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Questions and Answers
Which condition is NOT classified as a complication of puerperium?
Which condition is NOT classified as a complication of puerperium?
What is a common sign of infection during the puerperium?
What is a common sign of infection during the puerperium?
Which of the following is considered a severe complication that can occur during the puerperium?
Which of the following is considered a severe complication that can occur during the puerperium?
Which complication involves the retained placenta or products of conception?
Which complication involves the retained placenta or products of conception?
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Puerperal sepsis is primarily characterized by what symptom?
Puerperal sepsis is primarily characterized by what symptom?
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What is the role of midwives in the context of puerperal complications?
What is the role of midwives in the context of puerperal complications?
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Which condition is characterized by the presence of abscess formation in the breast?
Which condition is characterized by the presence of abscess formation in the breast?
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What is a primary cause of cardiogenic shock?
What is a primary cause of cardiogenic shock?
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Which of the following describes a characteristic of neurogenic shock?
Which of the following describes a characteristic of neurogenic shock?
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Which symptom is more commonly associated with septic shock compared to hypovolemic shock?
Which symptom is more commonly associated with septic shock compared to hypovolemic shock?
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What is the result of decreased venous return to the heart?
What is the result of decreased venous return to the heart?
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Which physiological mechanism primarily regulates vascular tone?
Which physiological mechanism primarily regulates vascular tone?
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What is the primary cause of primary post-partum hemorrhage (PPH)?
What is the primary cause of primary post-partum hemorrhage (PPH)?
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Which risk factor is associated with uterine atony?
Which risk factor is associated with uterine atony?
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What volume of blood loss classifies as major primary post-partum hemorrhage?
What volume of blood loss classifies as major primary post-partum hemorrhage?
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Which of the following is NOT one of the '4 T's' associated with primary post-partum hemorrhage?
Which of the following is NOT one of the '4 T's' associated with primary post-partum hemorrhage?
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Which type of delivery is most commonly associated with trauma that can lead to primary post-partum hemorrhage?
Which type of delivery is most commonly associated with trauma that can lead to primary post-partum hemorrhage?
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What term is used to describe the retention of placental tissue after delivery?
What term is used to describe the retention of placental tissue after delivery?
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Which condition is an example of a coagulopathy that can lead to primary post-partum hemorrhage?
Which condition is an example of a coagulopathy that can lead to primary post-partum hemorrhage?
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What should be done to manage the risk of primary post-partum hemorrhage after delivery?
What should be done to manage the risk of primary post-partum hemorrhage after delivery?
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How is primary post-partum hemorrhage defined in terms of blood volume?
How is primary post-partum hemorrhage defined in terms of blood volume?
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Which action is not recommended when managing a patient with suspected unsafe abortion?
Which action is not recommended when managing a patient with suspected unsafe abortion?
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What should be done if a patient is in shock?
What should be done if a patient is in shock?
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What is the definition of unsafe abortion?
What is the definition of unsafe abortion?
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Which medication should be administered if the patient is bleeding with products of conception?
Which medication should be administered if the patient is bleeding with products of conception?
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What is one of the incidence statistics related to unsafe abortion?
What is one of the incidence statistics related to unsafe abortion?
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What is an essential component of counseling for a patient after unsafe abortion?
What is an essential component of counseling for a patient after unsafe abortion?
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If manual vacuum aspiration (MVA) is not available, what is the next recommended step?
If manual vacuum aspiration (MVA) is not available, what is the next recommended step?
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Which fluid is typically used to prevent hypovolemia in these cases?
Which fluid is typically used to prevent hypovolemia in these cases?
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What is one of the symptoms the caregiver needs to monitor for after an unsafe abortion procedure?
What is one of the symptoms the caregiver needs to monitor for after an unsafe abortion procedure?
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How often should pulse and respiration be checked in a patient undergoing management for unsafe abortion?
How often should pulse and respiration be checked in a patient undergoing management for unsafe abortion?
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Which initial laboratory test is NOT included in the evaluation of primary post-partum haemorrhage?
Which initial laboratory test is NOT included in the evaluation of primary post-partum haemorrhage?
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What does the 'T' in TRIM stand for in the management of primary post-partum haemorrhage?
What does the 'T' in TRIM stand for in the management of primary post-partum haemorrhage?
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Which of the following is an important part of the resuscitation phase in primary post-partum haemorrhage?
Which of the following is an important part of the resuscitation phase in primary post-partum haemorrhage?
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What is the recommended frequency for monitoring vital signs in a patient with primary post-partum haemorrhage?
What is the recommended frequency for monitoring vital signs in a patient with primary post-partum haemorrhage?
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Which of the following measures is NOT considered a pharmacological method to address uterine atony?
Which of the following measures is NOT considered a pharmacological method to address uterine atony?
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What is the initial approach to securing the airway in a patient experiencing primary post-partum haemorrhage?
What is the initial approach to securing the airway in a patient experiencing primary post-partum haemorrhage?
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What is considered a last resort surgical intervention for managing primary post-partum haemorrhage?
What is considered a last resort surgical intervention for managing primary post-partum haemorrhage?
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Which team members are essential during the immediate management of primary post-partum haemorrhage?
Which team members are essential during the immediate management of primary post-partum haemorrhage?
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What is the purpose of performing catheterization in a patient with primary post-partum haemorrhage?
What is the purpose of performing catheterization in a patient with primary post-partum haemorrhage?
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Which of the following is emphasized as a response during investigation and monitoring of a patient with primary post-partum haemorrhage?
Which of the following is emphasized as a response during investigation and monitoring of a patient with primary post-partum haemorrhage?
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Study Notes
Complicated Midwifery II (Abnormal Puerperium, BMP 311)
- Third year, first semester course outline
- Course designed for students to recognize conditions deviating from normal during puerperium.
- Course emphasizes midwives' roles in early diagnosis, appropriate intervention, and referral.
Unit I: Complications of Puerperium
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Breast complications:
- Subinvolution
- Wound abscess and hematoma
- Primary and secondary postpartum hemorrhage
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Puerperal pyrexia:
- Fever and associated symptoms during puerperium
-
Puerperal sepsis:
- Infection during puerperium
- Pelvic abscess: -Collection of pus in the pelvic region
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Endometritis:
- Uterine wall infection
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Deep Venous Thrombosis (DTV)/Thrombophlebitis:
- Blood clot forms in a deep vein
- Severe anemia: Low hemoglobin levels
- Thrombophlebitis: Inflammation of a vein with a blood clot
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Puerperial psychosis/depression:
- Mental health conditions postpartum
- Shock: Severe low blood pressure
- Amniotic fluid embolism (AFE): Amniotic fluid entering the circulatory system
- Disseminated intravascular coagulation (DIC): Abnormal blood clotting throughout the body
- Eclampsia: Severe pregnancy complication with seizures
- Retained placenta/product of conception: Uterus failing to contract after delivery
Acute Puerperal Mastitis
- Inflammation of the breast, possibly leading to abscess formation
- Staphylococcus aureus is a common cause
Breast Abscess
- Accumulation of pus in the breast, often a consequence of mastitis.
- Typically painful, edematous, and inflamed.
Breast Engorgement
- Breast swelling and fullness after childbirth, often painful.
- May be related to inefficient breastfeeding or suckling
Inefficient Feeding/Suckling
- Poor suckling reflex
- Incorrect attachment/positioning
- Delayed initiation of breastfeeding
- Sudden cessation of breastfeeding
Complications of Puerperium
- Infection or pre-existing illness can interfere with the patient's well-being.
- Infections include pelvic infection, mastitis, and breast abscesses.
- Thromboembolism can occur frequently during the 6-week puerperium
Acute Puerperal Mastitis
- Inflammation of the breast, externally painful,
- May lead to abscess formation.
- Staphylococcus aureus is the primary pathogen.
- Typically occurs after the 8th postnatal day.
Breast Abscess-
- Pus accumulation within the breast-
- Usually a complication of mastitis
Post-Partum Haemorrhage
- Blood loss of 500ml or more within 24 hours of delivery.
- Leading cause of maternal mortality in low-income countries
Primary vs Secondary Postpartum Hemorrhage
- Primary PPΗ: Severe blood loss within the first 24 hours.
- Secondary PPΗ: Excessive bleeding lasting up to 12 weeks postpartum.
Causes of Secondary PPH
- Uterine infection (endometritis)
- Retained placental fragments/tissue
- Abnormal involution of the placental site
- Trophoblastic disease
Clinical features of Secondary PPH
- Excessive vaginal bleeding (slight spotting to severe hemorrhage)
- Presence of pain
- Foul smelling lochia (discharge)
- Abdominal tenderness
Investigations
- Full Blood Count
- Urea and electrolytes
- C-Reactive Protein
- Coagulation profile
- Group and Save and Blood Cultures
Management
- Prompt Treatment
- Antibiotic medication
- Uterotonic drugs
- Surgical intervention if necessary
Prevention
- Proper hygiene
- Attention to hand-washing
- Early treatment of infections or illness
Abortion
- Common cause of bleeding in early pregnancy
- Significant cause of maternal mortality worldwide.
- Definition: Loss of pregnancy before 24 weeks of gestation
(1) Threatened Abortion
- Signs and symptoms:light bleeding.
- Management: Bed rest. Observe regularly.
(II) Inevitable Abortion
- Signs and symptoms:heavy bleeding.
- Management: Expectant or MVA; urgent
(III) Incomplete Abortion
- Signs and symptoms:persistent bleeding, dilated cervix.
- Management: MVA or D&C
(IV) Missed Abortion
- Signs and symptoms:no bleeding, dilated cervix
- Management: evacuation, D&C
(V) Habitual Abortion
- Signs and symptoms:recurring miscarriage
- Management: investigate
(6) Rupture of the Uterus
- Signs and symptoms:severe, persistent pain.
- Management: urgent laparotomy or hysterectomy
(7) Ectopic pregnancy
- Signs and symptoms:vaginal bleeding.
- Management: Immediate referral and surgery.
(8) Placenta previa
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Signs and symptoms:vaginal bleeding
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Management urgent referral, surgical intervention
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(9) Abruptio placentae
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Signs and symptoms:pain, bleeding
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Management: urgent referral, surgery.
Puerperal Psychosis
- Rare but severe mental health disorder affecting women after childbirth.
- Sudden onset, marked by severe behavioral issues including hallucinations and delusions.
Obstetric Shock
- Life-threatening emergency conditions during pregnancy, labor, and the postpartum period.
- Characterized by inadequate tissue perfusion.
Causes of Shock
- Blood loss (hemorrhage)
- Fluid loss (dehydration)
- Cardiogenic issues (heart conditions)
- Allergic reactions (anaphylactic shock)
- Infections (septic shock)
- Spinal injuries, autonomic shock
Management of Shock
- Immediately treat cause
- Secure and maintain airway
- Rapid fluid replacement
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Description
Test your knowledge on the complications of puerperium, including signs of infection and severe conditions that may arise. This quiz covers critical aspects such as the roles of midwives and various shock types in postpartum scenarios. Ensure you understand these important concepts in maternal health.
