Problems after delivery

Question 1

common post delivery problems

Answer 1

retained placenta, PPH, uterine inversion, 3/4th degree tear, amniotic fluid embolisation

Question 2

retained placenta - ? / c /t

Answer 2

normally 3rd stage complete 35, placenta weight low, parity >5

T - avoid excessive cord traction (cord might snap/invert uterus)

• check placenta isnt in vagina
• syntometrine to stim contraction + empty bladder
• if unsuccessful remove manually + abx’s + oxytocin

Question 3

amniotic fluid embolisation - PC / T

Answer 3

PC - sudden SOB + hypotension +/- seizures +/- DIC –> can all lead to pulm oedema/ARDS

T - Resus + ABC
if mother dies deliver baby abdominally

Question 4

3/4th degree tear - CF / T

Answer 4

CF - damage involves anal sphincter (3rd degree) and anal mucosa (4th degree)

T - prophyllactic abx’s + suture
prevent with episiotomy

Question 5

still birth - c

Answer 5

pre-eclampsia, renal disease, infection, chromosomal abnorm

Question 6

maternal mortality - c

Answer 6

SPECIFIC
genital tract sepsis, eclampsia, thromboembolism, ectopic // GENERAL
PE, sepsis, anaesthetic

Question 7

miscarriage - ? / % / RF / C / I / T

Answer 7

loss of preg 35 / prev miscarriage / smoking / drugs / obesity
c - genetic (downs) infection (CMV/rubella), anti-phospholipid syn, SLE

I - Beta HcG (remain +ve for several days afterwards) + Trans Vag US

T - treat mother if shocked etc

Question 8

recurrent miscariage causes

Answer 8

genitic / anti-phospolipid syn / hypothyroid/ idiopathic / structural abnormality

Question 9

multiple births - how common / RF / CF / complication / T

Answer 9

1 in 75
RF - prev twins, FH twins, maternal age >35, IVF

CF - hyperemesis, polyhydramnios, 2 poles felt o/e + 2 heartbeats

complication - polyhydramnios, pre-eclampsia, aph (placenta praevia) anaemia, PPH, malpresentation

fetal complication = light for date, higher risk of congen abnorm, cerebral palsy

T - gestation for twins = 37 weeks // triplets = 33 weeks
GIVE additional folate+iron for both

Question 10

TOP - facts / method / complication

Answer 10

1967 act allows TOP

Question 11

ectopic pregnancy - ? / most common sites / RF / PC / I / T

Answer 11

? - fertilised ovum implants outside uterine cavity
most common site - tubal (99%) ovary, cervix, peritoneal

RF - anything which slows ovum passage (damaged tubes, prev ectpic, endometriosis, old IUD)

PC - sexually active with abdo pain/bleeding/fainting/D+V
also a history of ammenorhea is common
–> be aware of ruptured ectopic causing shock

I - Pelvic US (shows empty uterus)
serum HcG (will be =ve for several days after)
Diagnostic laparoscopy

T - Methotrexate, antiD if required, laparotomy/laparoscopy, salpingoscopy/salpingectomy