Puerperium and Postpartum

Question 1

What is primary PPH?

Answer 1

Blood loss over 500ml in the first 24hr after pregnancy,

Question 2

What is major PPH?

Answer 2

Blood loss >1500ml or smaller loss with clinical signs of shock

Question 3

What is secondary PPH and what causes it?

Answer 3

Excessive blood loss between 24 hr and 6 weeks after pregnancy, caused by endometritis sometimes with retained placenta

Question 4

What causes primary PPH, and what are the risk factors?

Answer 4

CAUSES: Tone, tissue (retained placenta), trauma, thrombin
RISK FACTORS: previous history, previous c-section, coagulation defect, instrumental/c-section, retained placenta, APH, multiple pregnancy, grand multiparity, uterine malformation, prolonged/induced labour

Question 5

How is PPH managed (primary and secondary)?

Answer 5

PRIMARY

• FBC, group and save
• Synometrine administration (ergometrine + oxytocin)
• Evacuation of retained products of conception (ERPC)
• Surgery if bleeding persists
• Vaginal exam once bleeding stops to identify cause

SECONDARY

• FBC, group and save
• Antibiotics
• ERPC

Question 6

What is ergometrine?

Answer 6

A medication used to cause contractions of the uterus to treat heavy vaginal bleeding after childbirth. It can be used either by mouth, by injection into a muscle, or injection into a vein

Question 7

What is the puerperium?

Answer 7

The 6 week period following delivery, when the body returns to the prepregnant state

Question 8

Following labour, what things are checked daily?

Answer 8

Uterine involution, lochia, BP, temperature, pulse, wound sites, fluid balance (if epidural)

Question 9

What causes lactation?

Answer 9

1. Rapid drop in oestrogen and progesterone after birth
2. Increase in prolactin release from anterior pituitary
3. This stimulates milk SECRETION
4. Increase in oxytocin release from posterior pituitary
5. This stimulates EJECTION in response to nipple sucking

Question 10

Why is breastfeeding important?

Answer 10

• Protection against infection in neonate (immunoglobulins)
• Bonding
• Protection against cancers in the mum
• Cost saving

Question 11

When should contraception be recommenced in the mother?

Answer 11

4-6 weeks after delivery (usually IUD)

NB - COC is contraindicated in breastfeeding

Question 12

What is postpartum pyrexia?

Answer 12

Maternal fever of >38C in the first 14 days

Question 13

When is genital tract sepsis most common, and how is it managed?

Answer 13

After c-section as group A strep, staphylococcus and E.coli can get into the wound site.
It can be managed with prophylactic antibiotics

Question 14

How is postpartum sepsis managed?

Answer 14

SEPSIS 6

Question 15

What scale can be used to assess psychiatric problems of the puerperium?

Answer 15

Edinburgh Postnatal Depression Scale

Question 16

What psychiatric problems can occur in the puerperium?

Answer 16

• Third day blues (common)
• Postnatal depression - often previous psych history
• Puerperal psychosis - onset around the 4th day

Question 17

What can puerperal anaemia cause?

Answer 17

• Increased risk of postnatal depression
• Increased prevalence of UTIs
• Fatigue
• Insufficient amount and quality of breast milk

Question 18

How can postpartum anaemia be managed?

Answer 18

• Diet
• Iron supplements
• Iron transfusion
• Blood transfusion

Question 19

What is lochia rubra?

Answer 19

Red discharge that occurs for 3-4 days after delivery

Question 20

What is lochia serosa?

Answer 20

Yellow-brown discharge that occurs for a week after lochia rubra

Question 21

What is lochia alba?

Answer 21

A whitish turbid fluid that drains from the vagina for 2 weeks after lochia alba