The puerperium Flashcards
How long should lochia be bloodstained after delivery?
4 weeks.
How long does it take for cardiovascular changes to revert to the pre-pregnancy state?
C.O. and plasma volume: 1 week.
Oedema and BP: 6 weeks.
How long does colostrum come through for before milk?
3 days.
When should you use contraception after pregnancy?
4-6 weeks.
What contraception is appropriate post-pregnancy?
If breast-feeding: progesterone-only pill.
If bottle-feeding: COCP.
IUS can be used at 6wks.
What is the definition of a primary PPH?
Loss of >500ml of blood <24h after delivery.
Secondary is >24h, <6wks.
What causes PPH?
Retained placenta: blood can collect behind the placenta.
Uterine causes (80%): failure to contract due to atony or retained placenta. Atony more common in prolonged labour, grand multiparity, overdistension (polyhydramnios / multiple pregnancy), fibroids.
Vaginal causes (20%): Perineal tear, episiotomy or high vaginal tear from instruments.
Cervical tears: rare.
Coagulopathy: rare.
How do you prevent PPH?
Routine Oxytocin reduces incidence by 60%.
How does a PPH present?
Blood loss.
Enlarged uterus (above the umbilicus) indicates a uterine cause.
Collapse / pain.
How do you manage a PPH?
Nurse PT flat. Get IV access. Cross match and transfuse.
Remove retained placenta.
Identify and treat the cause of bleeding.
If atony persistent, inject prostaglandin F2a.
If these fail to control bleeding, surgery is required - Rusch balloon, brace suture or uterine artery embolisation. Hysterectomy as a last resort.
What causes secondary PPH?
Endometritis +- retained placenta.
Occasionally gynae pathology or gestational trophoblastic disease.
How do you manage secondary PPH?
Swabs and FBC to investigate.
Abx to treat.
If heavy bleeding: ERPC.
If Abx slow but don’t stop bleeding, probably retained products -> ERPC.
What are the common causes of postpartum pyrexia?
Genital tract sepsis by group A strep, staph or e. Coli. Most common after C-S.
What is an appropriate medical treatment for postnatal depression?
Fluoxetine.
