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Postpartum haemorrhage
Postpartum haemorrhage management
Breast-feeding
Puerperal mental health
Contraception in the puerperium
100

What is primary postpartum haemorrhage?

bleeding within 24 hours of birth

from 24 hours to 12 weeks after birth is secondary

100
What medication can be used in the third stage of labour to reduce the risk and consequences of postpartum haemorrhage?
  • Active management with IM oxytocin
  • IV tranexamic acid in higher risk patients
100

What is the first line antibiotic for mastitis?

flucloxacillin

100

When is the mother’s mental health and wellbeing checked up on routinely after birth?

At the routine 6 week postnatal appointment

100

When is fertility considered to return after giving birth?

After 21 days

200

What is the classification of postpartum haemorrhage?

  • 500ml after vaginal delivery
  • 1000ml after caesarean section
200

Name 2 investigations for secondary postpartum haemorrhage

  • Ultrasound for retained products of conception
  • Endocervical and high vaginal swabs for infection
200

What 2 things can mastitis be caused by?

an obstruction or an infection

200

When is the peak of postnatal depression after birth?

3 months after

200

How effective is lactational amenorrhoea for contraception as a percentage?

Over 98% effective

300

Give 3 risk factors for Postpartum haemorrhage

  • Previous PPH
  • Multiple pregnancy
  • Obesity
  • Large baby
  • Failure to progress in the second stage of labour
  • Prolonged third stage
  • Pre-eclampsia
  • Placenta accreta
  • Retained placenta
  • Instrumental delivery
  • General anaesthesia
  • Episiotomy or perineal tear
300

Name 2 mechanical treatments used to stop the bleeding in postpartum haemorrhage

  • Rubbing the uterus through the abdomen to stimulates a uterine contraction (referred to as “rubbing up the fundus”)
  • Catheterisation (bladder distention prevents uterus contractions)
300

What is the UK department of health recommendation for the duration of exclusive breastfeeding?

First 6 months of life

300

What is the classic triad of postnatal depression?

  • Low mood
  • Anhedonia
  • Low energy
300

What are the 2 things that women must be doing in order for lactational amenorrhoea to be effective as contraception?

Fully breastfeeding and no periods

400

What are the 4 causes of postpartum haemorrhage? (T's)

Tone, trauma, tissue, thrombin

400

Name 4 surgical treatment options to stop the bleeding in postpartum haemorrhage

  • Intrauterine balloon tamponade – inserting an inflatable balloon into the uterus to press against the bleeding
  • B-Lynch suture – putting a suture around the uterus to compress it
  • Uterine artery ligation – ligation of one or more of the arteries supplying the uterus to reduce the blood flow
  • Hysterectomy is the “last resort” but will stop the bleeding and may save the woman’s life
400

Which anti-metabolite drug is contraindicated in breastfeeding?

Methotrexate

400

What is the scale used to assess postnatal depression?

Edinburgh postnatal depression scale

400

Can the progestogen-only pill/implant or the combined contraceptive pill be started any time after birth?

Only the progestogen only pill/implant (combined pill is 21 days)

500

A 32-year-old woman has a spontaneous vaginal delivery. Thirty minutes later, she is noted to have heavy vaginal bleeding. Examination reveals a firm, well-contracted uterus, but continued bleeding.

What is the most likely cause of her postpartum haemorrhage?

Genital tract trauma (e.g., cervical or vaginal laceration).

500

Name 5 medical treatments used to stop the bleeding in postpartum haemorrhage

  • Oxytocin (slow injection followed by continuous infusion)
  • Ergometrine (intravenous or intramuscular) stimulates smooth muscle contraction (contraindicated in hypertension)
  • Carboprost (intramuscular) is a prostaglandin analogue and stimulates uterine contraction (caution in asthma)
  • Misoprostol (sublingual) is also a prostaglandin analogue and stimulates uterine contraction
  • Tranexamic acid (intravenous) is an antifibrinolytic that reduces bleeding
500

A mother reports painful cracked nipples, on examination there is nipple damage and white plaques in the infant’s mouth, what is the most likely diagnosis and management?

  • Oral thrush (candida)
  • Topical antifungal cream for mother, in infant oral miconazole or oral nystatin
500

What is the management for a mother who is 2 weeks postpartum and has psychotic symptoms with no relevant history?

Hospitalisation in mother and baby unit

500

When can the combined pill be started after birth for women that are breastfeeding?

When can the copper coil/IUS be inserted after birth?

combined - After 6 weeks

copper coil - Within the first 48 hours of birth or more than 4 weeks after birth