Postpartum Period Flashcards
How does the genital tract change after pregnancy?
Uterus contracts to occlude blood vessels that supplied the placenta
Size reduces over 6 weeks
Internal os shuts by 3 days
Discharge maybe blood stained for 4 weeks, then yellow or white
Menstruation after 6 weeks
How does the cardiovascular system change after pregnancy?
CO and plasma volume decrease back to normal within a week
Odema and BP may take 6 weeks
How does lactation occur?
Prolactin from anterior pituitary stimulates milk secretion
- decrease in oestrogen and progesterone after birth reduces their antagonistic effects on prolactin
Oxytocin from posterior pituitary stimulates ejection in response to nipple suckling
Can be inhibited by stress acting on hypothalamus
What is PPH?
Loss of >500ml of blood within 24 hours of delivery
Occurs in 10%
What causes PPH?
Retained placenta - may not show as blood accumulates in uterus
Atonic uterus
Tear
What are risk factors for PPH?
Previous history Previous C-section Coagulation defect Instrumental/C-section delivery Retained placenta APH Polyhydramnios Grand multiparity
How is PPH prevented?
Oxytocin for 3rd stage of labour
Ergometrine causes vomiting and is contraindicated in hypertensive women
How is PPH managed?
Cross-match blood Remove retained placenta Give oxytocin to contract uterus Examination under anaesthetic Prostaglandin
Surgery -> hysterectomy
What is secondary PPH?
Excessive blood loss
Between 24hr and 6 weeks after delivery
What causes secondary PPH?
Endometritis +/- retaind placental tissue
Uterus is enlarged and tender with open cervical os
What is the management of secondary PPH?
Vaginal swabs
FBC + cross match
Give Abx
Evacuation of retained products of conception
What is postpartum pyrexia?
Maternal fever of >38 in first 14 days
What causes postpartum pyrexia?
Genital tract sepsis post C-section
Group A strep
Staph aureus
E coli
DVT
What other infections occur in postpartum?
UTI Chest infection Mastitis Perineal infection Wound infection post C-section
What psychiatric problems arise postpartum?
Third day blues
Postnatal depression - EPDS, consider postpartum thyroiditis
Puerperal psychosis - usually around 4th day
What other medical problems present in postpartum?
Pre-eclampsia takes 24hrs to clear Retention of urine UTI Incontinence Paravaginal haematoma Constipation and haemorrhoids
What is the difference between early and neonatal death?
Neonatal death within 28 days of delivery
Early neonatal death within 7 days
What is the perinatal mortality rate?
Sum of stillbirths and early neonatal deaths
Corrected - excludes stillbirths and early neonatal deaths due to congenital malformations
What is the perinatal mortality rate in UK?
7.5 per 1000
Stillbirth rate is 5.1/1000
What are risk factors for perinatal mortality?
Lower socioeconomic status Below 17 and >40 Smoker Obese Asian/Afro-Caribbean
What are the main causes of perinatal mortality?
Preterm delivery
IUGR
Prematurity
Congenital infections
What is the definition of a maternal death?
During pregnancy or within 42 days of cessation
Any cause related to or aggravated by pregnancy
Late death - between 42 days and 1 year
Can be split into direct and indirect
What is the maternal death rate in UK?
11.4/100,000 pregnancies
What are the main causes of maternal mortality globally?
Haemorrhage Obstructed labour Infection Severe pre-eclampsia Illegal abortions
What are the main direct causes of maternal mortality in the UK?
Sepsis - group A strep
Hypertensive disease - intracranial haemorrhage associated with poorly controlled BP
VTE -> PE and cerebral venous thrombosis
Haemorrhage
What are the main indirect causes of maternal mortality in UK?
Cardiac disease
Psychiatric disease
