Puerperium

Question 1

What is puerperium?

Answer 1

6 weeks after delivery

Question 2

What happens in the puerperium?

Answer 2

Uterus involutes
Afterpains as it contracts
Cervix becomes firm
Internal os closes by 3 days, external os by 3 weeks
Lochia (endometrial slough) passed PV
Red in 1st 3 days then yellow then white over next 10 days until 6 weeks
Breasts produce milky discharge and colostrum during laser trimester
Milk replaces colostrum 3 days after birth
Breasts are swollen, red and tender

Question 3

What should you consider in the first days after delivery?

Answer 3

Thomboprophyalxis
Anti-D if Rh negative
Temperature
BP - sustained HTN may need drugs
Breasts
Legs
Lochia
Fundal height
Teach pelvic floor exercises

Question 4

What is puerperal pyrexia?

Answer 4

> 38 degrees in first 14 days following delivery or misscarriage

Question 5

What are causes of puerperal pyrexia?

Answer 5

Endometritis - most common
UTI
Wound infection - perineal tears + C-section
Mastitis
VTE

Question 6

What investigations in puerperal pyrexia?

Answer 6

Culture MSU, High vaginal swabs, bloods, sputum

Question 7

What are features of endometritis?

Answer 7

Lower abdominal pain
Offensive lochia
Tender uterus on bimanual examination

Question 8

What is management for endometritis?

Answer 8

Urgent IV abx - clindamycin and gentamicin

Question 9

What is management for breast infection?

Answer 9

Flucloxacillin for >10 days to prevent abscesses

Question 10

How does superficial thrombophlebitis present? Management?

Answer 10

Painful tender usually varicose vein
NSAID
Anti-thromboembolic stockings

Question 11

What are postnatal blues?

Answer 11

Occurs in 50% of women 
Evident by 3rd day
Peak at 5th
Subside within 10 day
Tearfulness, irritability, anxiety about the baby and poor concentration

Question 12

What is postnatal depression?

Answer 12

Usual features of depression and fears about baby’s health, maternal deficiencies and marital tensions including loss of sexual interest
Can last months if not treated

Question 13

What is puerperal psychosis?

Answer 13

High suicidal drive, severe depression, amnia and more rates schizophrenic symptoms with delusions
Exclude puerperal infection causing delirium
Onset sudden and deterioration rapid
Admission to specialist mother and baby unit if eneded

Question 14

What happens at 6 week postnatal examination?

Answer 14

See how mother and baby relate
BP and weight
FBC if anaemic
Cervical smear if due
Check contraceptive palnce
Ask about backache, depression, incontinence