Postpartum Problemos Flashcards
Normal postpartum blood loss
Under 500mL.
Definitions of types of postpartum haemorrhage
Primary: minor = loss of 500-1000ml in 24hrs following delivery, major: loss of over 1000ml in 24hrs following delivery.
If c-section always over 1000ml.
Secondary = excessive blood loss from 24hrs post-delivery to 12 weeks postpartum.
Causes of postpartum haemorrhage primary and secondary.
Tone - uterine atony, general anaesthesia, multiple pregnancy, macrosomia, prolonged labour.
Tissue - retained placenta, placenta accreta.
Trauma - episiotomy, perineal tear.
Thrombin - pre-eclampsia.
Secondary = endometritis, gestational trophoblastic disease, retained placenta tissue.
Risk factors for PPH
Macrosomia, multiple pregnancy, prolonged labour, maternal pyrexia, operative delivery, shoulder dystocia, previous PPH.
Management of a primary PPH
IV access - FBC, blood grouping, coagulation screen.
Warmed crystalloid infusion/fluids, blood transfusion?
IV oxytocin infusion.
Management fo secondary PPH
Tranexamic acid.
Admit and consider blood transfusion.1
3 postpartum mental health problems
baby blues
Postnatal depression
Puerperal psychosis.
Screening for postnatal depression
Edinburgh scale. Includes question on self harm.
Baby blues
COMMON. Reassurance, health visitor support.
Postnatal depression
Peaks 3months post delivery. Rx with CBT, SSRI e.g. sertraline.
Puerperal psychosis
Onset usually within 2-3 weeks of delivery. Mood swings plus disordered perception.
Admit to hospital.
Amniotic fluid embolism pathophysiology
Amniotic fluid cells enter maternal circulation - massive immune response. Pulmonary embolism phase where there is a direct blockage and haemorrhage phase where complement pathway is activated.
Clinical features of amniotic fluid embolism
Similar to PE. Breathlessness, palpitations, dizzy, seizure, cough, loss of consciousness. Tachycardia, tachypnoea, hypotension, cyanosis, hypoxia, MI.
Management of amniotic fluid embolism
ABCDE
100% oxygen, fluid maintenance, correct coagulopathy, deliver baby via c-sec if not already out.
High mortality.
Vitamin K
1mg IM, avoid vitamin K associated bleeding disorders
Newborn physical examination timings and contents
within first 72hrs and then between weeks 6-8 of age. Include checking heart (rate, sounds, rhythm), head circumference, genitalia, spine, skin, cataracts, hips etc.
When is the newborn blood spot
5-8 days old
When is the newborn hearing test
By week 4 in hospital or week 5 in community.
Classification of perineal tears
1st degree - injury to perineal skin or vaginal mucosa only.
2nd degree - injury to perineal and perineal muscles but not anal sphincter.
Third degree - injury to perineum including anal sphincter.
Fourth degree - injury to perineum incline anal sphincter and anorectal mucosa.
Risk factors for perineal tears
Nulliparity Macrosomia Shoulder dystocia Occiputo-posterior position Prolonged labour stages Instrumental delivery
Perineal protection
Use hands to protect perineum and slow down delivery of head.
Management of a perineal tear
Rectal examination.
Adequate analgesia for mother.
Suture ASAP.
Breast feeding recommendations
for first 6months of baby’s life. Not for HIV positive women.
Sheehan’s syndrome
Postpartum hypopituitarism. Ischaemic necrosis due to blood loss and hypovolaemic shock after birth. Can lead to hypothyroidism, amenorrhea, galactorrhea.
When is the puerperium
Delivery to 6weeks after birth
Contraindicated post-partum contraception
COCP if breastfeeding.
Lochia
Vaginal bleeding after childbirth. Initially red then turns browny. Not pathological. 6 week duration
3 types rubra, serosa and alba
Endocrine changes in puerperium
Decrease in hCG, oestrogen and progesterone.
Hormones in lactation
Prolactin - milk production
Oxytocin - milk ejaculation
Milk at birth
Colostrum - rich in proteins, Vit A, NaCl, lactoferrin and antibodies.
Sepsis definition
Infection plus systemic manifestations of infection
Severe sepsis definition
Sepsis plus sepsis induced organ dysfunction and tissue hypo-perfusion.
Septic shock definition
Persistence of hypo-perfusion despite adequate fluid replacement therapy.
Risk factors for puerperium sepsis
Obese DM Anaemia Invasive obstetric procedure e.g amniocenteses. Prolonged ROM C-section
Signs of sepsis
3Ts (white with sugar) Low or high temp tachycardia tachypnoea Hyperglycaemia
Sepsis 6
Blood cultures Urine output Fluid resus Antibiotics Lactate Oxygen
Where is oxytocin produced
Produced in hypothalamus SECRETED from posterior pituitary gland
Where is prolactin produced
Anterior pituitary gland.
Findings on examination of uterine atony
Un-palpable uterus
Most common cause of primary PPH and its management
Uterine atony.
Empty bladder
Rub abdomen and bimanual compression of uterus.
IV Syntocinon (ergometrine + oxytocin)
IM Carboprost.
Surgical = B-lynch sutures, internal iliac artery ligation.
Most common cause of secondary PPH
Retained placental tissue
