Postpartum (Puerperium) Complications
Post Partum Haemorrhage (PPH)
Definition
PV loss >500ml in 1st 24h from birth till 6w post
Aetiology
T one (Atonic uterus)
T issue (placental remnants prevent myometrial retraction)
T rauma
T hrombin
Risk Factors
Diagnosis
Management
Prevent: prohphylatic oxytocin, avoid fundal fiddling
Treat:
Postpartum Infections
Definition
Temp >/= 38oC for >24h 10d post partum
Aetiology
Diagnosis
Management
Thromboembolism
Usually day 5 - 15 postpartum - DVT/ PE (1/6000)
Clinical Features
Investigation
Management
Psychiatric
Third-day blues
PND
PND (Psychotic)
Source
Llewellyn-Jones 9th Edition 2010
Definition
PV loss >500ml in 1st 24h from birth till 6w post
Aetiology
T one (Atonic uterus)
T issue (placental remnants prevent myometrial retraction)
T rauma
T hrombin
Risk Factors
- Prolonged labour
- Overdistension of uterus
- Antepartum haemorrhage
- Delivery via operations
- Deep GA
Diagnosis
- Excessive blood loss around 3rd stage of labour
Management
Prevent: prohphylatic oxytocin, avoid fundal fiddling
Treat:
- Upward (placenta in)/ rotary (placental out) fundal massage (move clots)
- GA --> Manual removal of placental/ remnants
- Hartmann's
- Oxytocin/ Misoprostol if HTN/ Carboprost for atonic uterus)
- >1L loss, blood transfusion
Postpartum Infections
Definition
Temp >/= 38oC for >24h 10d post partum
Aetiology
- Anaerobic strep (85%) - vaginal flora
- E coli (5%) - rectum
- Staphylococci (5%) - elsewhere
- CMV - endometrium
Diagnosis
- Breast - mastitis
- MSU - UTI
- Tender uterus/ offensive lochia - endometritis
Management
- IV gentamicin + clindamycin daily
Thromboembolism
Usually day 5 - 15 postpartum - DVT/ PE (1/6000)
Clinical Features
- Low grade fever
- Tachycardia
- Pleural pain (PE)
- Calf tenderness (DVT)
Investigation
- DVT: colour enhanced doppler US
- PE: CTPA
Management
- DVT: IV heparin + Warfarin, ted stockings, leg elevation
- PE: same + refer
Psychiatric
Third-day blues
- 70%
- Emotional, irritable, miserable
- Starts D3-5, last 1w-1mo
PND
- 20%
- 1st 6mo postpartum
- Risk factors: <16y, hx depression, FHx, poor support, pregnancy complications
- Rx: Allow to vent, respite, CBT, couple therapy, antidepressants (SSRI can breastfeed)
PND (Psychotic)
- 3/1000
- Delusions, hallucinations
- Rx: Admission (preferably with baby), psychotropics (haloperidol)
Source
Llewellyn-Jones 9th Edition 2010