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J Repro > Postpartum problems > Flashcards

Postpartum problems Flashcards

1
Q

postpartum haemorrhage (PPH) definition

A

blood loss >500ml after birth of baby

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2
Q

what is normal blood loss after birth of baby

A

<500ml

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3
Q

minor postpartum haemorrhage ml

A

500-1000ml

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4
Q

major postpartum haemorrhage ml

A

> 1000ml or shock

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5
Q

what are the 4 causes of postpartum haemorrhage <24h from birth

A

4Ts

tone - decreased uterus tone
trauma - to birth canal
tissue - retention of tissue eg placenta accreta
thrombin - clotting disorder

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6
Q

what is the most common case of postpartum haemorrhage <24h after birth (which of the 4Ts)

A

tone - decreased uterus tone = placenta doesn’t come out properly = bleeds
70%

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7
Q

risk factors

A

placenta praevia
prev PPH
prolonged labour
placenta accreta (retained placenta)

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8
Q

prevention of PPH if risk factors identified

A

synthetic oxytocin (syntocinon) in 3rd stage of labour = shortens time between delivery of baby and delivery of placenta = less bleeding risk

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9
Q

management of PPH

A

stop bleed (see other card for how)
determine cause (4Ts)
fluids - IV warmed crystalloid Hartmans
blood

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10
Q

how do you stop the bleed in PPH (3)

A

uterine massage
IV syntocinon (synthetic oxytocin) = induces contractions = expels clots
surgery eg balloon

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11
Q

what timeframe can a secondary PPH occur in

A

24h-6w after birth

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12
Q

what causes PPH >24h-6w

A

infection

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13
Q

management of PPH >24h-6w (think of cause)

A

antibiotics

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14
Q

complication of PPH

what is it

what does it cause

A

sheehan syndrome

hypopituitarism cause by hypovolaemic shock

= causes infertility

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15
Q

what is placenta accreta

what does it increase your risk of

A

abnormal attachment of placenta to uterus

can cause PPH if it doesn’t detach problem in 3rd stage of labour

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16
Q

treatment of placenta accreta

A

hysterectomy

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17
Q

what vessel condition has increased risk during pregnancy and puerperium

A

deep venous thrombosis (DVT)

18
Q

which part of virchows triad is altered in pregnancy to increase risk of DVT (2)

A

venous stasis is increased bc of uterine pressure

oestrogen = increases clotting factors to prevent bleeding at birth

19
Q

which leg is DVTs more common in

A

left

20
Q

presentation of DVT

A

oedema/swelling
red hot leg
pain/tenderness

21
Q

investigation for DVT

why not d dimers

A

compression duplex US

not d dimers bc high anyway in pregnancy

22
Q

prophylaxis for DVT (given at delivery) (1 drug, 1 lifestyle modification)

A

LMWH 20-80mg/day

increased mobility

23
Q

treatment of DVT

A

LMWH

24
Q

complication of untreated DVT

A

pulmonary embolism

25
Q

how does pulmonary embolism present

A 
SOB 
chest pain 
faint/collapse 
raised JVP
prev DVT
26
Q

investigations of PE

A

CXR/CTPA/V/Q scan (patient choice)

27
Q

why wouldn’t someone want a CTPA for ?PE

A

no exposure to foetus, but high radiation to breast = increased risk of breast cancer

eg Fx of breast cancer

28
Q

why wouldn’t someone want a V/Q scan for ?PE

A

small radiation exposure to foetus (low to breast)

29
Q

difference between baby blues and post natal depression

A

baby blues - last 3-10 days after birth

post natal depression - lasts 2-6 weeks after birth

30
Q

how common are baby blues

A

50% of people get them = normal response to childbirth

31
Q

how common is post natal depression

A

10% of people get it

32
Q

management of baby blues

A

reassurance

33
Q

management of post natal depression

A

mild - counselling
moderate - CBT and antidepressants
severe - admission to mother and baby unit

34
Q

presentation of baby blues/post natal depression

A 
tearfulness 
anxiety 
irritable 
poor sleep (can easily dismiss this bc of baby) 
confusion
35
Q

complications of post natal depression for child

A

decreased bonding

adverse childhood outcomes eg ASD, ADHD

36
Q

complications of post natal depression for mum

A

depression

37
Q

how does puerperal psychosis present (4)

A

sleep disturbance
confusion
irrational ideas
mania - delusions, hallucinations

38
Q

risk factors for puerperal psychosis (4)

A

unmarried
bipolar PMH
PMH puerperal psychosis
perinatal death

39
Q

management of puerperal psychosis

A

emergency admission to mother baby unit
antidepressants, mood stabilisers etc
ECT

40
Q

complications of puerperal psychosis (3)

A

suicide
bipolar
puerperal psychosis in future children

41
Q

how long is the puerperium period

A

<6weeks after birth of baby

42
Q

is discharge normal in puerperium

for how long

A

yes - red, then brown, then yellow for a few weeks

J Repro (28 decks)

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