Postpartum Period - Puerperal pyrexia, Postpartum thyroiditis, Postpartum MH

Question 1

Puerperal pyrexia
-definition
-causes
-management

Answer 1

38C+ 2wks post delivery
-MOST COMMON - endometritis
-UTI
-wound infection
-mastitis
-VTE

If endometritis suspected => IV ABx (clindamycin + gent) until afebrile for 24hrs+

Question 2

Postpartum thyroiditis
-why does this happen
-stages
-management

Answer 2

Transient autoimmunity that arises after immune modifications during pregnancy

Thyrotoxicosis => hypothyroidism => normal thryoid function

Thyrotoxic phase - propanolol for symptoms control
Hypothyroid phase - thyroxine

Question 3

Postpartum mental health problems
-how to differentiate between the baby blues, postnatal depression, puerperal psychosis
-how to screen for depression

Answer 3

Baby blues
-within a week of birth
-anxious, tearful, irritable
=> reassurance and support

Postnatal depression
-within 1month, peaks at 3months
-depression symptoms
=> CBT, SSRIs if severe
-AVOID FLUOXETINE DUE TO LONG HALF LIFE
-sertraline or paroxetine recommended

Puerperal psychosis
-within 2-3wks of birth
-bipolar symptoms with disordered perception
=> admit to MBU

Edinburgh Postnatal Depression Scale

Question 4

Postpartum hemorrhage
-definition
-4Ts
-risk factors
-management of primary

Answer 4

Blood loss 500ml+ after vaginal delivery

Primary - 1st 24hrs
Tone - UTERINE ATONY, BIGGEST CAUSE
Trauma - perineal tear
Tissue - retained placenta
Thrombin - clotting, bleeding disorder

Previous PPH
Prolonged labour
Preeclampsia
Increased maternal age
Polyhydramnios
Emergency CSection
Placenta previa/accreta
Macrosomia

ESCALATE
A-E
-2 peripheral cannulae, 14G
-supine
-G&S
-warmed crystalloid infusion

Mechanical - palpate fundus and rub to stimulate contractions
-catheterise to prevent bladder distention, monitor UOP

Medical
-IV oxytocin - slow IV injection followed by IV infusion
-slow IV/IM ergometrine unless Hx HTN
-IM carboprost unless Hx asthma
-sublingual misoprostol

Surgical
1st line - intrauterine balloon tamponade
-if severe, uncontrolled hemorrage => hysterectomy

Question 5

Secondary PPH
-most common cause

Answer 5

Between 24hrs-6wks
Retained placental tissue
Endometritis