Postpartum problems

Question 1

1. How do you define the Puerperium?
2. What is the difference between a 3rd and 4th degree Perineal tear?
3. How are 3rd and 4th degree tears managed?

Answer 1

1. From the end of the third stage of labour to 6 weeks post-partum.
2. 3rd degree- a and b involve external anal sphincter, c involves internal also,
   4th degree- involves anal or rectal sphincter.
3. Surgical management.

Question 2

1. Why is there a greater risk of Venous thromboembolism in pregnancy, labour and puerperium?
2. What are the recommendations for those at low risk of VTE and what about high risk?

Answer 2

1. Causes a hypercoagulable state
2. Low risk- hydration and mobilisation
   High risk- prophylactic LMWH.

Question 3

1. Identify some of the risk factors for pelvic infection in maternity.
2. How is a pelvic infection treated?

Answer 3

1. Prolonged labour, prolonged Rupture of membranes, retained placental tissue, Caesarean section.
2. IV antibiotics and IV fluids.

Question 4

1. What is a fistula?

2. How is a fistula caused?

Answer 4

1. An abnormal hole between the bladder and the vagina, and sometimes the rectum.
2. Prolonged obstructed labour.

Question 5

1. What is mastitis?
2. What is the most common cause?
3. How does it present?
4. How should it be treated?
5. If it progresses what complication may occur?

Answer 5

1. Infection of the breasts.
2. Staph Aureus
3. Fever and localised breast tenderness.
4. Oral/IV flucloxacillin
5. Breast abscess that requires surgical drainage.