Postpartum Complications

Question 1

When is the postpartum period?

Answer 1

Also called puerperium = from end of 3rd stage of labour until 6 weeks

Question 2

What are some changes that occur in the uterus during postpartum period?

Answer 2

Involution = uterus transformed from pregnant to non-pregnant state
Lochia passage = vaginal discharge after giving birth, clears by 4 weeks

Question 3

What are some changes that occur in the postpartum period?

Answer 3

Increased clotting factors and platelets

Cardiac changes = reduced HR, SV and CO

Question 4

What are some examples of vaginal trauma that can occur in the postpartum period?

Answer 4

Vaginal wall tears and labial tears

Perineal tears = 1st-3rd degree, treated by right medio-lateral episiotomy

Question 5

How are 3rd degree perineal tears graded?

Answer 5

3a = involves <50% of external anal sphincter
3b = involves >50% of external anal sphincter
3c = involves internal anal sphincter

Question 6

What is a 4th degree perineal tear?

Answer 6

Anal or rectal mucosa involvement

Question 7

How are 3rd and 4th degree perineal tears treated?

Answer 7

Repair in theatre = regional anaesthesia, repair anal mucosa and anal sphincters
Antibiotics, laxatives and physiotherapy

Question 8

What are some common postpartum complications?

Answer 8

VTE, puerperal infection, secondary postpartum haemorrhage, urinary problems, puerperal mental health problems, problems with lactation

Question 9

How common is VTE after pregnancy?

Answer 9

Very = major cause of maternal death

Question 10

Why should all women have their VTE risk assessed during pregnancy and labour?

Answer 10

Pregnancy is hypercoagulable state = women at increased risk of VTE

Question 11

How should VTE be managed?

Answer 11

Low risk = hydration and mobilisation
Moderate risk = 10 days prophylactic LMWH
High risk = 6 weeks prophylactic LMWH

Question 12

What is puerperal sepsis?

Answer 12

Genital tract infection any time between onset of membrane rupture and 42nd day postpartum

Question 13

What is puerperal fever?

Answer 13

Fever lasting >24hrs within the first 10 days postpartum

Question 14

What are the risk factors for postpartum pelvic infection?

Answer 14

Prolonged labour, prolonged rupture of membrane, multiple vaginal examinations, retained placental tissue, C-section

Question 15

What are some common organisms that cause postpartum pelvic infections?

Answer 15

Group B strep, staphylococcus, e.coli, anaerobes

Question 16

What are some examples of postpartum pelvic infections?

Answer 16

Endometritis, salpingitis, pelvic infection, pelvic abscess, peritonitis

Question 17

What investigations should be done for postpartum pelvic infections?

Answer 17

CT, US, FBC, CRP, Us & Es, blood cultures, ccoagulation

Question 18

How are postpartum pelvic infections treated?

Answer 18

IV antibiotics = co-amoxiclav + metronidazole +/- gentamicin
IV fluids

Question 19

What are some other infections that can occur in the postpartum period?

Answer 19

UTI, wound infection, perineal infection, chest infection, thrombophlebitis, breast abscess

Question 20

What is secondary postpartum haemorrhage?

Answer 20

Haemorrhage within 24hrs-6 weeks after delivery

Question 21

What are some causes of secondary postpartum haemorrhage?

Answer 21

Endometritis and retained placental tissue

Question 22

What is the management of secondary postpartum haemorrhage?

Answer 22

Investigations = bloods, US
Antibiotics and oxytocin (syntocinon/ergometrine)
Evacuation of retained placental tissue

Question 23

What is the most common cause of urinary incontinence in the UK?

Answer 23

Overflow incontinence with retention = can occur after removal of catheter

Question 24

What are some causes of urinary retention?

Answer 24

Pain or vaginal trauma

Question 25

How is urinary retention managed?

Answer 25

Catheterise and treat underlying cause

TWC after 48hrs and avoid bladder overdistension

Question 26

What is the most common cause of urinary incontinence in developing countries?

Answer 26

Vesico-vaginal fistula

Question 27

What is a vesico-vaginal fistula?

Answer 27

Abnormal hole between bladder and vagina

Question 28

What can cause a vesico-vaginal fistula?

Answer 28

Prolonged labour = tissue dies that is compressed between the baby’s head and pelvic bones

Question 29

How is a vesico-vaginal fistula treated?

Answer 29

Highly skilled surgery = needed to relieve severe suffering

Question 30

What are some examples of postpartum mental health problems?

Answer 30

Puerperal psychosis, postnatal depression, baby blues

Question 31

What are the features of puerperal psychosis?

Answer 31

Confusion, extreme anxiety, restlessness, extreme wakefulness, paranoia, hallucinations, delirium

Question 32

How is puerperal psychosis managed?

Answer 32

Exclude sepsis and involve perinatal mental health team = may need admission to mother-baby unit

Question 33

How common is recurrence of puerperal psychosis?

Answer 33

25% recurrence

Question 34

What are some problems with lactation that can occur?

Answer 34

Breast enlargement, mastitis, breast abscess

Question 35

When does mastitis occur?

Answer 35

At any time during breastfeeding

Question 36

What is the most common organism causing mastitis?

Answer 36

Staphylococcus

Question 37

How does mastitis present?

Answer 37

Fever and breast tenderness (often localised)

Question 38

What is the management of mastitis?

Answer 38

Continue breastfeeding and give oral/IV flucloxacillin

Question 39

What can mastitis progress to?

Answer 39

Breast abscess = needs surgical drainage

Question 40

What contraception can be used in the postpartum period?

Answer 40

Barrier methods and injectable progestogen
Oral hormonal = COCP, POP
LARC = Nexplannon, copper IUD, Mirena IUS
Sterilisation