Puerperium Flashcards
Obstetric palsy is AKA
traumatic neuritis
What is obstetric palsy?
One or both limbs may develop signs of a motor and/or sensory neuropathy following delivery
Cause of obstetric palsy?
Compression of lumbosacral trunk as it crosses the sacroiliac joint during descent of fetal head
Presentation of obstetric palsy
Sciatic pain
Foot drop
Paresthesia
Hypoesthesia
Muscle wasting
Tx of obstetric palsy
Orthopedic opinion
Bed rest
Analgesia
Physiotherapy
Peroneal nerve palsy presents with _________________
unilateral foot drop
Secondary postpartum hemorrhage
Bleeding from genital tract b/w 24 hours to 6 weeks after delivery
Most common time of Secondary PPH
7-14 days
Causes of Secondary PPH
Endometritis
Retained placenta
Signs of Endometritis
Constant lower abdominal pain
Tender uterus and closed os
Fever and pungent lochia
Signs of Retained placenta
Crampy lower abdominal pain
Uterus enlarged and open os
Fever and pungent lochia
What is puerperal pyrexia?
Raised temperature (>100.4/>38) on any two days of the first 10 days postpartum, exclusive of 24 hours
Causes of puerperal pyrexia
Endometritis (Most common)
Retained placental tissue
Pneumonia, Pulmonary embolism
DVT
Pyelonephritis
Meningitis
Mastitis/Breast Abscess
Puerperal sepsis is ______________
polymicrobial
Investigations in puerperal sepsis
CBC
UCE
CP
High vaginal swab
Pelvic ultrasound
ABGs
Tx of Puerperal sepsis
Cephalosporin
Metronidazole
Clindamycin
IVF
Drainage of pelvic abscess
Complications of puerperal sepsis
Ascending infection
Necrotizing fascitis of genital tract (clostridium perfringens)
Endometritis
Hematogenous and lymphatic spread
Postpartum Pink and Blues
Pink (Euphoric mood) time
Blue (Depressive mood) time
Pink time 24-48 hours
Blue time first 2 weeks
Postpartum pink and blues management
resolves within 10 days
Support
Postpartum psychosis is common in week _________ and _____th day
within 3 weeks
5th day most common and rarely before 3rd day
PPP risk factors
Hx of Bipolar/PPP
F Hx of Bipolar/PPP
Management of PPP
Psychiatric consultation
Lithium
Antidepressants
Acute neuroleptics
ECT
Lithium prophylaxis in high risk patients
Postpartum Depression presents in _______th week
6th
Features of breast milk
75 kcal/mL
Whey protein
Polyunsaturated FAs
Safe in children with gastroenteritis
All vitamins except Vitamin K
Iron concentration is low
Iron absorption is high due to lactoferrin
WHO recommends breastfeeding for _____ months with the introduction of other foods onwards
4-6 months
For how long a woman should breastfeed her child?
2 years
Benefits of breastfeeding
Cheap
Readily available at the right temperature
Benefits to country
Reduces illness
Reduces fertility with amenorrhea
Reduces atopic illness
Reduces necrotizing enterocollitis
Reduces Juvenile diabetes
Reduces Cancer
Reduces chances of PPH
HIV infected women should not breastfeed if _____________
they live in a resource rich setting
HIV infected women should breastfeed if they
live in poor resources setting
Suppression of lactation can be by
Cabergoline
Bromocriptine
Noninfective vs Infective mastitis causes
Noninfective → Restriction of feeding and bad position
Infective → Nipple trauma (S. Aureus/ Streptococcus viridians) from baby’s nose MC or infected umbilical cord
Management of noninfective mastitis
Continue feeding from the breast
Correct positioning
Ice packs
Analgesia
Avoid compression
Management of Infective Mastitis
Cease breastfeeding from affected side
Antibiotics
I/D (on US)
Breastfeeding continued)
