Pre-Term Labour and Puerperium

Question 1

Define preterm labour

Answer 1

When there is persistent uterine activity and cervical dilation and/or effacement before 37 weeks.

Question 2

What are 5 things that can be given to a premature baby to increase survival chances?

Answer 2

1) Steroids
2) Surfactant
3) Abx
4) Ventilation
5) Nutrition

Question 3

What are the main risk factors for a premature baby?

Answer 3

1) Previous pre-term birth
2) Vaginal bleeding
3) Ethnic Group
4) Genital Injections
5) Multiple pregnancies

Question 4

What is the main route of intrauterine infection?

Answer 4

ASCENDING = Most common
1) Haematogenous: Via placenta
2) Retrograde Seeding via FT
3) Iatrogenic: Following invasive procedures

Question 5

What else can Pre-term be a complication of?

Answer 5

1) Poor endovascular remodelling
2) Amniocentesis

Question 6

Define prematurity

Answer 6

Babies born before 37 weeks of age

Question 7

Which organs does prematurity affect the most?

Answer 7

Lungs and Brain as they develop during 3rd trimester

Question 8

What is the puerperium?

Answer 8

The period from placental delivery to 6w after birth - the post-natal period.

Question 9

What are the main endocrine changes happen during puerperium?

Answer 9

1) Reduced placental hormones
2) ^ in prolactin for lactation

Question 10

What are the main physiological changes in the puerperium?

Answer 10

1) Involution of the uterus.
2) Decidua sheds as lochia.
3) Lactation.

Question 11

What happens during the involution of the uterus?

Answer 11

1) Muscle ischaemia, phagocytosis and autolysis
2) Involution/return to original

Question 12

What are the 3 stages of lochia shedding known as?

Answer 12

1) Lochia Rubra
2) Lochia serosa
3) Lochia alba

Question 13

What is the colostrum and what are its main components?

Answer 13

Colostrum: Breast milk produced at birth
- Vit A, NaCl, Protein rich, AB’s, Lactoferrin, GF’s

Question 14

Briefly outline the physiology of lactation

Answer 14

1) Baby suckles, impulse to brain, prolactin from APG and lactocytes produce milk
2) Baby keeps suckling, impulse to brain again, oxytocin from PPG and myoepithelial contraction –> Milk ejection

Question 15

What are the major risks in puerperium?

Answer 15

Sepsis, Severe Haemorrhage, PTE, prolapse, VTE, incontinence, depression

Question 16

What are the minor risks in puerperium?

Answer 16

Fatigue, infection, haemorrhage, anaemia, back pain, haemorrhoids

Question 17

Which staff members are part of a post-natal MDT?

Answer 17

1) Midwives
2) Doula
3) BFeed support workers
4) Nurses
Paeds and Obs can both be involved too

Question 18

What are the 3 main RF for sepsis in pregnancy?

Answer 18

1) Obesity
2) Anaemia
3) Diabetes
4) Amniocentesis/Invasive procedure

Question 19

What are the main causes of sepsis in pregnancy?

Answer 19

1) Endometriosis
2) Skin infection
3) Pyelonephritis
4) Chorioamnionitis
5) Pneumonia

Question 20

What is a PPH?

Answer 20

Estimated loss of >500mls blood after birth of baby

Question 21

What is a major PPH?

Answer 21

> 1500mls blood loss after birth and continued signs of bleed/shock

Question 22

When is the greatest risk of a VTE? And best treatments?

Answer 22

Immediately post birth in post partum
Treat: LMWH and TED stockings

Question 23

What are the main RF of VTE?

Answer 23

1) Increasing gestational age
2) Obesity
3) Smoking
4) C Section
5) Fam Hx
6) immobility
7) Multiple pregnancy
8) Previous VTE

Question 24

Describe the physiology behind a post dural puncture headache?

Answer 24

Accidental dural puncture -> CSF leakage and decreased pressure in fluid around the brain.

Question 25

Give 3 symptoms of a post dural puncture headache.

Answer 25

Headache is worse on sitting/standing.
Neck stiffness.
Photophobia.

Question 26

What are the treatments for a post dural headache?

Answer 26

Lying flat.
Analgesia.
IV fluids.

Question 27

What are the reasons for post-natal urine retention?

Answer 27

1) Prolonged 2nd stage of labour
2) Epidural been used
3) Forceps/ventouse based delivery

Question 28

Give 3 red flag signs that a mother may be developing mental health problems postnatally.

Answer 28

Recent change in mental state.
Thoughts/acts of self harm.
Estrangement from the infant.

Question 29

Give 3 symptoms of post-natal depression.

Answer 29

Depressed, Irritable, Tired, Anxious, negative behaviour, Appetite change

Question 30

What is maternal death defined as?

Answer 30

Death of a woman when pregnant/within 42 days termination, irrespective of site/duration and from any cause/management that isn’t accidental