Post-partum care and complications Flashcards
(39 cards)
Whats meant by the term puerparium?
Period of 6 weeks after childbirth where the mothers reproductive organs return to pre-pregnant state
What are the main aspects of immediate post-partum care?
- 15-60 minute observations
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Ensure that:
- Uterus remains contracted
- Prophylactic antibiotics if needed
- Appropriate thrombopropphylaxis
- Monitoring of spinal/epidural anaesthesia
At what point do all women receive a post-natal check by the GP?
6 weeks after birth
What hormonal changes take place in the mother puerparium?
- B-HCG levels fall rapidly
- Human placental lactogen levels fall rapidly
- Pre-pregnant levels of oestrogen and progesterone reached 7 days post birth
What changes occur in the uterus post-partum?
Rapid involution - returns to pelvis and is no longer felt in the abdomen
What changes occur in the vagina post-partum?
- Initially swollen, but rapidly regains tone
- Vascularity and oedema decrease
- Rugae reappear - less prominent than nulliparous
What changes occur in the cervix poat-partum?
Os closes gradually after delivery - almost completely closed at day 10-14 post labour
What CVS changes occur in the post-partum/peurperium period?
- Cardiac output initially increases - return of blood from contracted uterus
- Plasma volume decreases - due to diuresis
- HR decreases - decreases CO in combination with decreased plasma voluem
What changes occur in the breast in the peurperium period?
Days 2-4
- Breasts become encorged
- Vascularity increases
- Areolar pigmentation increases
- Lobules enlarge
What is lochia?
Sloughed-off necrotic decidual layer mixed with blood - initially red and becomes paler as bleeding is reduced. It may last for up to 3-6 weeks
What is a primary post-partum haemorrhage?
Blood loss of >/= 500 ml from the genital tract occuring within the 24 hrs of delivery
What is regarded as secondary post-partum haemorrhage?
Excessive loss (>/= 500 ml) of blood between 24 h and 6 weeks of delivery
What are causes of primary PPH?
4 T’s - Tone, tissue, trauma, thrombin
- Uterine atony
- Genital tract trauma
- Coagulation disorders
- Large placenta
- Abnormal placental site
- Retained placenta
- Uterine inversion
- Uterine rupture
What is the most common cause of primary PPH?
Uterine atony (90%)
What is uterine atony?
Failure of uterus to contract effectively after delivery, which can lead to an acute hemorrhage, as the uterine blood vessels are not sufficiently compressed
What can cause uterine atony?
- Overdistended uterus
- Prolonged labour
- Infection
- Retained tissue
- Failure to actively manage 3rd stage labour
- Placental abruption
What gential tract trauma can lead to primary PPH?
- Tears
- Episiotomy
- Lacerations of the cervix
- Rupture of the uterus
What problems with placental site can increase the risk of primary PPH?
- Placenta praevia
- Placenta accreta
- Placenta percreta
What are antenatal risk factors for PPH?
- Previous PPH
- Previously retained placenta
- Increasedd BMI
- Para 4 or more
- Antepartum haemorrhage
- Overdistention of uterus
- Uterine abnormalities
- Maternal age >35 yrs
What are intrapartum risk factors for PPH?
- Induction of labour
- Prolonged 1st, 2nd, 3rd stage
- Use of oxytocin
- Precipitate labour
- Vaginal operative delivery
- C-section
How would you manage someone with uterine atony?
- Phyical methods to contract - bimanual compression, massage
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Medical management
- 500 mg ergometrine IV
- 40U oxytocin infusion
- Consider 800 mg misoprostol PR - if bleeding continues
- Consider 250 mg Carboprost
- Surgical management
What is the general principles to PPH management?
- Empty uterus - deliver foetus, remove placenta
- Treat atony - Massage, bimanual compression, medications
- Repair genital tract damage
What are causes of secondary PPH?
- Retained products
- Endometritis
- Tear/trauma
What are the main problems that can arise in the post-partum period?
- PPH
- VTE
- Sepsis and puerpural pyrexia
- Post-partum depression/psychosis
