Postpartum Problems Flashcards
what is the puerperium?
the postpartum period
from the end of the third stage of labour until six weeks post-partum
what happens to the uterus in the puerperium?
contracts immediately after delivery
not palpable after ten days
when does the internal cervical os close?
day 7-10 after delivery
when does menstruation occur after delivery?
usually at 6 weeks if not breastfeeding
first ovulation can be as early as 28 days after birth
what changes happen to the cardiovascular system in the puerperium?
cardiac output and plasma volume normal in a week
BP normal in six weeks
what changes happen to the urinary system in the puerperium?
dilatation of the ureters + calcyceal system reduces over three months
GFR decreases
who should be involved in the repair of a perineal tear?
1st and 2nd degree = midwives
3rd and 4th = obstetric input
what is a 3a perineal tear?
involves <50% of the external anal sphincter
what is a 3b perineal tear?
involves >50% of the external anal sphincter
what is a 3c perineal tear?
involves the internal anal sphincter
what is a 4th degree perineal tear?
involves the anal or rectal mucosa
what medications need to be given after the surgical repair of a perineal tear?
antibiotics - IV in theatre then 7 days oral
laxatives
what follow up needs to be done for a surgically repaired perineal tear?
physio follow up at 8-12 weeks to ensure anal sphincter has healed properly
postnatal follow up
what should be done for patients who are low risk for VTE in postpartum period?
hydration
mobilisation
what should be done for patients who are moderate risk for VTE in postpartum period?
10 days prophylaxis with LMWH
what should be done for patients who are high risk for VTE in the postpartum period?
6 weeks prophylaxis with LMWH
what are some risk factors for endometritis in the postpartum period?
prolonged labour PROM multiple VE's retained placental tissue CS
how is endometritis managed in the postpartum period?
broad spectrum IV antibiotics
co-amoxiclav, metronidazole +/- gentamicin
when does a secondary PPH occur?
24 hours to 6 weeks after delivery
what are two possible causes of secondary PPH?
endometritis
retained placental tissue
how is a secondary PPH managed?
antibiotics
consider oxytocics’
how is postpartum urinary retention managed?
catheterise
treat cause
TWOC after 48 hours
what is an obstetric fistula?
abnormal hole between the bladder + vagina
sometimes involves the rectum
what causes an obstetric fistula?
prolonged obstructed labour
tissue compressed by the baby’s head causing it to die
what is the management of an obstetric fistula?
surgical repair
how is mastitis managed?
continue breast feeding
oral/IV flucloxacillin
