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4th year passmedicine by topic > Postpartum Complications > Flashcards

Postpartum Complications Flashcards

1
Q

What is a Galactocele?

A

A build up of milk creates a cystic lesion in the breast. The lesion can be differentiated from an abscess by the fact that a galactocele is usually painless, with no local or systemic signs of infection.

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2
Q

Galactocele typically occurs in

A

women who have recently stopped breastfeeding and is due to occlusion of a lactiferous duct.

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3
Q

Breast feeding: suppressing lactation

Techniques

A

stop the lactation reflex i.e. stop suckling/expressing
supportive measures: well-supported bra and analgesia
cabergoline is the medication of choice if required

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4
Q

nipple pain: may be caused by

A

poor latch

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5
Q

frequent feeding in a breastfed infant is a sign of low milk supply

A

false

frequent feeding in a breastfed infant is not alone a sign of low milk supply

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6
Q

blocked duct (‘milk bleb’) sx

A

nipple pain when breastfeeding

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7
Q

blocked duct (‘milk bleb’) mx

A

Breastfeeding should continue. Advice should be sought regarding the positioning of the baby. Breast massage may also be tried

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8
Q

treatment for nipple candidiasis whilst breastfeeding

A

should involve miconazole cream for the mother and nystatin suspension for the baby

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9
Q

Mastitis affects around 1 in 10 breastfeeding women.

A

true

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10
Q

Mastitis antibiotic indications

A

systemically unwell, if nipple fissure present, if symptoms do not improve after 12-24 hours of effective milk removal of if culture indicates infection

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11
Q

Mastitis antibiotics

A

first-line antibiotic is flucloxacillin for 10-14 days

Breastfeeding or expressing should continue during treatment.

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12
Q

If left untreated, mastitis may develop into a breast abscess.

A

True

This generally requires incision and drainage.

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13
Q

Breast engorgement is one of the causes of breast pain in breastfeeding women.

A

true

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14
Q

Breast engorgement usually occurs

A

in the first few days after the infant is born

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15
Q

Breast engorgement usually affects both breasts

A

true

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16
Q

sx breast engorgement?

A

The pain or discomfort is typically worse just before a feed.

Milk tends to not flow well from an engorged breast and the infant may find it difficult to attach and suckle.

Fever may be present but usually settles within 24 hours.

The breasts may appear red.

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17
Q

what help relieve the discomfort of engorgement.

A

Although it may initially be painful, hand expression of milk

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18
Q

Raynaud’s disease of the nipple sx

A

Pain is often intermittent and present during and immediately after feeding.

Blanching of the nipple may be followed by cyanosis and/or erythema.

Nipple pain resolves when nipples return to normal colour.

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19
Q

Raynaud’s disease of the nipple mx

A

advice on minimising exposure to cold, use of heat packs following a breastfeed, avoiding caffeine and stopping smoking.
If symptoms persist consider specialist referral for a trial of oral nifedipine (off-license).

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20
Q

Around 1 in 10 breastfed babies lose more than the ‘cut-off’ threshold in the first week of life.

A

true

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21
Q

What is the ‘cut-off’ threshold for poor infant weight gain

A

loss 10% in first week

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22
Q

ix baby lose more than the ‘cut-off’ threshold in the first week of life.

A

prompt consideration of the above breastfeeding problems.
The infant should also be examined to look for any underlying problems. NICE recommends an ‘expert’ review of feeding if this occurs (e.g. midwife-led breastfeeding clinics) and monitoring of weight until weight gain is satisfactory

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23
Q

The following drugs CAN be given to mothers who are breastfeeding:

A

antibiotics: penicillins, cephalosporins, trimethoprim
endocrine: glucocorticoids (avoid high doses), levothyroxine
epilepsy: sodium valproate, carbamazepine
asthma: salbutamol, theophyllines

psychiatric drugs: tricyclic antidepressants, antipsychotics

hypertension: beta-blockers, hydralazine
anticoagulants: warfarin, heparin
digoxin

24
Q

Which antibiotics should be avoided in breastfeeding

A

ciprofloxacin, tetracycline, chloramphenicol, sulphonamides

25
Q

Which psychiatric drugs should be avoided in breastfeeding

A

lithium, benzodiazepines

26
Q

Which cardiovascular drugs should be avoided in breastfeeding

A

amiodarone

aspirin

27
Q

Which endocrine drugs should be avoided in breastfeeding

A

carbimazole

sulfonylureas

28
Q

Which rheumatoid drugs should be avoided in breastfeeding

A

methotrexate

29
Q

cytotoxic drugs should be avoided in breastfeeding

A

true

30
Q

The Edinburgh Postnatal Depression Scale may be used to screen for depression:

A

10-item questionnaire, with a maximum score of 30
indicates how the mother has felt over the previous week
score > 13 indicates a ‘depressive illness of varying severity’
sensitivity and specificity > 90%
includes a question about self-harm

31
Q

Outline post-partum mental health problems & epidemiology for the following:
‘Baby-blues’
Postnatal depression
Puerperal psychosis

A

‘Baby-blues’ - Seen in around 60-70% of women

Postnatal depression - Affects around 10% of women

Puerperal psychosis - Affects approximately 0.2% of women

32
Q

Onset of ‘Baby-blues’

A

Typically seen 3-7 days following birth and is more common in primips

33
Q

Onset of Postnatal depression

A

Most cases start within a month and typically peaks at 3 months

34
Q

Onset of Puerperal psychosis

A

Onset usually within the first 2-3 weeks following birth

35
Q

Baby blues sx?

A

Mothers are characteristically anxious, tearful and irritable

36
Q

Baby blues mx?

A

Reassurance and support, the health visitor has a key role

37
Q

Postnatal depression mx?

A

As with the baby blues reassurance and support are important

Cognitive behavioural therapy may be beneficial.

Certain SSRIs

38
Q

Postnatal depression mx - which SSRIs?

A

sertraline and paroxetine may be used if symptoms are severe

39
Q

SSRIs are not secreted in the breast milk

A

false

whilst they are secreted in breast milk it is not thought to be harmful to the infant

40
Q

Puerperal psychosis There is around a 25-50% risk of recurrence following future pregnancies

A

true

41
Q

Postnatal depression mx - paroxetine is recommended by SIGN because

A

low milk/plasma ratio

42
Q

Postnatal depression mx - fluoxetine

A

best avoided due to a long half-life

43
Q

Post-partum thyroiditis - Three stages

A
  1. Thyrotoxicosis
  2. Hypothyroidism
  3. Normal thyroid function (but high recurrence rate in future pregnancies)
44
Q

Post-partum thyroiditis antibodies?

A

Thyroid peroxidase antibodies are found in 90% of patients

45
Q

Post-partum thyroiditis mx

A

the thyrotoxic phase is not usually treated with anti-thyroid drugs as the thyroid is not overactive. Propranolol is typically used for symptom control
the hypothyroid phase is usually treated with thyroxine

46
Q

Postpartum haemorrhage (PPH) is defined as

A

blood loss of > 500mls and may be primary or secondary

47
Q

Primary PPH

occurs within

A

24 hours

48
Q

most common cause of PPH

A 
uterine atony (90% of cases)
Other causes include genital trauma and clotting factors
49
Q

Risk factors for primary PPH include

A 
previous PPH
prolonged labour
pre-eclampsia
increased maternal age
polyhydramnios
emergency Caesarean section
placenta praevia, placenta accreta
macrosomia
ritodrine (a beta-2 adrenergic receptor agonist used for tocolysis)
50
Q

PPH mx - medical

A

ABC including two peripheral cannulae, 14 gauge
IV syntocinon (oxytocin) 10 units or IV ergometrine 500 micrograms
IM carboprost
if medical options failure to control the bleeding then surgical options will need to be urgently considered

51
Q

PPH mx - surgical

A

intrauterine balloon tamponade is an appropriate first-line ‘surgical’ intervention for most women where uterine atony is the only or main cause of haemorrhage
other options include: B-Lynch suture, ligation of the uterine arteries or internal iliac arteries
if severe, uncontrolled haemorrhage then a hysterectomy is sometimes performed as a life-saving procedure

52
Q

Secondary PPH

occurs when

A

between 24 hours - 12 weeks

53
Q

Secondary PPH

occurs due to?

A

retained placental tissue or endometritis

54
Q

Puerperal pyrexia may be defined as

A

a temperature of > 38ºC in the first 14 days following delivery.

55
Q

Puerperal pyrexia causes

A 
endometritis: most common cause
urinary tract infection
wound infections (perineal tears + caesarean section)
mastitis
venous thromboembolism
56
Q

Puerperal pyrexia mx

A

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

4th year passmedicine by topic (96 decks)

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