Postpartum Problems

Question 1

what is the puerperium?

Answer 1

the postpartum period

from the end of the third stage of labour until six weeks post-partum

Question 2

what happens to the uterus in the puerperium?

Answer 2

contracts immediately after delivery

not palpable after ten days

Question 3

when does the internal cervical os close?

Answer 3

day 7-10 after delivery

Question 4

when does menstruation occur after delivery?

Answer 4

usually at 6 weeks if not breastfeeding

first ovulation can be as early as 28 days after birth

Question 5

what changes happen to the cardiovascular system in the puerperium?

Answer 5

cardiac output and plasma volume normal in a week

BP normal in six weeks

Question 6

what changes happen to the urinary system in the puerperium?

Answer 6

dilatation of the ureters + calcyceal system reduces over three months

GFR decreases

Question 7

who should be involved in the repair of a perineal tear?

Answer 7

1st and 2nd degree = midwives

3rd and 4th = obstetric input

Question 8

what is a 3a perineal tear?

Answer 8

involves <50% of the external anal sphincter

Question 9

what is a 3b perineal tear?

Answer 9

involves >50% of the external anal sphincter

Question 10

what is a 3c perineal tear?

Answer 10

involves the internal anal sphincter

Question 11

what is a 4th degree perineal tear?

Answer 11

involves the anal or rectal mucosa

Question 12

what medications need to be given after the surgical repair of a perineal tear?

Answer 12

antibiotics - IV in theatre then 7 days oral

laxatives

Question 13

what follow up needs to be done for a surgically repaired perineal tear?

Answer 13

physio follow up at 8-12 weeks to ensure anal sphincter has healed properly

postnatal follow up

Question 14

what should be done for patients who are low risk for VTE in postpartum period?

Answer 14

hydration

mobilisation

Question 15

what should be done for patients who are moderate risk for VTE in postpartum period?

Answer 15

10 days prophylaxis with LMWH

Question 16

what should be done for patients who are high risk for VTE in the postpartum period?

Answer 16

6 weeks prophylaxis with LMWH

Question 17

what are some risk factors for endometritis in the postpartum period?

Answer 17

prolonged labour
PROM
multiple VE's
retained placental tissue 
CS

Question 18

how is endometritis managed in the postpartum period?

Answer 18

broad spectrum IV antibiotics

co-amoxiclav, metronidazole +/- gentamicin

Question 19

when does a secondary PPH occur?

Answer 19

24 hours to 6 weeks after delivery

Question 20

what are two possible causes of secondary PPH?

Answer 20

endometritis

retained placental tissue

Question 21

how is a secondary PPH managed?

Answer 21

antibiotics

consider oxytocics’

Question 22

how is postpartum urinary retention managed?

Answer 22

catheterise
treat cause
TWOC after 48 hours

Question 23

what is an obstetric fistula?

Answer 23

abnormal hole between the bladder + vagina

sometimes involves the rectum

Question 24

what causes an obstetric fistula?

Answer 24

prolonged obstructed labour

tissue compressed by the baby’s head causing it to die

Question 25

what is the management of an obstetric fistula?

Answer 25

surgical repair

Question 26

how is mastitis managed?

Answer 26

continue breast feeding

oral/IV flucloxacillin