Puerperium

Question 1

What is puerperium?

Answer 1

The 6 week period following completion of labour

Question 2

What physiological changes occur in puerperium?

Answer 2

Uterine involution

Genital tract changes

Question 3

What is uterine involution?

Answer 3

The process by which the post partum uterus of 1kg returns to its pre pregnancy stage of 100g
The fundus moves from 12 cm above pubic symphysis to being no longer palpablee

Question 4

What causes involution in labour?

Answer 4

AUTOLYSIS (muscle cells diminish in size due to enzymatic degradation of the cytoplasm, as excess protein is absorbed and excreeted in the urine)

Question 5

What are signs of delayed involution

Answer 5

Full bladder, full rectum

Retained products / clots - opalpable iuterus, artefact on IUSS

Question 6

What are changes to the genital tract?

Answer 6

Thickening of the cervix
Should take about 2 weeks to close again
In some people the eexternal os reemains open permanently
Becomes funnel shaped

Question 7

What is LOCHIA?

Answer 7

The blood. stained uterine discharge that comes out of the vagina after birth n
Made up of blood and necrotic decidua

Question 8

What are the three types of lochia?

Answer 8

RSA

Lochia Rubra - red, during first few days
Lçochia Serosa - pink/brown, two weeks
Lçochia alba _ yellow white discharge, one month

Question 9

How do you manage perineal tears?

Answer 9

Change sanitary pads frequently + good hygene (wash and change sanitary pads frequently)

Medical mx:

• Analgesia
• Lactulose + bulking agent
• Antibiotics

Question 10

What is common as bladder dysfunction in puerperium=?

Answer 10

Voiding difficulty + bladder overdistension
Blòadder takes 8 h to regain normal sensation after epidural
THis can damage the detrusor, leading to hypocontractivle bladdert
Leads to overflow incontinence

Question 11

IWhat do you do to minimise risk of bladder distension=

Answer 11

Insert catheter for at least 12 h after spinal anaesthesia until woman is mobvinle

Question 12

What kind of. bowel abnormality is normal after birth?

Answer 12

CONSTIPATION

Due to interruption of normal diet, intrapartum dehydration, opiate. use, fear. of opening bowels due to pain

Question 13

What are three things that are a higher risk with C. secion?

Answer 13

infection
Anaemia
VTE

Question 14

What do you do for anaemia’

Answer 14

Give iron supplement
OR
Transfusion
Depending on Hb

Question 15

What is the most important obs to monitor Post partum?

Answer 15

BP

Question 16

What is secondary post partum haemorrhage?

Answer 16

Bleeding from or into the genital tract 24 h to 6 weeks after birth

Question 17

What are the two main causes of. secondary PPH?

Answer 17

Endometritis

Retained placenta

Question 18

What is endometritis?

Answer 18

Inflammation of the endometrium

Question 19

What are sx of endometritis?

Answer 19

Lower abdominal pain

Tender uterus with closed internal os

Question 20

What are sx of retained placent?

Answer 20

Crampy lower abdo pain
Large uterus
Open internal os
Prolonged third stage of labour

Question 21

How do you manage secondary PPH?

Answer 21

IV fluids / blood as required
Uterotonics
Uterine evacuation
Antibiotics (

Question 22

What is obstetric palsy?

Answer 22

Development of maternal motor / sensory neuropathy following delivery

Question 23

What are preseenting featueres of obstetric palsy?

Answer 23

Sciatic pain 
Foot drop 
Parasthesia 
Hypoaesthesia 
Muscle wsting

Question 24

What causes obstetric palsy?

Answer 24

Nerve damage

Because the lumbosacral plexus and nerve tracks are stretched and compressed by the foetal head

Question 25

What is the biggest RF for obstetric palsy?

Answer 25

Prolonged/obstructed labour

Question 26

What is pubic symphisis diastasis?

Answer 26

Spontaneous separation of the pubic symphisis

Question 27

What are features of pubic symphisis diastasis

Answer 27

Symphiseal pain aggravated by weight bearing and walking
Waddling gait
Pubic. tenderness
palpable interpubic gap

Question 28

How do you manage pubic symphisis diastasis

Answer 28

Rest
Anti inflammatories
Physio
Pelvic corset

Question 29

What causes puerperal sepsis?

Answer 29

Genital ttact infection following delivery

Question 30

How do you prevent puerperal sepsis?

Answer 30

Increased hygiene awareness
Good aseptic technique
Prophylactic antibiotics for CS patients

Question 31

What form of antibiotics is given to CS patients?

Answer 31

Single intraoperative dose (Co-amoxiclav + metronidazole) before the skin incision

Question 32

What is treatment once puerperal sepsis is identified

Answer 32

Further antibiootics (broad spectrum)

Question 33

What is a rare complication that can occur?

Answer 33

Necrotising fascitiis

Due. to clostridium perfingens

Question 34

What is colostrum

Answer 34

Yellow fluid secreted by breast from 16 weeks to 2nd post partum day
Contains antibodies and WBC
Aims to priotect baby from infection

Question 35

When is breast milk produced?

Answer 35

From 2nd post partum day

Question 36

What are major constituents of breast milk=?

Answer 36

lactose, protein, fat, water, all vitamins EXCEPT vit K

Question 37

What hormones induce lactation and how?

Answer 37

PROLACTIN stimulates milk synthesis

OXYTOCIN stimulates milk release

Question 38

What is the rooting reflex?

Answer 38

Baby’s mouth gapes when the skin around it is touched

Question 39

What are advantages of breastfeediung?

Answer 39

Readiliy available
Free
Contraceptive effect
Reduces diseases in babY: necrotising enterocolitis, childhood infective illnesses, atopic illnesses, T1DM; childhoow cancer, premenopausal preast ancer