the puerperium and itsa complications

Question 1

what is the puerperium ?

Answer 1

is the 6-8 week period after delivery where the body returns to its pre pregnant state

Question 2

when does the uterus return to its pre pregnant size ?

Answer 2

by 4 weeks post natally

Question 3

what is lochia ?

Answer 3

the postpartum genital discharge that consists of blood and necrotic tissue

Question 4

what are the types of lochia ?

Answer 4

lochia rubra
lochia serosa
lochia alba

Question 5

when is it normal to see lochia ?

Answer 5

for up to 40 days post-partum

Question 6

when is it normal to see each type of lochia in the puerperium ?

Answer 6

lochia rubra for the first 2 weeks after delivery
lochia serosa for the 3rd week
lochia alba till the end of the puerperium

Question 7

what are the physiological breast changes seen after delivery ?

Answer 7

yellow secretions from the breast called colostrum followed by proper milk secretion on day 3

Question 8

what is the most important hematological change post partum ?

Answer 8

increased clotting factors from day 1 to day 10 which increases the risk of DVT

Question 9

what is the most common cause of secondary post- partum haemorrhage ?

Answer 9

sepsis/infection

Question 10

if symptoms of thromboembolism are ignored what is the most life threatening complication that ma happen ?

Answer 10

pulmonary embolism

Question 11

what are the causes of direct deaths after labour ?

Answer 11

haemorrhage
genital tract sepsis
pre-eclampsia and eclampsia
thromboembolism

Question 12

what are the causes of indirect deaths after labour ?

Answer 12

cardiac disease
indirect neurological conditions
psychiatric causes

Question 13

what are the common symptoms of sepsis in the peurepium ?

Answer 13

offensive vaginal discharge 
fever 
diarrhea and vomiting 
rash 
tachypnea 
tachycardia 
hypotension 
delayed uterine involution

Question 14

what investigations should be performed for sepsis in the puerpieum ?

Answer 14

full blood count including ESR and CRP
lactate levels
blood culture esp before Ab administration
chest x ray
throat swab in case of signs of tonsillitis or pharyngitis

Question 15

what is serum lactate levels an indicator for ?

Answer 15

a level above 4 would be an indication of tissue hypoperfusion

Question 16

which antibiotics should be used for each type of orhanism ?

Answer 16

for gram negative gentamycin
for gram positive cephalosporins
for anaerobes clindamycin or metranidazole

Question 17

what is the management in the event of hypotension ?

Answer 17

rapid fluid resuscitation

along with use of vasopressors such as noradrenaline

Question 18

what contraceptive methods can be used after delivery ?

Answer 18

any contraceptive method can be used except combined oral contraceptives

Question 19

why are OCPs contraindicated post-partum ?

Answer 19

due to the increased levels of oestrogen which will further increase the already high risk of VTE

Question 20

what are the indications for inserting IUDs in post partum ?

Answer 20

they can be inserted immediately or up to 48 hours after delivery
if 48 hours have already passed the insertion can be delayed til 28 days post partum

Question 21

what are the assumptions or conditions for using LAM as a contraceptive method ?

Answer 21

woman must be fully breastfeeding her child
must be amenorrheic
must be less than 6 months post-partum

Question 22

how can anxiety be assessed post natally ?

Answer 22

using the GAD-2 scale
past month have you been feeling:
nervous or on edge
have not been able to stop worrying

Question 23

why may retention of urine happen post partum ?

Answer 23

due to catheterization
pain after delivery
epidural causes urinary retention