The puerperium

Question 1

when is the puerperium period?

Answer 1

from delievery to 42 days post natal

Question 2

what placental hormones change very quickly after delievery?

Answer 2

• oestrogen
• progesterone
• HPL
• cortisol

Question 3

how does the uterus change?

Answer 3

Autolysis

bleeding stops

Question 4

how long does it take the CVS system to adjust back to normal?

Answer 4

2 weeks

Question 5

how long does it take for coagulation to go back to normal?

Answer 5

• fibrinolysis normal within 30 minutse

- clotting factors still increased for 6 weeks

Question 6

how long does it take insulin resistance due to pregnancy to stop?

Answer 6

immediate stop

Question 7

why can a breast feeding lady not take the COCP?

Answer 7

oestrogen suppresses lactation

Question 8

why is suckling important after delivery for breast feeding?

Answer 8

• it causes a raise in prolactin

- it causes a release in oxytocin

Question 9

how does the composition of breast milk change?

Answer 9

first 48 hours is colostrum

day 3-4 becomes milk

Question 10

what is in colostrum?

Answer 10

• major source of IgA
• source of lysosomes and macrophages
• protein source

Question 11

what is in breast milk from day 3/4?

Answer 11

increased protein levels
lactose
lactalbumin
casein

Question 12

what immunoglobulin can cross the placenta?

Answer 12

IgG

Question 13

what are advantages of breast feeding?

Answer 13

• easy
• free
• convenient
• promotes bonding
• reduces atopy in the baby
• reduces infections especially GI
• contraceptive effect

Question 14

what is the normally cause of acute mastitis?

Answer 14

Due to cracked nipples allowing staph aureus in

Question 15

how does acute mastitis present?

Answer 15

painful, red hot breast

Question 16

what is the management of acute mastitis?

Answer 16

can carry on feeding

flucloxacillin

Question 17

what is the amount of blood loss to be abornmal for PPH?

Answer 17

• over 500ml

Question 18

what is the divisions of PPH?

Answer 18

• primary: first 24 hours
• secondary: >24 hours - 42 days
• tertiary: >42 days

Question 19

what are causes of primary PPH?

Answer 19

• retained products (RPOC)
• uterus atony
• trauma

Question 20

what are causes of secondary PPH?

Answer 20

• endometriosis

- retained products (RPOC)

Question 21

what four T’s are linked to primary bleeding causes?

Answer 21

Tone
Tissue
Trauma
Thrombin

Question 22

why is it important after delivery the uterus contracts properly?

Answer 22

because this pinches off the blood vessels and stops bleeding

Question 23

what is the single biggest cause of maternal mortality?

Answer 23

pulmonary embolism

Question 24

why is there a higher thrombo embolism risk in the puerperium?

Answer 24

The pro-coagulant state from pregnancy remains through this period

Question 25

what are extra risk factors of thrombo embolism to look for?

Answer 25

• obesity
• older
• intercurrent illness such as infection
• immobility
• operative delivery such as C-section
• previous TED
• family history
• known thrombophilia

Question 26

what can be given prophylactically for thromboembolism risk?

Answer 26

• TED stockings
• SC heparin
• early mobilisation
• hydration
• education

Question 27

what is the thromboembolism management?

Answer 27

• heparin and warfarin

Question 28

when does baby blues affect women?

Answer 28

first 3-4 days after childbirth

Question 29

when does post natal depression affect women?

Answer 29

from 4 weeks onwards

Question 30

what are risk factors for a psychological disorder after pregnancy?

Answer 30

• previous mental health
• family history
• previous PND
• alcohol or drug abuse
• lack of social and family support
• poor or no relationship
• financial conerns
• poor outcomes
• ambivalence towarsd pregnancy

Question 31

when does puerpural psychosis occur?

Answer 31

first 2 weeks