Labour & Delivery Flashcards
(139 cards)
1
Q
Labour is dependant on what 3 mechanical factors?
A
Power expelling the fetus (POWER)
Pelvis dimensions + resistance of soft tissues (PASSAGE)
Fetal head diameter (PASSENGER)
2
Q
What structures allow for uterine contractions to push DOWNWARDS
How does the cervix become effaced/dilated?
What 2 factors can cause reduced uterine activity?
A
Cardinal + uterosacral ligaments = lower uterus attached to pelvis
Intermittent uterus contractions / fetal head pushing
Nulliparous + Induction
3
Q
What are the 3 main planes of the pelvis and their rough diameters?
A
Inlet - 13cm transverse (x 11 AP)
Mid-Cavity - 11x11cm
Outlet - 12.5cm AP (x 11 transverse)
4
Q
Describe the physiology behind cervical ‘ripening’
A
Prostaglandins → inhibit collagen synthesis / stimulate collagenase activity
5
Q
Which 3 factors of the fetal head determines its ease through the pelvis?
A
Attitude (presentation)
Rotation
Size
6
Q
What are the 2 fontanelles called?
A
Bregma (frontal/brow)
Occiput
7
Q
How is diagnosis of labour confirmed?
A
Painful uterine contractions AND cervical effacement/dilation
OR
Painful uterine contractions AND show / rupture of membranes
8
Q
Describe the mechanism of labour in 6 steps
A
- Oblong head enters inlets in OT (occipital-transverse) position
- The neck flexes / head descends / cervix dilates (measured by ischial spine station)
- Internal rotation in the mid-cavity to OA (occipito-anterior) position (in 5% rotates to OP) + shoulders enter inlet
- Head descends / delivered by extension of neck
- External rotation (transverse - L/R) so shoulders enter AP diameter
- Anterior then posterior shoulder delivered by lateral flexion
9
Q
What 4 things are managed in the mother during the 1st/2nd stage of labour?
A
Fluid
Position
Analgesics
Observations
10
Q
How is the fetus managed during the 1st/2nd stage of labour?
A
Intermittent auscultation / CTG
FBS if HR abnormal (only possible in 1st stage)
LSCS if fetal distress
11
Q
How is progression of the 1st stage assessed and what 2 interventions can be done to augment it?
A
1st stage progression assessed by VE (cervical dilation)
If nulliparous / slow progression - augment with ARM ± Oxytocin
12
Q
How is progression augmented in the 2nd stage?
At what stage would instrumental delivery be done?
A
Oxytocin if nulliparous ± station high
If not delivered after 1hr of pushing
13
Q
What does the 1st stage consist of?
+ time periods/cervical dilation of Latent + Active phase
A
1st stage = labour Dx → full 10cm dilation
Latent = 3cm, several hrs
Active 1-2cm/hr, shouldn’t be >12hrs
14
Q
What does the 2nd stage consist of?
What happens/time periods of Passive + Active Phase
A
2nd stage = full dilation → delivery
Passive = head to pelvic floor + maternal desire to push; few mins
Active = mother pushing, 20-40m (dep on parity)
15
Q
What is the 3rd stage? / time period
What happens?
How is it managed (what does the midwife do)?
A
Delivery of placenta, approx. 15mins
Uterine contractions compress / shear away vessels
Blood loss approx. 500ml
Suprapubic pressure + gentle continuous traction on cord
16
Q
What time frame classes the 3rd state as ‘retained placenta’?
What is the incidence of retained placenta
A
3rd stage >30mins
2.5% deliveries
17
Q
What is the main complication of a retained placenta?
How is a retained placenta managed?
A
Partial separation → intrauterine blood loss
Oxytocin infusion via umbilical cord vv
If still retained + absence of bleeding for 1hr → manually remove (under GA/Spinal)
18
Q
Define 1st - 4th degree tears
A
1st: skin only
2nd: perineal muscles
- a: <50% anal sphincter
- b: >50%
- c: internal anal sphincter involved
4th: anal sphincter + mucosa involved
19
Q
How are 1st - 4th degree tears repairs
A
1st + 2nd → local anaesthetic + sutured
3rd/4rd repaired under spinal/epidural in theatre
20
Q
What is the incidence of 3rd/4th degree tears?
What are the RFs? (3)
A
1-3% deliveries
RFs: large baby, nulliparous, forceps
21
Q
What instances are episiotomies reserved for? (not routine practice)
A
Large tear likely
Fetal distress
Failure of head to pass perineum despite effort
22
Q
What 5 factors determine the Bishops score
At what scores are interventions done?
A
Cervical dilation Cervical length Cervical consistency Cervical position (post/anterior) Station of head (relative to ischial spines)
Score ≥6 → Prostaglandins
Score <6 → ARM + Prostaglandins
23
Q
What are the 3 methods of induction of labour?
A
Prostaglandins (insert suppository in posterior fornix)
→ 2 doses max (if 1st fails), min 6hrs b/wn
ARM (amniotomy(hook) ± oxytocin)
→ if no labour induced within 2hrs, IV oxytocin
Natural induction (cervical sweeping)
24
Q
What are the fetal indications for induction? (5)
What are the materno-fetal indications? (2)
A
Prolonged pregnancy Suspected IUGR APH Poor ObHx Prelabour term rupture of membranes
Pre-Eclampsia
Maternal Diabetes
25
What are the absolute contraindications of IoL? (5)
What are the relative contraindications? (2)
```
Placenta praevia
Acute fetal compromise
Abnormal lie
Pelvic obstruction (disproportion/mass)
> 1 previous C-Section
```
Prematurity
1 previous C-Section
26
When is CTG required in IoL?
1hr CTG required 1h after induction method
| Also required if oxytocin used
27
What are some complications of Induction of Labour (5)
Failed/slowed uterine activity → Instrumental/LSCS
Uterine hyperstimulation
Amniotomy can → umbilical cord prolapse
Increased risk of PPH
Increased risk of intrapartum/postpartum infection
28
What is the incidence of prolonged pregnancies?
6-10% pregnancies ≥42wks
29
How is maternal hypotension with an epidural managed?
IV fluids + ephedrine
30
What is pyrexia (>37.5) in labour usually due to?
| When are Abx given?
Usually due to chorioamnionitis
| Abx if >38 or if other risk factors for sepsis
31
What is uterine hyperactivity assoc w.?
How is it managed?
Too much oxytocin
SE of Prostaglandins
Placental Abruption
LSCS / IV salbutamol
32
What is recorded on the partogram? (5)
```
Progress of cervical dilation
Progress of head descent
Maternal Observations
Fetal HR
Liquor colour
```
33
What is the incidence of meconium staining of liquor in normal pregnancies? (+ in prolonged pregnancies)
Why can it sometimes suggest fetal compromise
How is it graded
15%
40% in ≥42wks
Related to parasymp relaxation of anal sphincter - poss due to hypoxia
Grade 1-3 depending on liquor content and meconium consistency (thicker = worse)
34
What may affect maternal supply to the placenta? (2)
Hyperstimulation
| Spinal/epidural may → hypo perfusion of placenta
35
What may fetal hypoxia lead to intrapartum?
```
Peripheral vasoconstriction (blood → heart/brain)
ACIDOSIS (from anaerobic)
```
36
What are some neonatal complications of prolonged vasoconstriction in fetal hypoxia?
Necrotising Enterocolitis
Acute Renal Failure
Resp Distress
37
What investigations can identify fetal hypoxia?
CTG/Fetal HR (increased baseline HR - high false +ve rate)
| Fetal scalp sample
38
What are the indications for fetal scalp sampling? (4)
What cervical dilation to make scalp sampling possible?
Variable/Late/Prolonged decelerations on CTG
Signif meconium staining of liquor (Grade 2/3) PLUS CTG abnormal
Persistent fetal tachycardia
Prolonged loss of baseline variability
Cervix must be at least 2-3cm dilated
39
What are the contraindications for fetal scalp sampling? (5)
Risk of maternal infection transmission to baby
Fetal bleeding tendency
Placenta praevia
<34wks (don't want to induce labour/want to delay)
Fetal membranes intact
40
How does pH reflect fetal status?
| At what pH are interventions carried out? (and what done if borderline?)
pH = momentary
pH <7.20 → LSCS / instrumental
pH 7.20-7.25 → repeat at 30-60m
41
How does Base Excess reflect fetal status?
| What is normal value for base excess + what value reflects metabolic acidosis
Reflects longer-term change
Normal = BE > -6
Metab acidosis = BE < -8
42
What interventions done if abnormal fetal blood sample?
if in 1st stage → LSCS
| if in 2nd stage → Instrumental
43
What measures/investigations done to predict a long-term prognosis of fetal hypoxic injury? (4)
CTG (can represent time in hypoxia)
Apgar scores (immediate status - prolonged low suggestive)
Neonatal behaviour (maintenance of respiration / abnormal tone + reflexes / altered consciousness or seizures)
Neonatal brain imaging
44
What % of fetal hypoxic injuries are antenatally caused and what % caused in labour?
List some antenatal causes of fetal hypoxic injury (6)
90% antenatal, 10% in labour
```
Intrauterine infection
IUGR
Csomal / congenital abn
Coagulation disorder
APH
Prematurity
```
45
List some RFs for Fetal Compromise (13)
Placental insufficiency (IUGR/Pre-Eclampsia/Abruption)
Cord Prolapse
Uterine rupture
Pre/post-maturity
Multiple Pregnancy
Oligohydramnios
Induction
Prolonged labour
Uterine hyperstimulation
Maternal Diabetes
Maternal hypotension (e.g. epidural)
Maternal pyrexia
Chorioamnionitis
46
What general measures are done if suspect fetal compromise? (3)
L lateral position
O2
CTG (if abnormal → VE to exclude malpresentation/prolapse and to assess progress)
47
What is the management of fetal compromise due to maternal hypotension?
+ due to maternal dehydration / ketosis
+ due to uterine hyperstimulation
Hypotension → fluid bolus
Dehydration/ketosis → IV fluids
Uterine hyperstim → stop syntocin infusion + start tocolytics (salbutamol, ritodrine)
48
What are some non-medical methods of pain relief in labour? (best for early labour) (5)
```
Antenatal class prep
Back rubbing
TENS machine
Maintenance of mobility
Water at body temp
```
49
What can overuse of Entonox (gas and air) lead to?
Light-headedness
Nausea
Hyperventilation
50
Which systemic opiates can be used in pregnancy? (+ how administered?) (2)
3 disadvantages of opiate use
Pethidine + Diamorphine IM
Require anti-emetics
More sedative than analgesic
Can cause resp depression in newborn (requiring naloxone reversal)
51
Which space is an epidural inserted into?
L3/4
52
Advantages of an epidural (2)
Disadvantages of an epidural (6)
Pain-free
Can help lower BP in hypertensives
Reduced bladder sensation (can → urinary retention)
Requires midwifery supervision (check obs)
Increased incidence of instrumental deliveries
Immobility (→ pressure sores)
Hypotension
Maternal fever
53
What are 2 serious possible complications of an epidural?
Spinal tap (puncture dura mater) → CSF leakage → severe headache (worse sitting up)
Local anaesthetic into spine → total spinal analgesia + respiratory paralysis
54
Where is the local anaesthetic inserted in a spinal?
| When is a spinal done? (2)
Through dura mater into CSF b/wn L3/4
| C-Sections + Mid-Cavity instrumentals
55
What anatomical location is a pudendal nerve block inserted into?
When is it used?
Bilaterally around pudendal nerve, near ischial spines
| Low-Cavity instrumentals
56
Which type of instrumentals allow for delivery with correction of presentation (OP→OA)
Ventouse + Keillands (rotational) forceps
57
What are some maternal complications of forceps delivery? (3)
And fetal complications of forceps delivery? (3)
Vaginal laceration
3rd degree tear
Blood loss
Facial nerve damage
Scalp laceration
Skull/neck fractures
58
List 4 indications for instrumental delivery
Prolonged 2nd stage
Fetal distress
Prophylactic (avoid pushing in e.g. severe cardiac / hypertension)
Breech (forceps to after-coming head to control delivery)
59
What is the Caesarean section rate in developed countries?
20-30%
60
What cases would a rare Classical Caesarean section be carried out?
Multi-fibroids
Extreme prematurity
Transverse lie
61
Describe the anatomical incision of LSCS
Suprapubic transverse incision
62
Indications for emergency C-Section (2)
Prolonged 1st stage
| Fetal distress
63
Elective C-sections carried out at what gestation?
| What must be administered if earlier than this gestation?
39wks (maximise lung development)
| <39wks → Steroids
64
List some absolute indications for C-Section (5)
| List some relative indications for C-Section (6)
```
Placenta Praevia
Severe antenatal fetal comprimise
Uncorrectable abnormal lie
Previous vertical (Classical) C-Section
Gross pelvic deformity
```
```
Previous C-Section
Breech
Severe IUGR
Twins
Diabetes / other medical disease
Older nulliparous women
```
65
What are the operative risks of a C-Section (5)
What is the risk for subsequent pregnancies after a C-section (2)
```
Haemorrhage (/need for transfusion)
Wound / uterus infection
Bladder / bowel damage
Post-op pain/ immobility
VTE
```
Increased incidence of placenta praevia
Risk uterine rupture
66
What is placenta accreta and placenta percreta?
How are they diagnosed
```
Accreta = Placenta implanted within myometrium
Percreta = placenta implanted in surrounding structures (e.g. bladder)
```
67
What is the incidence of shoulder dystocia
What structure can shoulder dystocia lead to the damage of?
1/200
Can damage brachial plexus (→ Erb's palsy)
68
What are the RFs for shoulder dystocia (6)
Large baby (>50% cases >4kg)
Diabetes
High maternal BMI
Short women
Previous shoulder dystocia
Instrumental delivery
69
How is shoulder dystocia managed in 90%?
| How else may it be managed?
in 90% McRobert's manouvre + suprapubic pressure works
in others, poss internal manoeuvres + episiotomy
70
What are the RFs for cord prolapse? (6)
```
Preterm
Breech
Abnormal lie
Polyhydramnios
Twins
ARM
```
71
How is cord prolapse diagnosed?
Palpable cord vaginally
| Fetal HR abnormal
72
How is cord prolapse managed? (3)
Push up + position all fours
Tocolytics
Emergency LSCS / Instrumental if cervix fully dilated + head low
73
What is the incidence rate of amniotic embolism?
| And the mortality rate
1/50,000
| Mortality rate 80%
74
What happens to the mother in amniotic embolism?
```
Anaphylaxis
Sudden dyspnoea - Hypoxia / Pulm Oedema
Seizures
Hypotension / Cardiac arrest
DIC/ARDS
```
75
What are the RFs for amniotic embolism? (3)
Caesarean
Termination
Strong contractions with polyhydramnios
76
What investigations can be done for amniotic embolism? (3)
Why is Dx not usually made until post-mortem?
ECG - shows RV strain
Coag abnormal
ABG shows reduced O2
Can be confused with other causes of maternal collapse
77
What are the management steps in amniotic embolism? (RIO FFADSI)
Resuscitation
Intubation
O2 100%
```
Fluids - restore circ vol
FFP (fresh frozen plasma) - if fibrinogen low
Acidosis correction
Dopamine + Steroids - poss
ITU transfer
```
78
List some causes for massive antepartum haemorrhage (6)
3 main ones:
Placenta praevia
Placental abruption
Undetermined origin
Genital tract pathology
Vasa praevia
Uterine rupture
79
How is massive APH managed?
Replace blood losses (to normovolaemia)
Stop bleeding if poss
Correct any coagulopathy (e.g. DIC)
Delivery
80
What are the 8 principle causes of maternal deaths?
```
Infection
VTE
Hypertensive disorders
Cardiac disorders (e.g. VSD)
Ectopic pregnancy and abortion
Haemorrhage
Neurological disorders
Psychiatric disorders / suicide
```
81
What are the 5 principle causes of perinatal mortality?
```
Unexplained antepartum stillbirth
IUGR
Prematurity
Congenital abnormalities
Intrapartum hypoxia
Antepartum haemorrhage
```
82
What proportion of multiple pregnancies are Dizygotic
What proportion of monozygotics are mono/dichorionic
2/3rds DZ (dichor/diamnio)
70% DZ monichorionic diamniotic
30% DZ dichorionic diamniotic
83
What 3 antenatal problems are commoner in multiple pregnancy?
Anaemia
Gestational Diabetes
Pre-Eclampsia
84
What further increases the risk of mortality / long-term handicap in multiple pregnancies? (3)
Preterm
IUGR
Monochorionic
85
List some complications of MC (monochorionic) twins (3)
Twin-twin transfusion syndrome
IUGR
Congenital abnormalities
86
What is the main cause of death in monoamniotic twins
V rare but cords entangle
87
What type of twins does Twin-Twin Transfusion Syndrome occur in?
(MZ) Monochorionic Diamniotic
88
List the complications of a multiple pregnancy
| Multiple Pregnancy Is A Lot More Terrible And Painful
```
Mortality (perinatal)
Preterm / miscarriage
IUGR
Abnormalities (congenital)
Malpresentation
Twin-Twin Transfusion Syndrome
APH/PPH
Pre-Eclampsia, Anaemia, DM
```
89
What is there increased risk of to the 2nd twin in delivery? (5)
```
Cord Prolapse
Breech
Placental Abruption
Tetanic uterine contraction
Hypoxia
```
90
What extra USS scans are done antenatally in multiple pregnancy?
```
USS cervix (to identify preterm risk)
Serial USS growth scans (28/32/36) checking for IUGR
```
91
How is delivery managed differently in multiple pregnancy?
if 1st not cephalic → C-section (even in uncomplicated)
36-37wks MC
37wks DC
if 1st cephalic → NVD (+try ECV for 2nd)
Syntocinon post-delivery (prevent PPH)
92
What is Twin-Twin Transfusion syndrome?
| What % of MC twins does it occur in?
Unequal disturb of blood within placenta → unequal liquor/blood/growth
Occurs in 15% MC twins
93
What features occur in the recipient in Twin-Twin Transfusion Syndrome? (6)
```
Larger,
Polyhydramnios,
Fluid overload
Cardiomegaly + heart failure
Hydrops fetalis
Polycythaemia
```
94
What features occur in the donor in Twin-Twin Transfusion Syndrome (4)
```
Smaller
Oligohydramnios
Volume depleted
Anaemia
IUGR
```
95
What are the complications of Twin-Twin Transfusion Syndrome? (4)
Late miscarriage
Severe preterm
Neurological damage
Death in utero
96
What new intervention can be done in Twin-Twin Transfusion Syndrome ( + its fetal survival rates)
Laser ablation therapy
85% one twin survives
60% both twins survive
97
What are the 3 types of Breech presentation?
Extended
Flexed
Footling
98
What are the 4 causes / aetiological circumstances in which breech may occur?
Preterm
Room to move (polyhydramnios, high parity/lax uterus)
Turning prevented (twins, fetal/uterine abnormality)
Engagement prevented (praevia, pelvic tumours)
99
List 3 complications of breech babies
Increased risk neuro handicap (regardless of delivery method)
Cord Prolapse
Trapped head
100
How/when is ECV carried out?
| What is the success rate?
37wks
Use tocolytic
CTG
Anti-D to Rh-ve
50% success rate (where fails, approx 3% spontaneously turn before delivery)
101
When/who is ECV less effective? (6)
```
Nulliparous
High uterine tone
Caucasians
Obese women
Engaged breech
Reduced liquor volume
```
102
What are the risks of ECV (5)
```
Fetal damage
Placental Abruption
Uterine Rupture
SROM
Cord entanglement
```
103
What are the contraindications to ECV? (5)
```
Fetal compromise
NVD contraindicated anyway (e.g. praevia)
Twins
Ruptured membranes
Recent APH
```
104
What are the contraindications to vaginal breech birth? (8)
```
PROM
Slow / no progress in labour (in 30%)
Lack of birth attendants
Severe prematurity
IUGR / placental insufficiency
Footling
Fetus >4kg
Fetal compromise
```
105
What is the incidence of placental abruption?
| What % are 'concealed'?
Occurs in 1% pregnancies (many undetermined APHs have element of PA)
20% concealed (haemorrhage within uterus)
106
List the RFs for placental abruption (8)
```
Pre-Eclampsia / Pre-existing Hypertension
Maternal Smoking / cocaine use
IUGR
Multiple pregnancy
High parity
Previous abruption (6% risk)
```
Trauma
Sudden reduction in uterine volume (e.g. polyhydramnios + SROM)
107
What investigations might be done (if clear clinical Dx can't be made)
CTG
FBC / Clotting
Transvaginal USS
108
What are the Signs/Symptoms of Placental Abruption
```
Dark vaginal bleeding
Abdo pain
Hard (woody), tender uterus
Tachycardia
Pallor
Signs of fetal distress / absent heart sounds
```
109
List some other possible features of major placental abruption (3)
Maternal collapse
Coagulopathy
Renal failure / reduced urine output
110
What are the principles of management in major placental abruption?
```
Fetal condition: CTG
Maternal condition: fluid balance, renal func, FBC + clotting
IV fluids
Steroids if <34wks
Early delivery
Transfuse blood ± Anti-D
```
111
How is delivery managed in placental abruption (dependant on fetal distress + gestation)
Preterm + No fetal distress → steroids (<34wks) + serial USS
No fetal distress + >37wks → IoL + amniotomy
Fetal distress → LSCS
112
What is the incidence of placenta praevia at term?
| What are the 2 classifications of placenta praevia?
0.4% pregnancies at term (many 'low-lying' at 20wks but lower uterus segment grows in 3rdT)
Marginal (lower seg, not covering os)
Major (completely/partially covering os)
113
List the RFs for placenta praevia (P SMAC SMAC)
```
Previous PP
Structural anomaly
Multiple preg
Age
C-Sec previously
Smoking
Multiparity
Assisted Conception
```
114
List the maternal complications of placenta praevia (4)
Air embolism
Haemorrhage (lower seg less able to contract/constrict)
Sepsis
115
What complication may arise with placenta praevia in a pt with previous LSCS
Praevia + previous LSCS scar → Accreta in 10%
| May → massive haemorrhage at delivery + require hysterectomy
116
What are the possible fetal complications of placenta praevia? (3)
Hypoxia
Malpresentation
Prematurity
117
What are the clinical features of placenta praevia (4)
How is it diagnosed?
Recurrent painless APHs (increase in freq)
Head high/not engaged
Post-coital / post-VE bleeding (exclude before VE)
Malpresentation
Dx USS (3D USS Dx accreta)
118
How is placenta praevia managed if presenting with bleeding?
| And if asymptomatic?
Bleeding → admission (risk massive APH)
FBC / Clotting / Cross-match / G&S / IV access
CTG
Steroids if <34wks
If asymp → delayed admission until 37wks / labour (but will need quick hosp access)
Both → delivery by C-Section 39wks
119
What are some indications for earlier C-Section in placents praevia (3)
≥37wks
Maternal/fetal compromise
Massive bleed (>1.5L) ± continuing
120
How is a C-Section carried out in accreta/percreta?
Incision should avoid placenta,
| if accreta - leave placenta in situ or consent for hysterectomy
121
List some other causes of APH (3)
Undetermined origin (often small placental abruptions)
Vasa praevia
Uterine rupture
Gynaecological (cervical/endometrial carcinoma)
122
Define a primary and secondary PPH
Primary = within 24hrs; >500ml vaginal + >1000ml LSCS
Secondary = 24hrs - 6wks (usually b/wn 7-14d)
123
What are the 4 categories of causes of primary PPH (TTTT)
Tone - atonic uterus
Trauma - tear (perineal, cervical, high vaginal), LSCS
Tissue - retained placenta fragments
Thrombotic disorders
124
List the RFs for primary PPH (PP PARTUM)
Prolonged labour
Previous LSCS / PPH
```
Polyhydramnios
APH (+Age)
Retained placenta
Twins (/multiple)
Uterine fibroids
Multiparity (lax uterus)
```
125
What investigations are done for primary PPH
Bloods - FBC/Clotting/Cross-match)
Obs (BP, Pulse, sats)
Urine output
VE + fundal ht
126
How is primary PPH prevented (3)
Treat anaemia during pregnancy
Identify pts at risk
Oxytocin in 3rd stage
127
What are the general management measures in primary PPH (3)
If if due to atonic uterus
If due to DIC
Rh Grp
Catheterise + estimate blood loss
Establish cause + treat
Atonic (high uterus on palp): IV syntometrine + Prostaglandins
DIC: call haematologist + keep APTT/platelets/fibrinogen over good level
128
When is the puerperium?
From delivery of placenta → 6wks after
129
List some of the physiological changes that occur in the puerperium
```
Uterus contracts + occludes vessels
Blood-stained 'lochia' discharge
Menstruation delayed (6wks due to lactation)
BP/CO/Plasma Vol return to normal (loss of oedema up to 6wks)
Hb + Haematocrit return to normal (if w/o haemorrhage)
U&Es return to normal (due to reduced GFR)
```
130
List some aspects of general care in the puerperium period
```
Mobility
Breastfeeding guidance
Check daily: lochia / BP / pulse / temp / perineal wound
Monitor any signs postnatal depression
Check FBC before discharge
Pelvic floor exercises
Analgesics for perineal wounds
```
131
List some aspects of postnatal perineal care (LADS PAIS)
```
Local cooling + topical
Anaesthetic (local)
Diclofenac suppositories
Swabs for culture
Pus drainage
Abx (broad spec)
Irrigate wound (twice/day)
Surgical repair (if gaping wound + no infection/cellulitis/exudate)
```
132
List the advantages of breast feeding
```
Cost saving
Bonding
Cancer protection (in mother)
Infection protection (neonate)
Cannot give too much
```
133
What is a secondary PPH usually due to?
| + What are the symptoms / Ix / Tx
Endometritis
S/s: Enlarged + Tender uterus, open cervical os
Ix: USS but poor (can't diff b/wn clot + placenta)
Tx: Abx / ERPC (if heavy bleeding)
134
List the causes of postpartum pyrexia (7)
```
UTI (10%)
Wound infection (C-Sec)
Endometritis
DVT
Chest infection
IV site infection
Mastitis
```
135
How long can postpartum pyrexia take to develop after birth?
When is it commonest
Symptoms
What pathogens often causative?
Up to 14d (temp ≥ 38)
Commonest after C-Sec (give props abx)
Large/tender uterus
Offensive lochia
Grp A Strep, staph, E.Coli
136
What urinary problems can occur postpartum?
UTI
Urinary retention
Fistula
Stress incontinence
137
What is the incidence of 3rd day blues + PND?
Who is more likely to get PND? (3)
What is a DDx
50% 3rd day blues
10% PND
PMH PND, after-birth problems, socially/emotionally isolated
DDx - postpartum thyroiditis
138
What bowel problems can occur after pregnancy? (4)
Constipation + haemorrhoids (in 20%)
| Incontinence / flatulence (from pudendal nn / anal sphincter damage)
139
List some RFs for postpartum bowel problems
Shoulder dystocia
Persistent OP position
Forceps
Large babies
