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O&G > Postnatal > Flashcards

Postnatal Flashcards

1
Q

Define postpartum haemorrhage

Classifications of severity

A

Loss of at least 500ml of blood within 24hrs of birth
• Minor (up to 1L)
• Mod (up to 2L)
• Major (more than 2L)

Primary: within first 24hrs
Secondary: within 6 (or 12) weeks post partum

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2
Q

11 risk factors for postpartum haemorrhage

A
  • Macrosomia
  • Big placenta
  • Clotting issues (low platelets)
  • Pre-eclampsia
  • Obesity
  • Antepartum haemorrhage
  • Maternal anaemia
  • Multiparity
  • Retained placenta (prolonged 3rd stage)
  • Smoking
  • Trauma (instrumental delivery, prolonged 2nd stage)
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3
Q

Causes of postpartum haemorrhage

A

4 T’s

  • Tone (placenta praevia, multiple pregnancy, pervious PPH, obesity, anaemia, prolonged labour, older mother, big baby)
  • Trauma (C section, esp emergency, episiotomy, operative vaginal delivery, big baby)
  • Tissue (retained placenta, partial placenta adhesion, membranes and clot stop uterus contracting)
  • Thrombin (abruption, PET, pyrexia/sepsis)
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4
Q

How can the incidence of post partum haemorrhage be reduced?

A 
Treat antenatal anaemia
Proactive management
Give oxytocin for 3rd stage/sindometrin if high risk
Venous access
MDT planning for placenta accreta
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5
Q

Name 5 uterotonics, class of drug and SE

A
  • Syntocinon (oxytocin) stimulates upper uterine segment to contract rhythmically, SE anti-diuretic due to similarity to ADH
  • Ergometrine (ergot alkaloid) smooth muscle contraction, SE hypertension, n+v
  • Syntometrine
  • Carboprost (prostaglandin) myometrial contraction SE n+v, diarrhoea, asthmatic wheeze
  • Misprostol (prostaglandin) myometrial contractions SE n+v, diarrhoea
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6
Q

Non medical treatment of PPH

A

Balloon tamponade
Laparotomy
B-lynch suture to fold uterus

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7
Q

Secondary PPH causes

A

Infection

Retained products of conception

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8
Q

Child’s benefits of breastfeeding

A 
Decreased risk of:
•	Asthma and atopic disease
•	Diarrheoa
•	Necrotising enterocolitis
•	Obesity and cardiovascular disease later in life
•	Otitis media, UTIs
•	T1DM and T2DM
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9
Q

Mum’s benefits of breastfeeding

A 
Reduced risk of:
•	Breast and ovarian cancer
•	Postnatal depression
•	Post-partum haemorrhage
•	T2DM
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10
Q

What needs to be considered in breastfeeding?

A

Age of baby
Baby’s comoribities (esp renal/hepatic)
Mother’s medication

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11
Q

Frequency of breastfeeding

A

2-3hrly in 1st 6 months

Single comfort feed at night after weaning

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12
Q

What helps a drug not be secreted in breast milk?

A

High molecular weight (eg insulin and heparin)
High protein binding (eg warfarin and NSAIDs)
Low lipid solubility (loratadine)
Lower pH (amoxicillin)

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13
Q

What antibiotics are safe for breastfeeding mums?

A

Amoxicillin (lower pH)
Cefalexin (low conc in breast milk)
Trimethoprim short term (affects folate metabolism)
Metronidazole-> but bitter milk!

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14
Q

Which analgesics should be avoided in breastfeeding mums?

A

Codeine
Opioids should be avoided
Aspirin (Reye’s syndrome)

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15
Q

Which analgesics can be given to breastfeeding mums?

A

NSAIDs
Tramadol
Paracetamol

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16
Q

Which antidepressants are safe for breastfeeding mums?

A

Amitriptyline if babies are full term (monitoring required)
Sertraline & paroxetine are 1st line
TCAs but not doxepin

17
Q

Which antidepressants are not safe in breastfeeding mums?

A

Fluoxetine
Doxepin
St John’s wort
MAOIs

18
Q

What should be done if a mother is taking antidepressants while breastfeeding?

A

Monitor infant (behaviour change, poor feeding, sedation)
Breastfeed immediately before drug administration
Can substitute 1 bottle at peak drug concentrations (1-3hrs or 6-8hrs in SSRIs)

19
Q

Which contraceptions are safe when breastfeeding?

A
  • COCP can be started after 3 weeks or after 6 weeks if VTE risk factor
  • Progesterone only pill/injection/implant are safe, can start any time
  • IUS safe, insertion either within 48hrs post partum or after 4 weeks
20
Q

Treatment of allergic rhinitis when breastfeeding?

A

No treatment unless severe
Topical if possible (sodium cromoglycate, nasal antihistamines, nasal flutiscasone)
Non sedating if oral (loratidine, certirizine)

21
Q

Causes of late maternal deaths

A 
Ocurring between 42 days-yr after abortion/miscarriage/delivery
•	Malignancy
•	Suicide
•	Acute MI
•	Aortic dissection
•	Cardiomyopathy
•	Sepsis
22
Q

Symptoms of endometritis

A

Fever, shivering, abdo pain/offensive vaginal loss, unusual bleeding. If after 7 days: chlamydia?

23
Q

Risk factors for endometritis

Treatment

A

C-section, young age, low socioeconomic status, prolonged labour, intrauterine balloon (to tamponade bleeding), twin delivery (more manual removal of placenta)
Broad spectrum abx

24
Q

Common infections post-natally

A
  • UTI, pyelonephritis
  • Lower genital tract
  • C-section incision/wound infection
  • Mastitis
  • Pneumonia
25
Q

Signs of group A strep infection post natally

A

Rapid progression SIRS-> sever sepsis
Rash
Toxic shock

26
Q

Define Sheehan syndrome

A

Ischaemia, congestion and infarction of pituitary gland
Usually caused by haemorrhagic shock at birth
Panhypopituitarism
Difficult lactation, breast involution

27
Q

Management of primary PPH

A

Placenta in situ? Placenta incomplete?
-> manual removal of placenta under anaesthesia
Uterus well contracted?-> syntocin
Contracted-> examine for genital tract trauma

28
Q

Define maternal death

A

Deaths of women while pregnant or within 42 days of end of pregnancy form any cause relating to/aggravated by the pregnancy
Includes ectopic, miscarriage and TOP)

29
Q

Name the most common causes of direct maternal deaths

A 
Sepsis
PET & eclampsia
Thrombosis/thromboembolism
Amniotic fluid embolism
Ectopic
Haemorrhage
Anaesthesia
30
Q

Name the most common indirect cause of maternal death

A

Cardiac disease

O&G (12 decks)

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