Puerperal disorders

Question 1

What is lochia?

Answer 1

Blood stained uterine discharge following pregnancy

Three types:
Lochia Rubra - Red stained discharge in first few days of pregnancy that changes to pink
Lochia Serosa - Discharge becomes serous in 2nd week (yellowish)
Lochia Alba - Yellow-white discharge lasting for a month

Question 2

What is the management of postnatal hypertension?

Answer 2

50% of eclamptic fits occur postnatally
Those with severe pre-eclampsia should be cared for in HDU postnatally until their blood pressure is controlled
Those with mild/moderate pre-eclampsia should be managed in postnatal ward till their BP is <150/100
Usually take same antihypertensive they used during pregnancy for 2 weeks and should have BP checked every 2 days

Should be seen by specialist if unresolved after 6 weeks

Question 3

What are the causes of secondary postpartum haemorrhage?

Answer 3

Fresh bleeding 24 hours - 6 weeks after delivery

Retained products of conception
Endometritis
Bleeding disorders

Question 4

What are the features of retained products of conception?

Answer 4

Vaginal bleeding
Crampy abdominal pain
Large uterus
Open internal os
Prolonged 3rd stage of labour

Question 5

What are the features of endometritis?

Answer 5

Vaginal bleeding
Fever
Lower abdominal pain
Tender uterus
Closed internal os

Question 6

What is the management of endometritis?

Answer 6

If endometritis is suspected the patient should be referred to hospital for intravenous antibiotics (clindamycin and gentamicin until afebrile for greater than 24 hours)