma causes of PPH

A

Uterine inversion/Rupture

Genital tract trauma e.g tears

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8
Q

Thrombin causes of PPH

A

Coag disorders

Abruption, Sepsis, AI, Liver disease

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9
Q

How do you manage a tissue induced PPH

A

Manual removal +/- GA/Spinal

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10
Q

How does a PPH B/C retained products present?

A

Pain, Bleeding, Offensive Lochia, Boggy poorly contracted uterus
May be infected

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11
Q

Management of a Hypotonic PPH

A

Compression ?Tranexamic acid IV 0.5-1g
IV Syntocinon bolus 10 units + IV Ergometrine 500mcg bolus
IM Carboprost (Prostaglandin) +/- Intramyometrial carboprost
Rectal Misprostol
Anaesthesia and IU Baloon Tamponade or Laparotomy

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12
Q

Eclampsia Management

A

Magnesium Sulphate 4g IV 5-10 mins-> 1g/hr

Delivery baby

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13
Q

How long should you continue magnesium sulphate in eclampsia?

A

Continue until 24 hour post-seizure/delivery

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14
Q

Do prophylactic anti-convulsants help in eclampsia? What is the best method of prevention?

A

No

Best way is to control BP

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15
Q

Causes of secondary PPH

A

Retained products, Endometritis, Infection

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16
Q

Management of secondary PPH

A

24 hours Abx and USS and evacuation

Tranexamic acid 1g stat IV

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17
Q

Most common cause of post-natal septic shock

A

Staph A

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18
Q

Abx for management septic shock

A

Cefotaxime, Metronidazole, Gentamicin

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19
Q

Presentation of amniotic fluid embolus

A

Collapse and unaccountable bleeding, DIC

Dx of exclusion

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20
Q

Management of an amniotic fluid embolus

A

Supportive, Early ITU transfer for inotropic and renal support, Correct clotting, Expert help

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21
Q

Presentation of a uterine rupture

A 
Fresh vaginal bleeding
Haematuria 
Fetal distress
Constant severe abdo pain which breaks through epidural 
Shock
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22
Q

Management of a uterine rupture

A

A->E
IV access
resus
Immediate laparotomy to salvage baby, repair damage +/- Hysterectomy

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23
Q

Risk factors for uterine rupture

A

Previous C-Section
Multips
Uterine stimulants

RARE IF PRIMIPS

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24
Q

What is Colostrum?

A

20weeks + gestation
Thick yellow lactation
Good for gut maturation and immunity of baby
Decreases following birth

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25
Q

Breast feeding benefits to mother

A

Helps uterine involution
Lactational amenorrhoea
Decreased breast cancer, ovarian cancer and OP

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26
Q

Benefits of breast feeding to infant

A

Decreased GI illness, Decreased UTIs, Decreased chest infections, Decreased Atopy, Decreased Leukaemia

27
Q

Problems with breast feeding

A 
Inadequate milk supply 
Breast engorgement 
Mastitis 
Breast abscess 
Cracked nipples
28
Q

Advice for breastfeeding mothers with mastitis

A

Continue breastfeeding
Analgesia
Consider oral Flucloxicillin

29
Q

Which BBVs can be transmitted through breastmilk?

What about if the mum has chickenpox?

A

HIV
Breast lesion +ve= HBV, HSV
Rubella can be but transmission of maternal Ab helps
(Encourage if Chicken pox)

30
Q

Difference in symptoms between galactocele and breast abscess

A

Galactocele will be painless and no infective signs

31
Q

Key drugs CI in breast feeding

A

Amiodarone, Lithium, Methotrexate, Tetracylcines, Chloramphenicol

32
Q

When is contraception required in post-partum?

A

After Day 21

N.B If started after this use additional contraception like Condoms

33
Q

Rules of POP post-partum

A

Anytime post partum

34
Q

Rules for COCP post-partum

A

Breast feeding and <6 weeks post partum= ABSOLUTE CI (decreases production)
UKMEC 2 if 6/52-6/12
Not breastfeeding= ?D21

35
Q

Rules of IUDs,IUS post-partum

A

Within 48 hours or post-4 weeks

36
Q

What is lactational amenorrhoea?

A

Effective contraception 98% of the time must be amenorrhoeic and <6 months post-partum and baby must be getting >85% of milk from breast

37
Q

What are the baby blues? When do they resolve?

A

3 days postpartum
Brief MILD emotional instability
Resolves spontaneously in 10 days

38
Q

What is Post-natal depression? What do you treat it with?

A

Peaks 3 months postpartum
Key features of depression + Specific parenting worries

Mild-mod= Self help, counselling
Sev= 1) CBT 2) Sertraline, Paroxetine
39
Q

What can antidepressants do to breast milk?

A

Decrease excretion

40
Q

What is puerperal psychosis?

A

Rapid onset and presentation within 2 weeks
Early non-specific signs with windows of normality
Then Psychotic symptoms and rapidly changing mood
Need urgent assessment and admission

41
Q

What is florid psychosis?

A

Rapid onset (hours)
Lability of mood
Mania, confusion, delusions of control, ramblind, distractibility
Pscyh emergency

42
Q

What is lochia and what should happen to it?

A

Vaginal discharge- Bloody, Uterine tissue, Mucus

Should stop before 6 weeks (USS if not)

43
Q

When should involution be complete by?

A

2/52 postpartum

44
Q

Presentation of endometritis?

A

Day 2-10 post natally
Offensive vaginal discharge with lochia getting heavier
Signs of infection, uterine enlargement with soft boddy tender uterus, abdo pain

45
Q

Investigations for ?endometritis

A

FBC, CRP, Cultures
HVS

USS useless as uterine distension means clot looks like placenta

46
Q

Management of ? Endometritis

A

Admit for IV Abx- admit any puerperal pyrexia!

Clindamycin and gent until >24hrs apyrexial

47
Q

When do you give iron tablets or transfusion for Postpartum anaemia?

A

80-100g/l- Tablets
<80-?Transfusion or IV iron
If there is >500ml blood loss always do FBC

48
Q

What is Sheehan’s syndrome

A

Post-partum hypopituitarism caused by ischaemic necrosis of the pituitary gland after blood loss
= Amenorrhoea, milk production decreased, Hypothyroidism

49
Q

Risk factors for GBS

A

Prematurity, Prolonged RoM, Previous sibling with GBS, Maternal pyrexia

50
Q

How do you test for GBS?

A

ONLY IF HIGH RISK
HVS
35-37 weeks
or 3-5 weeks prior to EDD

51
Q

Is there universal screening for GBS?

A

No

Only those at risk

52
Q

Transmission risk of GBS in +ve in previous pregnancy

A

50%

53
Q

If GBS +ve in previous pregnancy what should you do?

A

Maternal IV Abx prophylaxis

Testing at 36 weeks +/- Abx in late pregnancy

54
Q

What are the indications for IV Benzylpenicillin during/near labour

A

Preterm labour

Intrapartum pyrexia

55
Q

Action if there is maternal colonisation with GBS (1 minor RF)

A

Hospital for 24 hours and regular obs

56
Q

What do you do if someone has >2 minor RF for GBS or 1 red flag

A

Benzyl +Gent + Septic screen

57
Q

Abx of choice for GBS

A

Benzylpenicillin

58
Q

What is Ashermann’s syndrome

A

Intrauterine adhesions that prevent the endometrium responding to oestrogen
Amenorrhoea

59
Q

What is fibronectin? When is it CI?

A

Probability of labour in the next 2 weeks

CI: Bleeding, semen in last 24 hours as F+ve

60
Q

Indications for at least 6 weeks post-partum LMWH

A

Any previous VTE
Antenatal LMWH
High risk thrombophilia
Low risk thrombpophila and FHx

61
Q

Indications for at least 10 days post-natal LMWH

A 
C-section
Readmission
BMI>40
>3 Day admission
Any puerperium surgical procedure except perianal repair
Medical comorbidities 
=/More than 2 low risk factors
62
Q

minor indications for LMWH, =/>2 of which would require 10 days LMWH

A

Smoker, >35, BMI>30, p>3, Elective C-section, Gross varicose veins, current systemic infection, Immovility, Current pre-eclampsia, Multiple preg, Preterm, Stillbirth, prolonged

63
Q

What do you do about LMWH if <2 minor indications

A

Encourage early mobilisation and avoid dehydration

GOSH (5 decks)

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