puerpartum Flashcards
what is postpartum haemorrhage
blood loss ≥ 500ml after birth of the baby
what is primary PPH
occurs within the first 24 hours following delivery
what is the most common cause of primary PPH
uterine atony
what is secondary PPH
occurs from 24hrs to 6 weeks postpartum
what are the 2 main causes of secondary PPH
infection or retained products of conception
what is given during ABCDE for PPH
tranexamic acid and IV crystalloid fluid bolus
name some complications of postpartum haemorrhage
death, DIC, renal failure, sheehans syndrome
what is DIC
widespread activation of the coagulation cascade leading to the formation of small blood clots throughout the body
what is the consequence of DIC
organ dysfunction due to clots and increased bleeding due to depleted clotting factors
what is sheehans syndrome
pituitary gland damage by ischaemia from severe blood loss and shock after birth
what are the 4 main types of causes of PPH
tone - uterus fails to contract following delivery
tissue - retention of placental tissue preventing uterus from contracting
trauma - damage during delivery e.g. tears
thrombin - coagulopathies and vascular abnormalities which increase the risk of PPH
name some vascular abnormalities which increase the risk of PPH
placental abruption, hypertension, pre-eclampsia
name some coagulopathies which increase the risk of PPH
VWD, haemophilia, HELLP, DIC
management of uterine atony
bimanual compression to stimulate contraction
oxytocin, ergometrine, carboprost
which patients should NOT be given oxytocin or ergometrine
patients with hypertension
what is endometritis
infection/inflammation of the uterine lining following delivery or miscarriage
name some risk factors for endometritis
operative delivery, prolonged labour, retained products of conception
clinical presentation of endometritis
abdo pain, abnormal bleeding and smelly discharge
management of endometritis
co-amoxiclav +/- surgical evacuation if RPOC
management of endometritis in penicillin allergic patients
co-trimoxazole + metronidazole
what is mastitis
inflammation and swelling of the breast tissue
clinical presentation of mastitis
unilateral painful and inflamed breast in breast feeding mothers
management of mastitis
ensure complete breast emprying by feeding and expressing, NSAIDs, warm compresses
flucloxacillin if not improving (clindamycin if allergic)
investigation for epidural abscess
MRI
management of epidural abscess
IV antibiotics +/- surgical decompression
clinical presentation of epidural abscess
back pain and fever
name some risk factors for perineal tears
first time, forceps delivery, large babies
how are perineal tears categorised
severity 1-4
what is a first degree perineal tear
limited to the superficial perineal skin or vaginal mucosa only
what is a second degree perineal tear
extends to perineal muscles and fascia, but anal sphincter is intact
what is a third degree perineal tear
tear involving anal sphincters, but anal mucosa intact
what is a fourth degree perineal tear
perineal skin, muscle, anal sphincter and anal mucosa are torn
which perineal tears require surgical repair under general anaesthetic
3rd and 4th degree
name some consequences of 3rd and 4th degree tears
faecal incontinence, urinary incontinence, dyspareunia
name some red flags for referral to a specialist perinatal mental health team
recent change in mental state or new symptoms
new thoughts or acts of violent self harm
new or persistent expressions of incompetency or estrangement from their baby
when is mental health screened for during pregnancy
booking appointment
what is tokophobia
pathologically extreme fear of childbirth/pregnancy
what are the 2 types of tokophobia
primary: someone who has never given birth
secondary: following a previous traumatic birth
what are the baby blues
transient mood disorder manifesting at around day 3
management of the baby blues
resolves in 2 weeks without medical intervention
clinical presentation of the baby blues
tearfulness, anxiety or irritability, feelings of being overwhelmed, insomnia, fatigue, appetite changes
when does postnatal psychosis usually develop
within the first 2 weeks following childbirth
name some risk factors for postnatal psychosis
bipolar disorder, previous history, family history
what delusion is commonly associated with postnatal psychosis
capgras delusions - someone has been replaced by an imposter who looks physically the same
clinical presentation of postpartum psychosis
paranoia, delusions, hallucinations, confusion
management of postpartum psychosis
urgent admission to a mother and baby unit
what is postpartum depression
depression that develops any time up to one year after the birth of a baby
name some risk factors associated with postpartum depression
history of mental health, low socioeconomic status, lack of social support
clinical presentation of postnatal depression
persistent low mood and energy levels, poor appetite, sleep disturbance, concerns related to bonding with the baby
screening tool used for postnatal depression
edinburgh postnatal depression scale
conservative management of postpartum depression
CBT or interpersonal therapy
medical management of postpartum depression
antidepressants
first line antidepressant in the perinatal period
sertraline
what antipsychotics are usually the safest in pregnancy
olanzapine and quetiapine
which antipsychotic should be avoided in the perinatal period and why
clozapine - risk of agranulocytosis to the infant
which 2 mood stabilisers must be avoided in the perinatal period and why
lithium - secreted in breast milk
valproate - neonatal development problems
