Postpartum Complications Flashcards
When is the postpartum period?
Also called puerperium = from end of 3rd stage of labour until 6 weeks
What are some changes that occur in the uterus during postpartum period?
Involution = uterus transformed from pregnant to non-pregnant state
Lochia passage = vaginal discharge after giving birth, clears by 4 weeks
What are some changes that occur in the postpartum period?
Increased clotting factors and platelets
Cardiac changes = reduced HR, SV and CO
What are some examples of vaginal trauma that can occur in the postpartum period?
Vaginal wall tears and labial tears
Perineal tears = 1st-3rd degree, treated by right medio-lateral episiotomy
How are 3rd degree perineal tears graded?
3a = involves <50% of external anal sphincter 3b = involves >50% of external anal sphincter 3c = involves internal anal sphincter
What is a 4th degree perineal tear?
Anal or rectal mucosa involvement
How are 3rd and 4th degree perineal tears treated?
Repair in theatre = regional anaesthesia, repair anal mucosa and anal sphincters
Antibiotics, laxatives and physiotherapy
What are some common postpartum complications?
VTE, puerperal infection, secondary postpartum haemorrhage, urinary problems, puerperal mental health problems, problems with lactation
How common is VTE after pregnancy?
Very = major cause of maternal death
Why should all women have their VTE risk assessed during pregnancy and labour?
Pregnancy is hypercoagulable state = women at increased risk of VTE
How should VTE be managed?
Low risk = hydration and mobilisation
Moderate risk = 10 days prophylactic LMWH
High risk = 6 weeks prophylactic LMWH
What is puerperal sepsis?
Genital tract infection any time between onset of membrane rupture and 42nd day postpartum
What is puerperal fever?
Fever lasting >24hrs within the first 10 days postpartum
What are the risk factors for postpartum pelvic infection?
Prolonged labour, prolonged rupture of membrane, multiple vaginal examinations, retained placental tissue, C-section
What are some common organisms that cause postpartum pelvic infections?
Group B strep, staphylococcus, e.coli, anaerobes
What are some examples of postpartum pelvic infections?
Endometritis, salpingitis, pelvic infection, pelvic abscess, peritonitis
What investigations should be done for postpartum pelvic infections?
CT, US, FBC, CRP, Us & Es, blood cultures, ccoagulation
How are postpartum pelvic infections treated?
IV antibiotics = co-amoxiclav + metronidazole +/- gentamicin
IV fluids
What are some other infections that can occur in the postpartum period?
UTI, wound infection, perineal infection, chest infection, thrombophlebitis, breast abscess
What is secondary postpartum haemorrhage?
Haemorrhage within 24hrs-6 weeks after delivery
What are some causes of secondary postpartum haemorrhage?
Endometritis and retained placental tissue
What is the management of secondary postpartum haemorrhage?
Investigations = bloods, US
Antibiotics and oxytocin (syntocinon/ergometrine)
Evacuation of retained placental tissue
What is the most common cause of urinary incontinence in the UK?
Overflow incontinence with retention = can occur after removal of catheter
What are some causes of urinary retention?
Pain or vaginal trauma
How is urinary retention managed?
Catheterise and treat underlying cause
TWC after 48hrs and avoid bladder overdistension
What is the most common cause of urinary incontinence in developing countries?
Vesico-vaginal fistula
What is a vesico-vaginal fistula?
Abnormal hole between bladder and vagina
What can cause a vesico-vaginal fistula?
Prolonged labour = tissue dies that is compressed between the baby’s head and pelvic bones
How is a vesico-vaginal fistula treated?
Highly skilled surgery = needed to relieve severe suffering
What are some examples of postpartum mental health problems?
Puerperal psychosis, postnatal depression, baby blues
What are the features of puerperal psychosis?
Confusion, extreme anxiety, restlessness, extreme wakefulness, paranoia, hallucinations, delirium
How is puerperal psychosis managed?
Exclude sepsis and involve perinatal mental health team = may need admission to mother-baby unit
How common is recurrence of puerperal psychosis?
25% recurrence
What are some problems with lactation that can occur?
Breast enlargement, mastitis, breast abscess
When does mastitis occur?
At any time during breastfeeding
What is the most common organism causing mastitis?
Staphylococcus
How does mastitis present?
Fever and breast tenderness (often localised)
What is the management of mastitis?
Continue breastfeeding and give oral/IV flucloxacillin
What can mastitis progress to?
Breast abscess = needs surgical drainage
What contraception can be used in the postpartum period?
Barrier methods and injectable progestogen
Oral hormonal = COCP, POP
LARC = Nexplannon, copper IUD, Mirena IUS
Sterilisation
