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Y4 GOSH obs CCs > Post Partum Care > Flashcards

Post Partum Care Flashcards

1
Q

What is the difference between primary PPH and secondary PPH?

A

PRIMARY = blood loss of 500ml or more from the genital tract, occurring within 24h of delivery
SECONDARY = excessive loss occurring between 24h and 6 weeks after delivery
MAJOR = loss of >1000ml

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2
Q

What are the main causes of PPH? (4 Ts)

A

TONE (most common)
-Uterine atony means the uterus is unable to contract after delivery
TISSUE
-Large placenta or abnormal placenta site (praevia, accreta)
TRAUMA
-Genital tract trauma (tears, episiotomy, lacerations to cervix, uterine rupture
THROMBIN
-Coagulation disorders (eg placental abruption, sepsis, autoimmune disease, clotting disorders)

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3
Q

What can cause uterine atony?

A

-Over-distended uterus eg polyhydramnios, twins
-Prolonged labour
-Induction
-Infection
-Retained tissue
-Failed active management of 3rd stage

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4
Q

What are some antepartum and intrapartum risk factors contributing to PPH?

A

ANTEPARTUM
-Previous PPH
-Previous retained placenta
-High BMI
-Para 4+
-Antepartum haemorrhage
-Over-distended uterus
-Uterine abnormalities
-Low-lying placenta
-Maternal age >35
INTRAPARTUM
-Induction
-Prolonged labour
-Use of oxytocin
-Instrumental delivery
-C-section

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5
Q

How is PPH managed?

A

-If placenta is retained – manual removal under GA / spinal
-Bimanual compression if bleeding is uncontrolled
-If uterine atony is the cause:
–1st line = syntocinon IV
–2nd line = ergometrine IV
–3rd line = carboprost IM
–4th line = misoprostol PR
-Fluid resus
-Surgery

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6
Q

What are the main postpartum complications?

A

-PPH
-VTE
-Eclampsia
-Septic shock
-Amniotic fluid embolus
-Uterine rupture

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7
Q

How is eclampsia managed in the post partum period?

A

-A-E, recovery position
-O2
-Bloods - FBC, U+Es, LFTs, coagulation screen
-Haemolysis –> elevated liver enzymes, low platelets

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8
Q

What is the most common causative organism of PP septic shock?

A

-Strep A

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9
Q

How is PP septic shock managed?

A

-IV broad spec abx eg cefotaxime, metronidazole, gentamicin
-Uterine evacuation if retained products noted

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10
Q

What are the signs and symptoms of amniotic embolus and how is it normally diagnosed?

A

-Collapse
-DIC
-Unaccountable bleeding
-Usually diagnosed by exclusion or at post-mortem

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11
Q

How is an amniotic embolus managed?

A

-Supportive treatment, transfer to ICU
-Correct clotting

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12
Q

What are the signs and symptoms of uterine rupture?

A

NB almost always occurs during labour, rare in primigravid patients
-Fresh vaginal bleeding
-Haematuria
-Foetal distress
-Constant severe abdo pain
-Shock

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13
Q

How is uterine rupture managed?

A

-A-E, resuscitation
-Immediate laparotomy to salvage baby –> either repair or hysterectomy

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14
Q

What are the two forms of lactation product?

A

Colostrum
-Thick yellow fluid produced from 20 weeks gestation
-High levels of secretory IgA and protein-rich
-Promotes gut maturity and immunity in the infant
-Small quantities produced following birth
Human milk
-Produced rapidly, increasing to 500ml at 5 days
-More energy efficient than formula milk

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15
Q

What factors influence early initiation of breastfeeding?

A

-Skin-to-skin contact (increases success of breastfeeding initially and also 2-3 months later)
-Feeding within the first 2 hours

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16
Q

How frequently should infants breastfeed and for how long?

A

-Varies widely
-Demand feeding should be encouraged - promotes weight maintenance and prevents hyperbilirubinaemia and breast engorgement
-Median = 8 times a day
-Exclusive breast feeding is recommended for 4-6 months

17
Q

Which viruses can the mother pass on her immunity and which can she directly pass on during breastfeeding?

A

DIRECT TRANSMISSION
-HIV
-Rubella
ANTIBODIES
-VZV
-Rubella
NO EFFECT
-HBV
-HSV
-CMV

18
Q

What benefits does breastfeeding have for both the infant and mother?

A

INFANT - reduces:
-GI illness
-UTIs
-Chest infections
-Likelihood of atopy
-Childhood leukaemia
MOTHER
-Helps uterine involution
-Reduces risk of breast cancer, ovarian cancer and osteoporosis
-Amenorrhoea

19
Q

What drugs are contraindicated or should be avoided in breastfeeding?

A

CONTRAINDICATED
-Aspirin
-Amiodarone
-Chloramphenicol
-Ergometrine (reduces lactation)
-Iodines
-Methotrexate (and other antineoplastics)
-Lithium
-Tetracycline
-Pseudophedrine
AVOID
-Acebutalol, ACEis
-Alcohol, caffeine, cocaine, marijuana
-Fluoxetine, iodine, sulphonamides

20
Q

What pattern do women’s periods follow in the post-natal period and when is contraception needed?

A

PERIODS
-Return within 5-6 weeks if not breastfeeding
-Lactational amenorrhoea means BF delays periods
-Can become pregnant before periods start
CONTRACEPTION
-Not needed within first 3 weeks - earliest ovulation occurs 28 days post-birth
-If exclusively breastfeeding, can be used as contraception

21
Q

What considerations can affect the choice of contraception in the post-natal period?

A

-COCP, patch and ring should not be used until 6 weeks post partum or breastfeeding (bear in mind risks of breastfeeding)
-IUD and IUS can start within 48h of birth
-Emergency pill can be used from 21 days
-Emergency IUD can be used from 28 days

22
Q

How common are ‘baby blues’ and how long do they last?

A

-50% of women experience a mild period of emotional instability
-Usually starts around 3 days after delivery and resolves spontaneously within 10 days
-Tearfulness, irritability, anxiety, poor sleep

23
Q

What features does postnatal depression have?

A

-Key features of depression eg low mood, anhedonia, reduced energy
-Specific parents worries eg bad mother, preoccupations about baby’s health
-Reduced affection, poor bonding
-Failure to respond to appropriate reassurance

24
Q

When should postnatal depression be screened for?

A

-Antenatally
-At 4-6 weeks post delivery
-3-4 months post delivery
RISK ASSESSMENT IS VITAL

25
Q

How does postnatal depression affect the mother’s future mental health?

A

-High lifetime risk of further depression
-25% risk of depression in subsequent deliveries

26
Q

How does puerperal psychosis tend to present?

A

-Rapid onset, usually within 2 weeks
-Early signs tend to be non-specific - insomnia, agitation, odd behaviour, fluctuating presentation, rapidly changing mood
-Florid psychosis may be rapidly progressive (develops within hours)
–Labile mood, mania, confusion, delusions, rambling
-A psychiatric emergency - significant risk to mother and child

27
Q

How common is puerperal psychosis?

A

-1 in 500 deliveries
-5% associated suicide risk and 4% infanticide risk

28
Q

What risk factors are associated with puerperal psychosis?

A

-Personal history of BAD
-Previous episode of puerperal psychosis
-1st degree relative with a history of the above

29
Q

What physiological changes occur in the postpartum period?

A

-Involution of uterus - fungus recess from below umbilicus into pelvis, no longer palpable after 2 weeks
-Lochia (=blood + necrotic decidua)
–Beware of anaemia
-Lactation (regulated by prolactin and oxytocin)

30
Q

What thresholds of Hb require treatment?

A

-Hb 80-100g/l –> oral iron
-Hb <80g/l + symptomatic –> blood transfusion
-Hb 80-100g/l + symptomatic –> iv iron

31
Q

What is endometritis and how does it present?

A

-Infection with the uterus
-Starts around day 2-10
SYMPTOMS
-Offensive vaginal loss
-Fever, malaise, rigors, headache
-Abdo pain
-Lochia stops and then gets heavier
-Secondary PPH
-Suprapubic tenderness / uterine enlargement

32
Q

What is Sheehan’s syndrome?

A

-Aka postpartum hypopituitarism
-Reduction in function of the pituitary gland following ischaemic necrosis due to blood loss and hypovolaemic shock following birth

33
Q

What is checked in the day 1 post-delivery check?

A

-Maternal obs
-Pain relief
-Observe lochia, involution, wounds
-Ensure passing urine, flatus and stool normally
-Eating and drinking
-VTE risk assess
-Encourage mobility
-Assess for anaemia
-Anti-D if Rh-
-Mental health risk assessment

34
Q

When is the post-natal check?

A

-6 weeks after delivery

35
Q

When should mastitis be treated?

A

-If systemically unwell, nipple fissure present, symptoms not improving
-Flucloxacillin 10-14 days
-Affects 1 in 10
-Can be caused by engorgement and blocked ducts

Y4 GOSH obs CCs (18 decks)

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