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Summary Final year MD notes - post-natal care
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  • Macquarie University (MQ )

A collection suite of final obstetrics and gynaecology MD notes to ace your penultimate and final year exams! Look no further and save the stress of accessing multiple resources as this PDF collates and summarises information from several resources including but not limited to: -Talley and O�...

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Document information

  • December 4, 2023
  • 6
  • 2023/2024
  • Summary

Subjects

  • post natal
  • care
  • childbirth
  • obstetrics
  • medicine
  • final
  • student
  • year
  • post partum
  • breastfeeding
  • notes

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  • Macquarie University (MQ )
  • Unknown

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POST-NATAL CARE

Post-Partum Haemorrhage (PPH)

Definition Risk factors Preventative measures
Ø Primary PPH: blood loss > 500ml (NVD) or > 1000mL Maternal issue 2/3rd of primary PPH cannot be predicted
(LSCS) in 1st 24 hrs Ø Previous PPH
Ante-natal
Ø Severe PPH: blood loss > 1000ml Ø Obesity
Ø Secondary PPH = PPH b/w 24 hrs and 6 wks Ø Pre-eclampsia Ø Treat anaemia
Ø Major obstetric haemorrhage Ø Multi-pregnancy Ø Empty bladder prior to birth (full bladder reduces contraction)
o blood loss > 2500ml Placental issue
o require transfusion > 5 units red cells Ø Placental abruption
Ø Placental accrete Peri-natal
Ø Primary within 24h birth or secondary 24h → 6w
Foetal issue 1. Prophylactic 10U IM syntocinon (once anterior shoulder seen)
Ø Large baby 2. Cord clamp + placenta delivery (support fundus and identify
Remember: Delivery itself signs of placental separation)
Ø Maternal blood volume » 7L Ø Failure to progress
Ø Blood loss of > 30% (2.1L) è critical 3. IV TXA (in high risk LSCS patients)
Ø Instrumental delivery
Ø Placenta 600-700mL blood loss/min Ø GA
Ø Episiotomy



Active Mx of PPH
Listen and clarify handover [patients may NOT present classically]
How to stop the bleed – pharmacotherapy - uterotonics?
Ø Turn lights on
1) Ø Elicit concerns – where is baby? Any complications w/ delivery? *CONTINUE uterine massage
o Ask how they are feeling? – SOB, light-headed?
Ø Obtain ante-natal card
1st line = increase uterine contraction
Recognise ED ® SEND FOR HELP
• Check vitals (↑HR, ↑RR, ↓sats, ↓BP) 1. 250µg ergometrine IM or Ergometrine = arterial A/E = HTN, chest pain,
2) • EBL (weigh pads + swabs) slow IV injection vasoconstriction and palpitations, raynaud’s
AND/OR myometrial contraction CI: pre-eclampsia, HTN
• Palpate fundus (?boggy) + inspect vulva + placenta
Request PPH box + notify blood bank IV 40U syntocinon (500mL ) ↑ uterine tone and A/E: N/V. headache
3) 2.
infusion myometrial contraction
4) Lie Patient FLAT + keep patient warm
2nd line = Reduce blood loss due to atony if 1st line unsuccessful (exclude other causes)
A - patent
Rule of 30’s: 4.
800µg misoprostol (PR) Pg analogue → A/E: anaphylaxis, abdo
B – high FiO2 contraction pain, diarrhoea
C – 2x large bore 16G cannulas [critical] Ø HR ↑30 IM 250µg Carboprost Pg analogue → A/E: high fever, light-
• Bloods = FBC, Coags, Group + X-match Ø EBL > 30%
5) (ask for O negative for blood bank)
5. (every 15 mins – 8x doses) contraction headed, SOB
Ø SBP ↓30 CI: HTN, asthma
• IVF – warm 2L Hartman’s
Ø Hct/Hb ↓30 IV 1g TXA in 100mL ns anti-fibrinolytic → Clotting –
• Insert IDC – reduce bladder volume + 6.
measure UO prevents clot breakdown PE/Stroke/AMI

Identify causes Activate MTP By senior 4x pRBC SEE GUIDELINES
7. clinician è Hb < 70
5) Ø Continue Baseline Obs 2x FFP
Ø Weigh linen pads ® estimate blood loss Surgery – bakri balloon tamponade (PRESS against bleeding)

RF Cause Specific Mx 8. • B-lynch suture (suture uterus to compress it)
• Uterine artery embolization
Overdistension • Hysterectomy (last resort)
Ø atonic uterus
Ø Poly, macro, prolong
Ø Multi-gest, fibroids
Ø uterine Ø Uterine fundal Care after PPH:
exhaustion massage
Maternal 1) Beware of 2nd PPH (24 hrs to 12 wks post-partum) è retained POC or infection
Tone (70%) Ø precipitous Ø LOOK for what
Ø Advanced age delivery comes out – clots,
(endometritis)
Ø BMI >35 blood? a. USS (visualise retained POC) or high vag swabs (infection)
Ø drugs (GA,
Ø Hx of APH, PPH
MgSO4) b. Surgical removal of POC OR antibiotics if infection
Ø IoL, instrumental
2) CVS – vitals, fundal tone, weigh pads, DIC (bleed + clots)
Ø Precipitous bith
Ø Instrumental Ø vaginal / cervix Inspect genital tract ® a. Check fluid intake + urine output
Trauma
/ perineal lacerations 3) Resp – RR, sats, LOC
(19%) Ø Episiotomy lacerations haematomas
Ø LSCS 4) Renal – fluid restriction, haematuria, oliguria
Ø retained 5) Patho- FBC, EUC, LFT, coags
Ø retained placenta
Tissue placenta, Assess placenta and 6) Psych Support – depression, social support
Ø placenta accrete
(10%) membrane or membranes
Ø Manual removal clots
7) Exercise + Ted Stockings, mobilise

Ø pre-eclampsia
Thrombin DIC or VWF, ↓plt MTP + ROTEM
(1%) Ø amniotic fluid
Coag defects • plt, FFP, cryoppt
embolism

, O+G Abnormal Early Pregnancy Presentations




Blood products:

1) Group and X-
match (pink-
hand-labelled
tube)

2) Whole blood
(RBC, WCC, plt)

3) pRBC =severe
anaemia (Hb <70)

4) plt = <10

5) cryoppt = clot
factors
(fibrinogen def,)

6) FFP (albumin +
cryoppt) = correct
factor def of
hypovol. Shock

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