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Questions and Answers
What is the main purpose of this course?
What is the main purpose of this course?
To prepare the student to recognize conditions that suggest deviation from normal during puerperium.
Which of the following is NOT a complication of puerperium discussed in the lecture?
Which of the following is NOT a complication of puerperium discussed in the lecture?
What is the most common infectious organism associated with acute puerperal mastitis?
What is the most common infectious organism associated with acute puerperal mastitis?
Breastfeeding should always be stopped if pus is found in the milk.
Breastfeeding should always be stopped if pus is found in the milk.
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What is the most common cause of primary postpartum hemorrhage?
What is the most common cause of primary postpartum hemorrhage?
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Which of the following is a major risk factor for uterine atony?
Which of the following is a major risk factor for uterine atony?
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Secondary postpartum hemorrhage typically occurs within the first 24 hours after delivery.
Secondary postpartum hemorrhage typically occurs within the first 24 hours after delivery.
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Which of the following is NOT a risk factor for developing secondary postpartum hemorrhage?
Which of the following is NOT a risk factor for developing secondary postpartum hemorrhage?
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What is the main clinical symptom of secondary postpartum hemorrhage?
What is the main clinical symptom of secondary postpartum hemorrhage?
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Obstetric hemorrhage only refers to bleeding that occurs during labor.
Obstetric hemorrhage only refers to bleeding that occurs during labor.
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Which of the following is the most common cause of maternal death in Nigeria?
Which of the following is the most common cause of maternal death in Nigeria?
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Most cases of obstetric hemorrhage occur in the first 24 hours after birth.
Most cases of obstetric hemorrhage occur in the first 24 hours after birth.
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What is the term used for the termination of a pregnancy before 24 weeks of gestation?
What is the term used for the termination of a pregnancy before 24 weeks of gestation?
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Which of the following is a risk factor for developing an ectopic pregnancy?
Which of the following is a risk factor for developing an ectopic pregnancy?
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Septic abortion is a complication of complete abortion.
Septic abortion is a complication of complete abortion.
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What is the most common cause of bleeding in early pregnancy?
What is the most common cause of bleeding in early pregnancy?
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Which of the following is a risk factor for developing unsafe abortion?
Which of the following is a risk factor for developing unsafe abortion?
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Unsafe abortion is a leading cause of maternal death worldwide.
Unsafe abortion is a leading cause of maternal death worldwide.
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Which of the following is a potential immediate effect of unsafe abortion?
Which of the following is a potential immediate effect of unsafe abortion?
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What is the term for a fever greater than or equal to 38°C within six weeks postpartum?
What is the term for a fever greater than or equal to 38°C within six weeks postpartum?
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Which of the following is NOT a common cause of puerperal sepsis?
Which of the following is NOT a common cause of puerperal sepsis?
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A pelvic abscess is a common complication of pelvic inflammatory disease.
A pelvic abscess is a common complication of pelvic inflammatory disease.
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Which of the following is usually the first-line treatment for a pelvic abscess?
Which of the following is usually the first-line treatment for a pelvic abscess?
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Endometritis is a common cause of infection after childbirth.
Endometritis is a common cause of infection after childbirth.
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Which of the following is NOT a common risk factor for developing endometritis?
Which of the following is NOT a common risk factor for developing endometritis?
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Venous thrombosis is a blood clot that forms within a vein.
Venous thrombosis is a blood clot that forms within a vein.
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What is the term for a blood clot that breaks loose and travels in the blood?
What is the term for a blood clot that breaks loose and travels in the blood?
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Which of the following is NOT a common cause of venous thrombosis?
Which of the following is NOT a common cause of venous thrombosis?
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Puerperal psychosis is a common postpartum complication.
Puerperal psychosis is a common postpartum complication.
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What is the term for a sudden collapse of a woman due to circulatory failure?
What is the term for a sudden collapse of a woman due to circulatory failure?
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Which of the following is NOT a potential cause of obstetric shock?
Which of the following is NOT a potential cause of obstetric shock?
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The management of shock should include the use of fluids to replace lost blood volume.
The management of shock should include the use of fluids to replace lost blood volume.
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Which of the following is a common nursing diagnosis associated with shock?
Which of the following is a common nursing diagnosis associated with shock?
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The anti-shock garment is primarily used to control bleeding in the upper body.
The anti-shock garment is primarily used to control bleeding in the upper body.
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Which of the following is a contraindication for using the anti-shock garment?
Which of the following is a contraindication for using the anti-shock garment?
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Anaemia is a common medical condition that can occur during pregnancy.
Anaemia is a common medical condition that can occur during pregnancy.
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Which of the following is NOT a common clinical symptom of anaemia?
Which of the following is NOT a common clinical symptom of anaemia?
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The best way to prevent anaemia during pregnancy is to avoid iron supplements.
The best way to prevent anaemia during pregnancy is to avoid iron supplements.
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Which of the following conditions is NOT a potential complication of severe anaemia during pregnancy?
Which of the following conditions is NOT a potential complication of severe anaemia during pregnancy?
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Study Notes
LECTURE NOTE ON COMPLICATED MIDWIFERY II
- This lecture note details abnormal puerperium and is part of BMP 311.
- The target audience is third-year, first-semester basic midwives.
- The document covers the 2019 set of Basic Midwives curriculum.
INTRODUCTION
- The course aims to equip students to identify conditions deviating from normal puerperium.
- It emphasizes the role of midwives in early diagnosis, appropriate intervention, and referrals.
- The course also highlights their role in emergency and operative interventions.
OBJECTIVES
- Students will demonstrate competence in early diagnosis and appropriate intervention, and referral for puerperium complications.
COURSE CONTENT (UNIT I)
-
Breast Complications:
- Sub-involution
- Breast abscess and hematoma
-
Postpartum Hemorrhage:
- Primary and secondary
-
Puerperal Pyrexia:
- Infection leading to fever during puerperium
-
Puerperal Sepsis:
- Infection following childbirth
-
Pelvic Abscess:
- Infection in the pelvic area
-
Endometritis:
- Inflammation of the uterine lining
-
Deep Venous Thrombosis (DVT)/Thrombophlebitis:
- Blood clot in a deep vein
-
Severe Anemia:
- Low red blood cell count
-
Thrombophlebitis:
- Inflammation and clot formation in a vein
-
Puerperal Psychosis/Depression:
- Mental health conditions
-
Shock:
- Life-threatening condition
-
Amniotic fluid embolism (AFE):
- Fluid from the amniotic sac entering the bloodstream
-
Disseminated intravascular coagulation (DIC):
- Abnormality of blood clotting
-
Eclampsia:
- High blood pressure during pregnancy
-
Retained placenta/product of conception:
- Placenta or membranes not completely expelled
BREAST COMPLICATIONS (Page 3, 4)
-
Acute Puerperal Mastitis:
- Breast inflammation
- Common cause: Staphylococcus aureus
- Symptoms: Rapid onset, fever, throbbing pain, indurated area
-
Breast Engorgement:
- Breast swelling and hardness
- Causes: Inefficient feeding, delayed breastfeeding
- Treatments: Warm compresses, gently expressing milk, support with binder or brassiere
-
Breast Abscess:
- Collection of pus in the breast
- Causes: Untreated mastitis, nipple cracks.
- Treatment: Surgical incision and drainage with antibiotics.
COMPLICATIONS OF PUERPERIUM (Page 3)
- Usually, women recover well but existing health problems or infection can affect the patient's status.
- There are complications encountered during pregnancy that can happen more often Post-partum.
BREAST ABSCESS (Page 6)
- Accumulation of pus in the breast
- Most common in lactating women
- Causes: Mastitis, untreated infection from the breast or baby, cracked nipples in lactating and non-lactating women
- Symptoms: Pain, redness, swelling, warm skin, pus discharge, fever
- Diagnosis: History and physical examination
ACUTE PUERPERAL MASTITIS (Page 4)
- Inflammation of the breast
- Symptoms: Fever, rapid pulse, sharp pain/tenderness
- Treatment: Antibiotic and analgesic if pus is present.
- Prevention: Proper feeding, supportive care
HAEMATOMA (Page 10)
- Blood accumulation in the uterus
- Types: Subchorionic, retroplacental
- Causes: Placental separation and cord insertion, large subchorionic hematomas.
POST-PARTUM HAEMORRHAGE (Page 10)
- Blood loss of >500ml within 24 hours of delivery
- Causes: Uterine atony, retained placental fragments, uterine trauma, coagulopathies
- Risk Factors: Maternal profile, over-distension, induction labour, placental abnormalities
- Management: Measures for uterine tone, prevention of retained tissue, management of trauma.
PRIMARY POST-PARTUM HAEMORRHAGE (Page 10)
- Blood loss >500ml vaginally within 24 hours of delivery
- Classification: Minor (500–1000 ml) and major (>1000ml)
- Causes: Uterine atony, retained tissue, trauma, thrombopathy
SECONDARY POST-PARTUM HAEMORRHAGE (Page 14)
- Blood loss 24 hours after delivery to 12 weeks postpartum.
- Causes: Retained placental fragments, infection (endometritis), placental site abnormality
ABORTION (Page 17-28, 29-30)
- Common reasons for induced abortion include:
- Non-usage of family planning methods,
- Failure of contraception.
- Lack of access to contraceptives.
- Unwanted pregnancy due to financial difficulties
- Fear of parent's reaction to pregnancy
- Unwanted pregnancy for other social or personal reasons
- Methods: Use of drugs, vaginal interference. These are unsafe.
- Unsafe abortions commonly result in medical or mental health problems.
- Complications: Infection (septic abortion), injuries.
- Management: Antibiotics, surgical procedures.
- Prevention: Family planning counseling
PUERPERAL PSYCHOSIS (Page 49)
- Rare mental health disorder in postpartum period
- Symptoms: Bizarre behavior, hallucinations, inability to sleep, harm to baby.
- Treatment: Psychiatric hospital admission under consultant care.
OBSTETRIC SHOCK (Page 49)
- Life-threatening condition due to insufficient blood flow to organs.
- Causes: Haemorrhage, infection, hypersensitivity reactions.
- Symptoms: Decreased blood pressure, rapid pulse, cold/clammy skin, restlessness
ANEMIA IN PREGNANCY (Page 66)
- Low red blood cell count during pregnancy
- Symptoms: Weakness, dizziness, shortness of breath, and pale skin
THROMBOPHLEBITIS (Page 47)
- Inflammation of a vein with a blood clot
- Causes: Blood clotting disorders, prolonged immobility, pregnancy, high estrogen levels.
- Symptoms: Pain, swelling, redness along the vein, tenderness
- Management: Rest, elevation of the affected limb, compression, anti-coagulants
PUERPERAL PYREXIA (Page 53)
- Fever during the postpartum period (within 6 weeks post-delivery).
- Causes: UTI, mastitis, retained placental tissue complications.
- Management: Identification of the cause, treatment (antibiotics as appropriate).
PELVIC ABSCESS (Page 37)
- Localized collection of pus in the pelvic cavity.
- Causes: Operative procedures, infection.
- Symptoms: Fever, lower abdominal pain, vaginal discharge, vaginal bleeding.
- Management: Surgical drainage, antibiotics, supportive care.
PUERPERAL SEPSIS (Page 36-37)
- Infection of the genital tract after childbirth.
- Causes: Infection, retention of placental fragments, trauma or retained products
- Symptoms: Fever, abdominal pain, foul vaginal discharge, tachycardia, etc
- Management: Antibiotics (IV), supportive care , monitor vital signs
Other Topics
- Miscellaneous topics are included as part of the lecture notes and some are mentioned above with specific details, as a guide for the learners.
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Description
This lecture note covers abnormal puerperium, focusing on the role of midwives in identifying and managing complications following childbirth. Designed for third-year midwifery students, it aligns with the 2019 Basic Midwives curriculum and emphasizes early diagnosis and interventions for various conditions. Key topics include breast complications, postpartum hemorrhage, puerperal pyrexia, and sepsis.
