Puerperium Flashcards
Define Puerperium
Puerperium is the 6-week period following delivery when the body returns to its pre-pregnant state
How long does the uterus take to reduce in its size? When will the uterus not be palpable?
What might be experienced during this period?
Uterus takes over 6 weeks to reduce in its size and will become non-palpable within 10 days.
Contractions or ‘after pains’ might be experienced for 4 days.
How many days does it take for the internal os of the cervix to close?
3 days
What is the name of the discharge from the uterus during puerperium?
Describe the colour of the discharge
Lochia.
May be blood stained for 4 weeks, but thereafter becomes yellow or white.
Rubra –> Serosa –> Alba
Why are women predisposed to thrombosis in puerperium?
Women are predisposed to thrombosis due to the rise in Platelet and clotting factors during puerperium.
What are the 3 main common reasons that cause PPH?
Retained placental fragments, atonic uterus and perineal trauma
What is the management of atonic uterus?
Bimanual compression, followed by IV oxytocin or Ergometrine.
If uterine atony persist, prostaglandin F2 is injected into the myometrium
What is the routine drug given to women during the 3rd stage of labor?
Oxytocin
After how long will there be intervention to remove the retained placenta?
A retained placenta will be removed manually if it is not expelled by normal methods within 60 mins of delivery
What is postpartum pyrexia?
Maternal fever of >38 degree celsius in the first 14 days
What is a major cause of postpartum pyrexia? What is the major cause of maternal mortality?
Infection, with genital tract sepsis being the major cause of maternal mortality.
What are the symptoms and signs of genital tract sepsis?
The lochia may be offensive and the uterus is enlarged and tender.
What are the causes and sites of postpartum pyrexia?
IV site, Chest infection, Mastitis, Urinary tract infection, wound infection after Caesarean section, endometritis, deep vein thrombosis
What are the urinary tract issues that can arise postpartum?
Retention of urine
Urinary tract infection
Incontinence
What are the hormonal changes in puerperium - sex steroids, thyroid hormones, prolactin, cortisol, aldosterone, renin.
In puerperium, there will be falling levels of sex steroids, thyroid hormones, renin, cortisol and aldosterone.
Prolactin falls unless mother is breast-feeding.
What are the changes in Hb levels, Haematocrit and plasma volume?
There is a fall in plasma volume, a rise in Hb and haematocrit from day 4.
Define secondary PPH
Secondary PPH is bleeding after 24 hours postpartum, until 6 weeks postnatal.
What could be the causes of secondary PPH? Describe the symptoms
RPOC - retained products of conception: Persistent heavy lochia
Endometritis - Sudden heavy bleeding and malaise
What is the management of RPOC?
ERPC - evacuation of retained products of conception, with USS guidance
Antibiotics
What are the main direct causes of maternal collapse and death?
Thrombosis, Genital tract sepsis, Haemorrhage and Amniotic fluid embolism
What are the main indirect causes of maternal collapse and death?
Cardiac disease, sepsis from pneumonia or flu
What are the risks of getting amniotic fluid embolism?
Hyperstimulated uterus (too much oxytocin)
ARM - artificial rupture of membrane
Polyhydramnios
Pre-eclampsia
advanced maternal age >35 years old
Placental problems like placental abruption
When is the most likely period to get amniotic fluid embolism?
During labour or immediately after delivery
What is the presentation of the mother with amniotic fluid embolism?
Sudden SOB, acute hypoxia, respiratory distress, sudden hypotension
Define Maternal Collapse
Maternal collapse is an acute event involving the cardiorespiratory systems and brain, resulting in a reduced or absent conscious level (and potential death) at any stage in pregnancy up to 6 weeks after delivery.
What are the causes of maternal collapse?
4H - Hypovolaemia (bleeding, sepsis, neurogenic shock), Hypoxia, Hypothermia, Hypo/Hyperkalaemia
4T - Tamponade, Toxicity, Tension Pneumothorax, Thromboembolism
Eclampsia and Intracranial haemorrhage
