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GOSH > Prescribing postnatal care and the puerperium psychiatry > Flashcards

Prescribing postnatal care and the puerperium psychiatry Flashcards

1
Q

What are 3 main possible problems in pregnancy, related to drugs?

A

Teratogenicity - organ formation completed at end of first trimester

Miscarriage/death

growth restriction

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2
Q

Which conditions are more common in pregnancy?

A

VTE - body preparing for blood loss in child birth

haemorrhage

Pain

Infection

Hypertension

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3
Q

What can we give a woman as VTE prophylaxis/treatment?

A

Unfractionated heparin (not commonly)

LMWH - tinzaparin

Alteplase may be used only if life threatening (unsure of effects)

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4
Q

What CANNOT be given for VTE/treatment? Why is this?

A

Warfarin

stillbirth
prematurity
haemorrhage
ocular defects.

Fetal warfarin syndrome: nasal hypoplasia
hypoplasia of the extremities developmental delay.

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5
Q

How do you manually compress uterus (to stop bleeding)?

A

2 fingers in vagina

Pressure on fundus to try and contract it down

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6
Q

What things can cause postpartum haemorrhage?

A

Infection
Prone to bleeding
Multip (>4 children)
Trauma: cervical trauma, tear etc.

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7
Q

Where should the uterus be palpable following delivery?

A

below umbilicus

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8
Q

When is misoprostol given in gynaecology?

A

To start a termination pregnancy or if someone is bleeding after miscarriage

Management of miscarriage 800mcg

causes cramping in uterus, helps it to expel anything that’s inside

Cervial softner

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9
Q

When is mifepristone given? What dose?

A

mid-trimester loss/TOP

given to prime cervix before any other treatment

200mg

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10
Q

When is methotrexate given?

A

given in ectopic pregnancy

usually given as one off dose, or given as a second dose

EXTREMELY TOXIC TO PREGNANCY

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11
Q

When is tranexamic acid given?

A

menorrhagia

post-partum haemorrhage

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12
Q

What type of drug is tranexamic acid?

A

anti-fibrinolytic

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13
Q

When is mefenamic acid given? What type of drug is it?

A

period pain

NSAID

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14
Q

What type of drug is prostap/gonapeptyle? What does it do? When is it given?

A

GnRH analogues

Induces a massive drop off of oestrogen (chemical hysterectomy)

Given in endometriosis - treat (or one dose can be used of diagnosis)

Can also be used to shrink fibroids

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15
Q

When are progesterones given? (POP, injection, mirena)

A

All used to suppress ovulation

Can be used as a form of contraception

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16
Q

What pain relief can be used in pregnancy?

A

paracetamol

opiates (can cause neonatal resp. depression, but generally safe codeine/diamorphine)

entonox

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17
Q

Why must you avoid NSAIDS in pregnancy?

A

miscarriage and malformation in 1st trimester

premature closure of the DA in 3rd trimester

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18
Q

What can happen if a woman take opioids regularly for a long period of time?

A

Baby may need further care after birth

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19
Q

Why don’t you give trimethoprim in first trimester?

A

anti-folate

increases risk of neural tube defects
teratogenic

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20
Q

Why don’t you use nitrofurantoin in the third trimester?

A

neonatal haemolysis

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21
Q

What ABX would you give to a pregnant woman with a UTI?

A

penicillins and cephalosporins

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22
Q

What ABX should you avoid in pregnancy? why?

A

co-amoxiclav - necrotising enterocolitis

tetracyclines - brown teeth

trimethoprim in 1st trimester - teratogenic and anti-folate

nitrofurantoin in 3rd trimester - neonatal haemolysis

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23
Q

What investigation should you do for a woman who has lost >500mls of blood?

A

FBC day after delivery?

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24
Q

What is endometritis?

A

infection within uterus

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25
Q

After how many days does endometritis occur?

A

2-10 days

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26
Q

Does C-section make endometritis more or less common?

A

more

27
Q

How might endometritis present?

A

Offensive vaginal loss

Symptoms:
Fever, malaise, rigors,
tachycardia
Headache
Abdo pain/suprapubic tenderness/uterine enlargement
Offensive lochia
Secondary PPH
28
Q

What investigations would you do for a women in whom you suspected endometritis?

A

FBC
CRP
HVS
Blood cultures

NOT USS in first instance

29
Q

in which leg will most DVTs occur?

A

L

30
Q

which investigation for DVT/PE has a higher risk for the mum? which one for the baby?

A

CTPA - mum

V/Q can - baby

31
Q

How long do you generally have to wait before starting/re-starting progesterone pill after childbirth?

A

6 weeks afterwards

32
Q

What is the main cause of post-natal/post-partum haemorrhage? What are other causes?

A

Uterine atony

Four Ts: tone
trauma
tissue/infection
thrombin

33
Q

How can uterine atony be treated medically?

A

Uterotonics:

Syntoncinon = synthetic oxytocin (bolus 5 units IV, followed by infusion)

Syntometrine (3rd stage management): combo of oxytocin 5 units and ergometrine 500mcg
(IM bolus)

Misoprostol - prostaglandin 800mcg PR
Haemabate 250mcg IM

34
Q

What ABX are safe to give a pregnant woman with RTI?

A

Penicillins

Marcolides

35
Q

What ABX are safe to give a pregnant woman with PPROM?

A

Erythromycin 250mg QDS PO 10/7 to prevent chorioamnionitis

36
Q

What ABX would you give a woman with chorionamionitis?

A 
Cefuroxime
1.5g TDS IV 
AND
Metronidazole 
500mg TDS IV
37
Q

What ABX would you prescribe a woman with endometritis?

A

Co-amoxiclav 1.3g iv tds

Clindamycin + Metronidazole if penicillin allergic

38
Q

What antihypertensives would you prescribe a pregnant woman?

A

Labetalol - beta blocker (contraindicated in asthma).

Nifedipine - calcium channel blocker (good in black/africa/carribean patients)

39
Q

Why should you NOT use ACEi or ARBs in pregnancy?

A

fetal renal damage in 2nd and 3rd trimester

possible malformation in 1st trimester

40
Q

What anticonvulsant is first line in eclampsia?

A

MgSO4 iv

41
Q

What are first line anti-epileptics for pregnant women?

A

Lamotrogine

Levieracetam

42
Q

Why shouldn’t valproate be used in pregnancy for epilepsy?

A

Associated with neural tube and development defects

43
Q

What dose of folic acid should be given to pregnant women with epilepsy (or those trying to conceive)? Why?

A

5mg folic acid

Neural tube defect reduction

44
Q

What is puerperium?

A

6 week period following birth

changes that occurred during pregnancy and childbirth revert to non-pregnant state

45
Q

What are some maternal physiological changes that occur during puerperium?

A

Involution (funds below umbilicus immediately - no longer palpable 2/52)

Lochia - blood + necrotic decidua

Lactation - due to raised prolactin and oxytocin levels

46
Q

If a woman has a Hb of 80-100g/l after childbirth, how would you treat this?

A

oral iron

47
Q

If a woman has a Hb of <80g/l and is symptomatic after childbirth, how would you treat this?

A

blood transfusion

48
Q

If a woman has a Hb that is not low enough to warrant transfusion, but is symptomatic, how would you treat this?

A

IV iron

49
Q

When does endometritis generally present after birth?

A

day 2-10

50
Q

When is endometritis more common?

A

After section

51
Q

How does endometritis present?

A

Offensive vaginal loss

Fever, malaise, rigors, headache

Tachycardia

abdo pain, suprapubic tenderness/uterine enlargement

offensive lochia

secondary PPH

52
Q

How would you investigate for endometritis?

A

FBC
CRP
HVS
Blood cultures

NOT USS IN FIRST INSTANCE

53
Q

What is the most common cause of endometritis?

A

Group A strep

54
Q

What are other causes of endometritis?

A

Staph
Enterococcus

E coli

anaerobes: cocci

55
Q

How would you treat puerperium endometritis?

A

Co-amoxiclav

Cefuroxime + metronidazole

56
Q

What are common sites of infection after birth?

A 
Uterus, vagina etc.
Perineum
UTI
Chest
Throat
Breast
57
Q

What are common puerperium breast problems?

A

Breast engorgement

Mastitis (not always infective, can be due to blocked ducts)

Sore/cracked nipples

58
Q

How might thromboembolism present?

A

unilateral calf pain

redness or swelling

SOB or chest pain

59
Q

How would you investigate a woman in the puerperium for thromboembolism?

A

Obs
ECG
Leg dopplers
VQ scan/CTPA

60
Q

How would you manage a woman with thromboembolism during puerperium?

A

LMWH

Warfarin

61
Q

What are the different types of post-natal depression?

A

Baby blues

Postnatal depression (PND)

Puerperal psychosis

62
Q

What are some PND symptoms?

A 
MOOD CHANGES:
FEELING LOW
 MISERABLE
TEARFUL
IRRITABLE WITH OTHERS

SLEEP DISTURBANCE
NO ENERGY

POOR APPETITE

ANXIETY
PANIC ATTACKS

FEELING WORTHLESS
UNABLE TO COPE

SUICIDAL THOUGHTS
HARMFUL THOUGHTS possibly to baby

63
Q

What post-natal care is given to women?

A

Maternal observations

Pain relief

Observe lochia and involution

Observe wounds - perineal and LSCS

Ensure passing urine, eating, drinking, stool, flatus

VTE assessment, VTE prevention advice

HB check

Rubella vaccination

Anti-D

Early neonatal feeding/neonatal care

GOSH (33 decks)

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