Postpartum problems

Question 1

postpartum haemorrhage (PPH) definition

Answer 1

blood loss >500ml after birth of baby

Question 2

what is normal blood loss after birth of baby

Answer 2

<500ml

Question 3

minor postpartum haemorrhage ml

Answer 3

500-1000ml

Question 4

major postpartum haemorrhage ml

Answer 4

> 1000ml or shock

Question 5

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

Answer 5

4Ts

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

Question 6

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

Answer 6

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

Question 7

risk factors

Answer 7

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

Question 8

prevention of PPH if risk factors identified

Answer 8

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

Question 9

management of PPH

Answer 9

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

Question 10

how do you stop the bleed in PPH (3)

Answer 10

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

Question 11

what timeframe can a secondary PPH occur in

Answer 11

24h-6w after birth

Question 12

what causes PPH >24h-6w

Answer 12

infection

Question 13

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

Answer 13

antibiotics

Question 14

complication of PPH

what is it

what does it cause

Answer 14

sheehan syndrome

hypopituitarism cause by hypovolaemic shock

= causes infertility

Question 15

what is placenta accreta

what does it increase your risk of

Answer 15

abnormal attachment of placenta to uterus

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

Question 16

treatment of placenta accreta

Answer 16

hysterectomy

Question 17

what vessel condition has increased risk during pregnancy and puerperium

Answer 17

deep venous thrombosis (DVT)

Question 18

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

Answer 18

venous stasis is increased bc of uterine pressure

oestrogen = increases clotting factors to prevent bleeding at birth

Question 19

which leg is DVTs more common in

Answer 19

left

Question 20

presentation of DVT

Answer 20

oedema/swelling
red hot leg
pain/tenderness

Question 21

investigation for DVT

why not d dimers

Answer 21

compression duplex US

not d dimers bc high anyway in pregnancy

Question 22

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

Answer 22

LMWH 20-80mg/day

increased mobility

Question 23

treatment of DVT

Answer 23

LMWH

Question 24

complication of untreated DVT

Answer 24

pulmonary embolism

Question 25

how does pulmonary embolism present

Answer 25

``` SOB chest pain faint/collapse raised JVP prev DVT ```

Question 26

investigations of PE

Answer 26

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

Question 27

why wouldn't someone want a CTPA for ?PE

Answer 27

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

Question 28

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

Answer 28

small radiation exposure to foetus (low to breast)

Question 29

difference between baby blues and post natal depression

Answer 29

baby blues - last 3-10 days after birth | post natal depression - lasts 2-6 weeks after birth

Question 30

how common are baby blues

Answer 30

50% of people get them = normal response to childbirth

Question 31

how common is post natal depression

Answer 31

10% of people get it

Question 32

management of baby blues

Answer 32

reassurance

Question 33

management of post natal depression

Answer 33

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

Question 34

presentation of baby blues/post natal depression

Answer 34

``` tearfulness anxiety irritable poor sleep (can easily dismiss this bc of baby) confusion ```

Question 35

complications of post natal depression for child

Answer 35

decreased bonding | adverse childhood outcomes eg ASD, ADHD

Question 36

complications of post natal depression for mum

Answer 36

depression

Question 37

how does puerperal psychosis present (4)

Answer 37

sleep disturbance confusion irrational ideas mania - delusions, hallucinations

Question 38

risk factors for puerperal psychosis (4)

Answer 38

unmarried bipolar PMH PMH puerperal psychosis perinatal death

Question 39

management of puerperal psychosis

Answer 39

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

Question 40

complications of puerperal psychosis (3)

Answer 40

suicide bipolar puerperal psychosis in future children

Question 41

how long is the puerperium period

Answer 41

<6weeks after birth of baby

Question 42

is discharge normal in puerperium | for how long

Answer 42

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