Postpartum Problems Flashcards
What is classed as postpartum?
End of 3rd stage of labour until 6 weeks after
Describe the physiological postpartum changes of the uterus
Contracts immediately after delivery. The top of the uterus sits at the umbilicus but by 10 days post natal it reduces to below the pubic symphysis and is no longer palpable
By what day is the cervical os shut?
10 days
When will menstruation return?
6 weeks if not breast feeding but can occur as early as 28 days
How long does the cardiovascular system take to return to normal?
CO and PV reduce to normal by the end of the first week
Oedema and BP will be normal within 6 weeks
Name four types of tear that can occur in childbirth
Vaginal wall
Labial
Perineal
Describe the difference between the degrees of tears
1st - superficial tissues
2nd - superficial tissue and deep perineal muscles
3a - involves <50% external anal sphincter
3b - >50% external anal sphincter
3c - involves internal anal sphincter
4 - anal or rectal mucosa
How are first and second degree tears managed?
Sutured by midwife or if very small may heal naturally
What is the purpose of an episiotomy?
Speed up delivery or prevent anal sphincter tear - right medio-lateral direction (2nd degree)
How are 3rd and 4th degree tears managed?
Repair in theatre with regional anaesthesia, antibiotics, laxative, physio and follow up
How long are antibiotics given for a tear repair?
IV then 7 days oral
What is the purpose of prescribing laxatives in tear repair?
Prevent disruption of repair
How are the different risks for venous thromboembolism managed?
Low - hydration and mobilisation
Moderate - 10 days prophylactic LMWH
High - 6 weeks prophylactic LMWH
What are the risk factors for postpartum infection?
Prolonged labour, prolonged ROM, multiple vaginal examinations, retained placenta and c-section
Which organisms commonly cause postpartum infection?
GBS, staph aureus, staph epidermidis, E.coli, anaerobes
Describe the progression of infection
Chorionamnitis - endometritis - salpingitis - pelvic infection - abscess - peritonitis
What investigations are done in a postpartum woman?
Blood tests - FBC, CRP, UandE, coagulation, culture and high vaginal swabs
Ultrasound - retained placenta
CT - pelvic abscess
How is postpartum infection treated?
IV antibiotics - co-amoxyclav, metronidazole, gentamicin
IV Fluids
What other infections can postpartum women still experience?
Chest infection, mastitis, UTI, endometritis, wound infection, DVT, IV site, perineal infection (tear)
What are the two common causes of secondary post partum haemorrhage?
Endometritis - hyperaemia
Retained placenta
How is secondary postpartum haemorrhage treated?
Bloods, clotting screen, HVS, ultrasound for retained placenta tissue and broad spec antibiotics
What can cause urinary retention?
Pain Vaginal trama Vulval haematoma Epidural Catheter removal
How is urinary retention managed?
Catheterise for 48 hours - TWOC afterwards
Avoid bladder overdistention (>1litre)
Describe the main cause of urinary incontinence in the developing world
Vesicle-vaginal fistula - abnormal hole between bladder and vagina - prolonged obstructed labour tissue is compressed between the baby’s head and the pelvic bones
Avascular necrosis - fistula formation
In the developed world how can urinary incontinence occur
Overflow incontinence with retention after removal of catheter usually short lived
Name four changes woman can experience due to lactation
- cracked/sore nipples
- breast engorgement
- mastitis
- breast abscess
What organism commonly causes mastitis?
Staph aureus
How does mastitis present?
Fever and breast tenderness
How is mastitis managed?
Continue breast feeding
Oral/IV flucloxacillin
If a sore progresses to an abscess how is it managed?
Surgical drainage
Which forms of contraception cannot be started immediately post partum?
COCP - delay 6 weeks
LARC - 6 weeks or at time of C section
How long after c-section should women wait to have another baby?
1 year
Which form of contraception can be started straight away?
POP
