Postpartum Complications Flashcards
What is a postpartum haemorrhage
Refers to bleeding after delivery of the baby and placenta, specifically,
500ml after a vaginal delivery
1000ml after a caesarean section
Define secondary post partum haemorrhage
Blood loss of >500ml from 24 hours of delivery to 6 weeks
What are the causes of PPH?
4 T’s
Retained tissue
- Placenta or membranes
Tears/trauma
- Forceps delivery
Thrombin
- Haemophilia
Tone
- Uterine atony
Other
- Infection
- PET
- Multi-parity
Give risk factors for primary PPH
Previous PPH
Prolonged labour
PET
>Age
Polyhydramnios
Emergency C section
Placenta praevia and abruption
Macrosomia
Ritodrine
Multiple pregnancy
Fibroids
Induction of labour
Grand multiparity
APH
How is PPH managed?
IV fluid resucitation
Oxygen regardless of sats
Insert 2 large bore cannulas
Uterine massage
Tranexamic acid
Uterotonics
Further surgical methods
Give examples of uterotonic drugs used in PPH management
Oxytocin
Ergometrine
Carboprost
Misoprostol
What is first line uterotonic drug used in PPH?
IV oxytocin
What is first line surgical management of PPH?
Balloon tamponade
What further surgical methods can be used in PPH management?
Insertion of intrauterine balloon
Uterine artery embolisation
Uterine artery ligation
Hysterectomy
Give the prophylactic management of PPH
Optimise haemoglobin levels
Active management of 3rd stage
Tranexamic acid
Prophylactic oxytocin in high risk patients
Give complications of PPH
Sheehan’s syndrome
How common are perineal tears?
Common, affecting 90% of nulliparous women
Give risk factors for perineal tears
Primigravida
Large babies
Precipitant labour
Shoulder dystocia
Forceps delivery
How common are third and fourth degree tears?
Less common affecting 1% of all vaginal deliveries
Describe a 1st degree perineal tear
Involves skin only
Describe 2nd degree peritneal tear
Involves skin and peritneal muscle
Describe a 3rd degree peritneal tear
Involves the anal sphincter
Describe a 4th degree peritneal tear
Extends through internal and external anal sphincter and through anal mucosa
Give complications of perineal tear
Pain
Infection
Bleeding
Dyspareunia
Flatus
Faecal urgency and incontinence
What is puerperal pyrexia?
Maternal pyrexia (>38C) within the first 14 days of delivery
What can cause puerperal pyrexia?
Genital/urinary tract infection
Mastitis
Wound infection
VTE
What screening tool is used to assess post partum depression risk?
The Edinburgh Scale
How is post partum thyroiditis managed and why?
The thyrotoxic phase is not usually treated with anti-thyroid drugs as the thyroid is not overactive, propranolol is typically used for symptom control instead
How long is colostrum produced for?
First few days following birth
