Puerperium

Question 1

Thromboprohylaxis for patient with previous VTE

Answer 1

Enoxaparin 40mg subcut in the evening for 6 weeks

Question 2

Thromboprophylaxis for normal vaginal delivery/ESCS with two or more major risk factors/one major + 2 or more minor risk factors/emergency c section

Answer 2

Enoxaparin 40mg subcut evening for 5 days AND until mobilizing

Question 3

VTE Major Risk factors

Answer 3

History of previous VTE
Immobility greater than 1 week 
PPH >1000mk with surgery 
Postpartum infection
BMI >30kg/m2 
Blood transfusion 
Thrombophilic disorder 
FGR and Pre-eclampsia 
Other medical conditions

Question 4

VTE minor RF

Answer 4

Multiple preg 
PPH >1000ml without surgery 
FGR 
Pre-eclampsia 
Age >35 
Varicose brings 
Smoking >10 cigs a day

Question 5

If using epidural or spinal catheter VTE prophylaxis

Answer 5

cannot give pharmaco prophylaxis from 12hrs before to 6hrs after insertion, removal or manipulation

Question 6

Management of endometritis

Answer 6

Commence parenteral/IV antibiotics
- gentamicin + metronidazole + amoxicillin
- can continue breastfeeding
Must admit for Iv therapy
Analgesia
Possible transfusion depending on FBE
If bleeding increases, does not settle or condition worsens
- u/s to check for retained products
- may need suction curettes after 24hrs of IV
- high risk of perf
Continue supportive care