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Obstetrics & Gynaecology > The Puerperium > Flashcards

The Puerperium Flashcards

1
Q

Routine post-natal care

A

Analgesia as required

Help establishing breast or bottle-feeding

Venous thromboembolism risk assessment

Monitoring for postpartum haemorrhage

Monitoring for sepsis

Monitoring blood pressure (after pre-eclampsia)

Monitoring recovery after a caesarean or perineal tear

Full blood count check (after bleeding, caesarean or antenatal anaemia)

Anti-D for rhesus D negative women (depending on the baby’s blood group)

Routine baby check

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2
Q

What happens at the 6 week post-natal check?

A

General wellbeing

Mood and depression

Bleeding and menstruation

Scar healing after episiotomy or caesarean

Contraception

Breastfeeding

Fasting blood glucose (after gestational diabetes)

Blood pressure (after hypertension or pre-eclampsia)

Urine dipstick for protein (after pre-eclampsia)

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3
Q

What is lochia?

A

Vaginal bleeding as endometrium initially breaks down, then returns to normal over time

Mix of blood, endometrial tissue and mucus

Initially dark red, then brown, then lighter in flow and colour

Tampons should be avoided during this period, as they carry a risk of infection

Bleeding should settle within six weeks

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4
Q

What is lactational amenorrhoea?

A

Women who are breastfeeding may not have a return to regular menstrual periods for six months or longer (unless they stop breastfeeding)

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5
Q

How soon after birth do periods return for bottle-feeding mothers?

A

3 weeks onwards

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6
Q

When does fertility return after birth?

A

21 days onwards

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7
Q

How long is lactational amenorrhoea effective for as contraception?

A

Up to 6 months

99% effective

Must be fully breastfeeding and amenorrhoeic

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8
Q

Contraception after birth

A

POP and implant safe during breastfeeding and can be started any time after birth

COCP should be avoided during breastfeeding and should not be started earlier than 6 weeks after childbirth

IUD/IUS can be inserted EITHER within 48hrs or after 4 weeks

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9
Q

What is postpartum endometritis?

A

Inflammation of endometrium (usually caused by infection)

More common after C-section

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10
Q

Presentation of postpartum endometritis

A

Foul-smelling discharge or lochia

Bleeding that gets heavier or does not improve with time

Lower abdominal or pelvic pain

Fever

Sepsis

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11
Q

Diagnosis of postpartum endometritis

A

Vaginal swabs (including chlamydia and gonorrhoea if there are risk factors)

Urine culture and sensitivities

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12
Q

Presentation of retained products of conception

A

Vaginal bleeding that gets heavier or does not improve with time

Abnormal vaginal discharge

Lower abdominal or pelvic pain

Fever (if infection occurs)

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13
Q

Key complications of ERPC

A

Endometritis

Sherman’s syndrome

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14
Q

What is postpartum anaemia?

A

Hb <100 in the postpartum period

Common due to acute blood loss

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15
Q

In which patients is FBC checked the day after delivery?

A

Postpartum haemorrhage over 500ml

Caesarean section

Antenatal anaemia

Symptoms of anaemia

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16
Q

Management of postpartum anaemia

A

Hb <100 g/l – start oral iron (e.g. ferrous sulphate 200mg three times daily for three months)

Hb <90 g/l – consider an iron infusion in addition to oral iron (e.g. Monofer, CosmoFer or Ferinject)

Hb <70 g/l – blood transfusion in addition to oral iron

17
Q

Contraindication to iron infusion

A

Infection

18
Q

What are “baby blues”?

A

First week of birth

Affects >50% of women

Mild symptoms resolving within two weeks of delivery

19
Q

Symptoms of baby blues

A

Mood swings

Low mood

Anxiety

Irritability

Tearfulness

20
Q

What is post-natal depression?

A

Typically around 3 months after birth

Low mood

Anhedonia

Low energy

21
Q

Management of post-natal depression

A

Mild: additional support, self-help and follow up with their GP

Moderate: antidepressants (e.g. SSRIs) and CBT

Severe: may need input from specialist psychiatry services, and rarely inpatient care on the mother and baby unit

22
Q

Symptoms of puerperal psychosis

A

Delusions

Hallucinations

Depression

Mania

Confusion

Thought disorder

23
Q

Management of puerperal psychosis

A

Urgent assessment and input from specialist mental health services

Admission to the mother and baby unit

Cognitive behavioural therapy

Medications (antidepressants, antipsychotics or mood stabilisers)

Electroconvulsive therapy (ECT)

24
Q

Mastitis presentation

A

Breast pain and tenderness (unilateral)

Erythema in a focal area of breast tissue

Local warmth and inflammation

Nipple discharge

Fever

25
Q

Mastitis causes

A

Obstruction - occurs in ducts and milk accumulates

Infection - bacteria enter nipple and back-tuck into ducts (Staph. aureus)

26
Q

Management of mastitis

A

Conservative: continue BF, express milk, breast massage, simple analgesia, heat packs

Medical: flucloxacillin or erythromycin

27
Q

Candida of the nipple presentation

A

Sore nipples bilaterally, particularly after feeding

Nipple tenderness and itching

Cracked, flaky or shiny areola

Symptoms in the baby, such as white patches in the mouth and on the tongue, or candidal nappy rash

28
Q

Management of candida of the nipple

A

Both mother and baby need treatment

Topical miconazole 2% after each breastfeed

Treatment for the baby (e.g. miconazole gel or nystatin)

29
Q

What is postpartum thyroiditis?

A

Changes in thyroid function within 12 months of delivery, affecting women without a history of thyroid disease

Can involve thyrotoxicosis (hyperthyroidism), hypothyroidism, or both

30
Q

Stages of postpartum thyroiditis

A
  1. Thyrotoxicosis (usually in the first three months)
  2. Hypothyroid (usually from 3-6 months)
  3. Thyroid function gradually returns to normal (usually within one year)
31
Q

Levels of TSH and T3/T4 in hyperthyroidism

A

TSH - Low

T3/T4 - High

32
Q

Levels of TSH and T3/T4 in hypothyroidism

A

TSH - High

T3/T4 - Low

33
Q

Management of thyrotoxicosis

A

Symptomatic control e.g. beta-blocker

34
Q

Management of hypothyroidism

A

Levothyroxine

35
Q

Follow up in postpartum thyroiditis

A

Annual monitoring of TFTs

Identifies those that go on to develop long-term hypothyroidism

36
Q

What is Sheehan’s syndrome?

A

Rare complication of PPH where the drop in circulating blood volume leads to avascular necrosis of the pituitary gland

37
Q

Hormones affected in Sheehan’s syndrome

A

Anterior pituitary hormones

Thyroid-stimulating hormone (TSH)
Adrenocorticotropic hormone (ACTH)
Follicle-stimulating hormone (FSH)
Luteinising hormone (LH)
Growth hormone (GH)
Prolactin
38
Q

Presentation of Sheehan’s syndrome

A

Reduced lactation (lack of prolactin)

Amenorrhea (lack of LH and FSH)

Adrenal insufficiency and adrenal crisis, caused by low cortisol (lack of ACTH)

Hypothyroidism with low thyroid hormones (lack of TSH)

39
Q

Management of Sheehan’s syndrome

A

Oestrogen and progesterone as hormone replacement therapy for the female sex hormones (until menopause)

Hydrocortisone for adrenal insufficiency

Levothyroxine for hypothyroidism

Growth hormone

Obstetrics & Gynaecology (13 decks)

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