Puerperium Flashcards
Causes of maternal death
Haemorrhage by far biggest cause (developing countries)
Sepsis
Thromboembolism
Pre-eclampsia / eclampsia
Indirect causes – Heart disease (1st in UK!!)
Suicide
what is the puerperium
Time from delivery to 42-days post-natal.
changes that occur in the puerperium
PHYSICAL ENDOCRINE IMMUNOLOGICAL PSYCHOLOGICAL SOCIAL
purpose of postnatal care
Facilitate and reassure normality for mother and baby including bonding and establishing feeding
Identify, investigate and manage abnormality
Consideration during lactation e.g. prescribing
Provide contraceptive advice
Make plans for next time!
hormonal control of puerperium
E2/P/HPL/cortisol cause:
- reversal of many changes
- uterine involution- autolysis of endometrial lining, back in pelvis by d10, bleeding stops, resumption of menstruation
- CVS changes
- coag changes: fibrinolysis normal within 30mins, pro-coagulant state remains, CF increased
- metabolic changes: IR goes immediately
effect of hormones on breast development
development of glandular tissue and supporting stroma
what inhibits PRL before delivery
E2
what is contained in the colostrum
- Major source IgA (mucosal type Ig)
- Lysosyme / macrophages
- Mod. CHO / FAT (protein)
What is contained in breast milk
Incr. CHO / FAT (protein)
Lactose (glu/galactose)
Lactalbumin / Casein
pros of breastfeeding
Easy / Free / Convenient Promotes bonding Red. Atopy Red. Infections esp. GI Red. Breast cancer Contraceptive Promotes weight loss
cons of breastfeeding
Not easy / convenient Embarrassing Painful Drugs pass thru e.g. anti-thyroid Perinatal infection e.g. HIV Non delegable!
problems with lactation
Failure of lactation - rare
Cracked nipples and pain - common
Acute Mastitis
Usually following cracked nipple
Staph. Aureus
Presentation - pain / red, hot breast / fever
Mx of breast feeding problems
Mx - maintain feeding / expressing / antibiotics (flucloxacillin)
Breast abscess
Sequelae of left / untreated mastitis
Mx - as above BUT needs I+D
puerperal abnormalities
Haemorrhagic Post partum haemorrhage (PPH) Thrombo-embolic Deep Vein Thrombosis (DVT) / Pulmonary Embolism (PE) Lactational Puerperal pyrexia Psychological
what is a PPH
Blood loss > 500ml from genital tract
3 types of PPH
Primary
first 24 hours
Secondary
>24 hours to 42 days
Tertiary
> 42 days
causes of primary PPH
uterine atony / RPOC / trauma to gen. tract
causes of secondary PPH
endometritis +/- RPOC`
presentation of PPH
Excessive lochia / pain / fever
Mx of PPH
Antibiotics
Analgesia
If no improvement 48 hrs: ERPC (Evacuation of retained products of conception)
basic causes of PPH
tone
tissue
trauma
thrombin
basic management of PPH
remedy cause
replace volume
replace O2 carrying capacity
replace CF
RFs for VTE
Obesity Older Intercurrent illness e.g. infection / PET Immobility Operative delivery – CS Previous VTE FH VTE Known thrombophilia
prophylaxis of VTE
TED stockings S/C heparin early mobilisation adequate hydration EDUCATION, EDUCATION, EDUCATION!!
management of VTE
Formal anticoagulation (Heparin and Warfarin) Imaging to confirm (Leg Dopplers / CTPA)
common causes of puerperal pyrexia
Genital tract - endometritis / perineum Pelvis - peritonitis (ascending infection) UTI - esp. catheterized Wound infection - CS Respiratory - esp. GA Breast - mastitis / abscess Other: Venflon sites Epidural sites Concurrent infection
Non-Infective:
Physiological in first 24-48 hours (<380C)
Thrombo-embolism - DVT / PE
ALWAYS check their LEGS and CHEST!
