Puerperium Flashcards Preview

Specialities > Puerperium > Flashcards

Flashcards in Puerperium Deck (26)
Loading flashcards...
1
Q

Causes of maternal death

A

Haemorrhage by far biggest cause (developing countries)
Sepsis
Thromboembolism
Pre-eclampsia / eclampsia
Indirect causes – Heart disease (1st in UK!!)
Suicide

2
Q

what is the puerperium

A

Time from delivery to 42-days post-natal.

3
Q

changes that occur in the puerperium

A
PHYSICAL
ENDOCRINE
IMMUNOLOGICAL
PSYCHOLOGICAL
SOCIAL
4
Q

purpose of postnatal care

A

Facilitate and reassure normality for mother and baby including bonding and establishing feeding
Identify, investigate and manage abnormality
Consideration during lactation e.g. prescribing
Provide contraceptive advice
Make plans for next time!

5
Q

hormonal control of puerperium

A

E2/P/HPL/cortisol cause:

  • reversal of many changes
  • uterine involution- autolysis of endometrial lining, back in pelvis by d10, bleeding stops, resumption of menstruation
  • CVS changes
  • coag changes: fibrinolysis normal within 30mins, pro-coagulant state remains, CF increased
  • metabolic changes: IR goes immediately
6
Q

effect of hormones on breast development

A

development of glandular tissue and supporting stroma

7
Q

what inhibits PRL before delivery

A

E2

8
Q

what is contained in the colostrum

A
  • Major source IgA (mucosal type Ig)
  • Lysosyme / macrophages
  • Mod. CHO / FAT (protein)
9
Q

What is contained in breast milk

A

Incr. CHO / FAT (protein)
Lactose (glu/galactose)
Lactalbumin / Casein

10
Q

pros of breastfeeding

A
Easy / Free / Convenient
Promotes bonding
Red. Atopy
Red. Infections esp. GI
Red. Breast cancer Contraceptive
Promotes weight loss
11
Q

cons of breastfeeding

A
Not easy / convenient
Embarrassing
Painful
Drugs pass thru e.g. anti-thyroid
Perinatal infection e.g. HIV
Non delegable!
12
Q

problems with lactation

A

Failure of lactation - rare

Cracked nipples and pain - common

Acute Mastitis
Usually following cracked nipple
Staph. Aureus
Presentation - pain / red, hot breast / fever

13
Q

Mx of breast feeding problems

A

Mx - maintain feeding / expressing / antibiotics (flucloxacillin)
Breast abscess
Sequelae of left / untreated mastitis
Mx - as above BUT needs I+D

14
Q

puerperal abnormalities

A
Haemorrhagic 
Post partum haemorrhage (PPH)
Thrombo-embolic 
Deep Vein Thrombosis (DVT) / Pulmonary Embolism (PE)
Lactational
Puerperal pyrexia
Psychological
15
Q

what is a PPH

A

Blood loss > 500ml from genital tract

16
Q

3 types of PPH

A

Primary
first 24 hours

Secondary
>24 hours to 42 days

Tertiary
> 42 days

17
Q

causes of primary PPH

A

uterine atony / RPOC / trauma to gen. tract

18
Q

causes of secondary PPH

A

endometritis +/- RPOC`

19
Q

presentation of PPH

A

Excessive lochia / pain / fever

20
Q

Mx of PPH

A

Antibiotics
Analgesia
If no improvement 48 hrs: ERPC (Evacuation of retained products of conception)

21
Q

basic causes of PPH

A

tone
tissue
trauma
thrombin

22
Q

basic management of PPH

A

remedy cause
replace volume
replace O2 carrying capacity
replace CF

23
Q

RFs for VTE

A
Obesity
Older
Intercurrent illness e.g. infection / PET
Immobility
Operative delivery – CS
Previous VTE
FH VTE
Known thrombophilia
24
Q

prophylaxis of VTE

A
TED stockings
S/C heparin
early mobilisation
adequate hydration
EDUCATION, EDUCATION, EDUCATION!!
25
Q

management of VTE

A
Formal anticoagulation (Heparin and Warfarin)
Imaging to confirm (Leg Dopplers / CTPA)
26
Q

common causes of puerperal pyrexia

A
Genital tract - endometritis / perineum
Pelvis - peritonitis (ascending infection)   
UTI - esp. catheterized
Wound infection - CS
Respiratory - esp. GA
Breast - mastitis / abscess
Other: 
Venflon sites 
Epidural sites
Concurrent infection 

Non-Infective:
Physiological in first 24-48 hours (<380C)
Thrombo-embolism - DVT / PE
ALWAYS check their LEGS and CHEST!