Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

EVERYTHING YOU NEED TO KNOW ABOUT MUM AND BABY Shazia & Maria Here’s what we do: ■ Weekly tutorials open to all! ■ Focussed on core presentations and teaching diagnostic technique If you’re new here… ■ Bstudentsl students, for medical ■ Reviewed by doctors to ensure W elcome to accuracy T eaching ■ We’ll keep you updated about our Things! upcoming events via email and groupchats! PERI-LABOUR COMPLICA TIONS ShaziaWhat we’ll talk aboutWhat we’ll talk about Things going wrong before delivery: PROM Abruption Chorioamnionitis + GBS Induction of labourWhat we’ll talk about Things going wrong before delivery: Things going wrong after delivery: Abruption PPH Chorioamnionitis + GBS Induction of labourWhat we’ll talk about Things going wrong before delivery: Things going wrong after delivery: PROM PPH Abruption Chorioamnionitis + GBS Induction of labour Things we won’t go through but definitely look at: Breech presentations Uterine rupture Umbilical cord prolapse Uterine prolapse Amniotic fluid embolism Uterine inversion Placenta praevia Perineal tears Vasa praevia Placenta accretaDefinitions Pre-term: Post-term:Definitions Pre-term: < 37 weeks Post-term: > 42 weeksDefinitions Pre-term: < 37 weeks Post-term: > 42 weeks PPROM: PROM:Definitions Pre-term: < 37 weeks Post-term: > 42 weeks PPROM: Pre-term pre-labour rupture of membranes PROM: Pre-labour rupture of membranesDefinitions Pre-term: < 37 weeks Post-term: > 42 weeks PPROM: Pre-term pre-labour rupture of membranes Rupture of membranes before < 37 weeks PROM: Pre-labour rupture of membranes Rupture of membranes > 1 hour before onset of labour i.e. regular contractionsPROM/PPROM Risk factorsPROM/PPROM Risk factors Multiple pregnancies Pre-eclampsias IUGR Placental abruption Fibroids Previous PROM/PPROM Infections Smoking AmniocentesisPROM/PPROM Risk factors Multiple pregnancies Pre-eclampsias IUGR Placental abruption Fibroids Previous PROM/PPROM Infections Smoking AmniocentesisPROM/PPROM InvestigationsPROM/PPROM Investigations Infection: high vaginal swab Fetal fibronectin: protein that acts as glue to hold amniotic sac to endometrium - if > 200 indicates increased risk of PPROM/PROM Examination: sterile speculum only, no DVE - pooling of fluid in vaginal vault - if no pooling: test fluid for PAMG-1/IGFBP-1 with actim-PROM vaginal swab USS: oligohydramniosPROM/PPROM Investigations Infection: high vaginal swab Fetal fibronectin: protein that acts as glue to hold amniotic sac to endometrium - if > 200 indicates increased risk of PPROM/PROM Examination: sterile speculum only, no DVE - pooling of fluid in vaginal vault - if no pooling: test fluid for PAMG-1/IGFBP-1 with actim-PROM vaginal swab USS: oligohydramniosPROM/PPROM ManagementPROM/PPROM Management > 36 weeks 34-36 weeks < 33 weeksPROM/PPROM Management > 36 weeks 34-36 weeks < 33 weeks Monitor for signs of PO erythromycin for 10 days PO erythromycin for 10 days chorioamnionitis Corticosteroids – why? Corticosteroids Induction of labor if not occurred within 24 hours Expectant management until > 34 weeksPROM/PPROM Management > 36 weeks 34-36 weeks < 33 weeks Monitor for signs of PO erythromycin for 10 days PO erythromycin for 10 days chorioamnionitis Corticosteroids – Corticosteroids Induction of labor if not encourages fetal surfactant occurred within 24 hours production! Expectant management until > 34 weeksPROM/PPROM Management > 36 weeks 34-36 weeks < 33 weeks Monitor for signs of PO erythromycin for 10 days PO erythromycin for 10 days chorioamnionitis Corticosteroids Corticosteroids Induction of labor if not occurred within 24 hours – Expectant management until how do we know if > 34 weeks spontaneous labor likely?Induction of labour Bishops score High chance of spontaneous labour if score > ?Induction of labour Bishops score High chance of spontaneous labour if score > 8Induction of labour Bishops score High chance of spontaneous labour if score > 8 Membrane sweep before formal induction Score < 6: vaginal or oral prostaglandin OR balloon catheter Score > 6: IV oxytocin OR amniotomyChorioamnionitisChorioamnionitis Ascending bacterial infection of amniotic fluid/ membranes/ placentaChorioamnionitis Ascending bacterial infection of amniotic fluid/ membranes/ placenta Green waters on rupture of membranes High risk with PROM/PPROM Need to test for which organism?Group B streptococcusGroup B streptococcus Most likely causative organism of neonatal sepsisGroup B streptococcus Most likely causative organism of neonatal sepsis All mums tested with vaginal swab in event of PROM/PPROM or signs of infectionGroup B streptococcus Most likely causative organism of neonatal sepsis All mums tested with vaginal swab in event of PROM/PPROM or signs of infection: if found requires IV benpen/clindamycinGroup B streptococcus Most likely causative organism of neonatal sepsis All mums tested with vaginal swab in event of PROM/PPROM or signs of infection: if found requires IV benpen/clindamycin Intrapartum GBS prophylaxis if: GBS in previous pregnancy, PROM/PPROM, pyreticG3 P1+1 at 37 weeks presents with abdominal pain & slight vaginal bleeding O/E: tender, tense, hard abdomen, slight vaginal bleeding visible Obs: BP 88/60, O2 99% on room air, HR 110, RR 21What do we think? bleedingat 37 weeks presents with abdominal pain & slight vaginal O/E: tender, tense, hard abdomen, slight vaginal bleeding visible Obs: BP 88/60, O2 99% on room air, HR 110, RR 21Placental abruption bleedingat 37 weeks presents with abdominal pain & slight vaginal O/E: tender, tense, hard abdomen, slight vaginal bleeding visible Obs: BP 88/60, O2 99% on room air, HR 110, RR 21Placental abruption bleedingat 37 weeks presents with abdominal pain & slight vaginal O/E: tender, tense, hard abdomen, slight vaginal bleeding visible Obs: BP 88/60, O2 99% on room air, HR 110, RR 21Placental abruption G3 P1+1 at 37 weeks presents with abdominal pain & slight vaginal bleeding O/E: tender, tense, hard abdomen, slight vaginal bleeding visible Obs: BP 88/60, O2 99% on room air, HR 110, RR 21 Shock out of proportion to visible blood loss!Placental abruption Risk factors Abruption previously Blood pressure e.g. hypertension, pre-eclampsia Ruptured membranes e.g. PROM, PPROM Uterine injury Polyhydramnios Twins Infection Older age Narcotic usePlacental abruption Investigations Transabdominal USS to confirm CTG to monitor fetal distressPlacental abruption ManagementPlacental abruption Management A-E! Bloods requires cross match 6-8 units + clotting and coagulation < 36 weeks + fetal distress: < 36 weeks + no fetal distress: > 36 weeks + fetal distress: > 36 weeks + no fetal distress: No viable fetus:Placental abruption Management A-E! Bloods requires cross match 6-8 units + clotting and coagulation < 36 weeks + fetal distress: category 1 C-section < 36 weeks + no fetal distress: > 36 weeks + fetal distress: category 1 C-section > 36 weeks + no fetal distress: No viable fetus:Placental abruption Management Must be < 30 minutes! A-E! Bloods requires cross match 6-8 units + clotting and coagulation < 36 weeks + fetal distress: category 1 C-section < 36 weeks + no fetal distress: > 36 weeks + fetal distress: category 1 C-section > 36 weeks + no fetal distress: No viable fetus:Placental abruption Management A-E! Bloods requires cross match 6-8 units + clotting and coagulation < 36 weeks + fetal distress: category 1 C-section < 36 weeks + no fetal distress: observation + steroids > 36 weeks + fetal distress: category 1 C-section > 36 weeks + no fetal distress: vaginal delivery No viable fetus:Placental abruption Management A-E! Bloods requires cross match 6-8 units + clotting and coagulation < 36 weeks + fetal distress: category 1 C-section < 36 weeks + no fetal distress: observation + steroids > 36 weeks + fetal distress: category 1 C-section > 36 weeks + no fetal distress: vaginal delivery No viable fetus: induced vaginal deliveryRemember to look over other pre-delivery complications! Breech presentation Umbilical cord prolapse Amniotic fluid embolism Placenta praevia Placenta accreta Vasa praeviaPost partum hemorrhage Primary: Secondary: Major: Minor:Post partum hemorrhage Primary: Blood loss > 500 ml < 24 hours after delivery Secondary: Blood loss > 500 ml > 24 hours + < 12 weeks after delivery Major: Blood loss > 1000ml or shock Minor: Blood loss 500ml-1000ml + no shockPost partum hemorrhage Primary: Blood loss > 500 ml < 24 hours after delivery Secondary: Blood loss > 500 ml > 24 hours + < 12 weeksafter delivery Major: Blood loss > 1000ml or shock Minor: Blood loss 500ml-1000ml + no shockPost partum hemorrhage CausesPost partum hemorrhage Causes 4TsPost partum hemorrhage Causes 4Ts Tone: uterine atony – Most common Thrombin – coagulopathies Tissue – retained tissue TraumaPost partum hemorrhage Causes Secondary PPH: endometritis most commonPost partum hemorrhage Risk factors Previous PPH Induction of labor or prolonged labor Vasa previa, placenta previa, placental abruption Pre-eclampsia, gestational diabetes Macrosomia C-sectionPost partum hemorrhage Management Very common OSCE station!Post partum hemorrhage Management A-E!Post partum hemorrhage Management A-E! Some important questions to ask?Post partum hemorrhage Management A-E! Relevant PMHx & engaged with antenatal care Known coagulopathies EBV (estimated blood loss) Has placenta been delivered + was it intact rd Active management of 3 stage of laborPost partum hemorrhage Management A-E! Relevant PMHx & engaged with antenatal care Known coagulopathies EBV (estimated blood loss) Has placenta been delivered + was it intact Active management of 3 stage of labor rd 3 stage of labor: after delivery to full delivery of placenta Involves 10 U IM oxytocin after delivery of anterior shoulder +/-controlled cord tractionPost partum hemorrhage Management Initial measures: ABG/VBG Feel for uterine atony: soft and high up 2 wide bore cannulas: cross match 6-8 units, clotting and coagulation Flat and supine positioning Measure blood loss by weighing soaked padsPost partum hemorrhage Management Initial measures: ABG/VBG Feel for uterine atony: soft and high up 2 wide bore cannulas: cross match 6-8 units, clotting and coagulation Flat and supine positioning Measure blood loss by weighing soaked pads Don’t forget basic things: CXR, O2, CRT, BP, ECGPost partum hemorrhage Management At C: activate major obstetric hemorrhage protocol Who to call?Post partum hemorrhage Management At C: activate major obstetric hemorrhage protocol 2222 – ask for SOAPS Senior midwife, obstetrician, anesthetist, porter, scribePost partum hemorrhage Management At C: activate major obstetric hemorrhage protocol 2222 – ask for SOAPS Senior midwife, obstetrician, anesthetist, porter, scribe Don’t forget to complete D & E – glucose, PEARL, temperature, full exposurePost partum hemorrhage Management Specific managementPost partum hemorrhage Management Specific management Mechanical Pharmaceutical SurgicalPost partum hemorrhage Management Specific management Surgical Mechanical Pharmaceutical Controlled cord traction Palpation + rubbing of uterine fundus Bimanual compression of uterus CatheterizationPost partum hemorrhage Management Specific management Mechanical Pharmaceutical Surgical Controlled cord Of course traction Everyone Palpation + rubbing of uterine fundus Can Bimanual compression Make of uterus iT! CatheterizationPost partum hemorrhage Management Specific management Mechanical Pharmaceutical Surgical Controlled cord Oxytocin IV traction Ergometrine IV/IM Palpation + rubbing of uterine fundus Carboprost IM Bimanual compression Misoprostol PR of uterus iTranexamic acid IM CatheterizationPost partum hemorrhage Management Specific management Contraindications? Mechanical Pharmaceutical Surgical Controlled cord Oxytocin IV traction Ergometrine IV/IM Palpation + rubbing of uterine fundus Carboprost IM Bimanual compression Misoprostol PR of uterus iTranexamic acid IM CatheterizationPost partum hemorrhage Management Specific management Contraindications Mechanical Pharmaceutical Surgical Controlled cord Oxytocin IV traction Ergometrine IV/IM - No in hypertension! Palpation + rubbing of - No in asthma! uterine fundus Carboprost IM Bimanual compression Misoprostol PR of uterus iTranexamic acid IM CatheterizationPost partum hemorrhage Management Specific management Mechanical Pharmaceutical Surgical Controlled cord Oxytocin IV 5U traction Ergometrine IV/IM 500 Palpation + rubbing of mcg uterine fundus Carboprost IM 250 mcg Bimanual compression of uterus Misoprostol PR 1000 mcg Catheterization iTranexamic acid IM 1g Can remember doses but I wouldn’t stress!Post partum hemorrhage Management Specific management Mechanical Pharmaceutical Surgical Controlled cord Oxytocin IV Only if failed initial traction measures! Ergometrine IV/IM 1. Intrauterine balloon Palpation + rubbing of Carboprost IM tamponade uterine fundus 2. B lynch suture Bimanual compression Misoprostol PR of uterus iTranexamic acid IM 3. ligation of uterine/ internal iliac arteries Catheterization 4. HysterectomyPost partum hemorrhage Management Specific management Remember blood transfusion and IDA cut offs: Transfuse if Hb < 80 Iron supplements for 3 months if Iron < 100SBAs A 31Y G3 P2 has ongoing bleeding after a vaginal delivery. Mechanical and pharmaceutical measures have failed, and she has been brough to theatre for surgical intervention. What is the most appropriate initial intervention? A. Stepwise uterine devascularization B. B-Lynch suture C. Uterine artery embolization D. Hysterectomy E. Intrauterine balloon tamponadeSBAs A 31Y G3 P2 has ongoing bleeding after a vaginal delivery. Mechanical and pharmaceutical measures have failed, and she has been brough to theatre for surgical intervention. What is the most appropriate initial intervention? A. Stepwise uterine devascularization B. B-Lynch suture C. Uterine artery embolization D. Hysterectomy E. Intrauterine balloon tamponadeSBAs A 29Y G2 P1 presents to antenatal clinic at 22 weeks. She is concerned about her previous delivery where her baby developed GBS sepsis after delivery. What is the most appropriate steps to be taken in this pregnancy? A. IV antibiotics offered to all women during pregnancy B. Intrapartum IV benzylpenicillin C. IV antibiotics from 38 weeks D. A vaginal swab at labor to check for GBS E. Intrapartum IV erythromycinSBAs A 29Y G2 P1 presents to antenatal clinic at 22 weeks. She is concerned about her previous delivery where her baby developed GBS sepsis after delivery. What is the most appropriate steps to be taken in this pregnancy? A. IV antibiotics offered to all women during pregnancy B. Intrapartum IV benzylpenicillin C. IV antibiotics from 38 weeks D. A vaginal swab at labor to check for GBS E. Intrapartum IV erythromycinSBAs A 23Y G3P1+1 attends at 41+3 for induction of labour. On examination, her cervix is difficult to reach and is very posterior. It is long, closed and firm to touch. What is the most appropriate initial intervention? A. Terbutaline B. Amniotomy C. IV oxytocin D. Vaginal prostaglandin E2 pessary E. IM corticosteroidsSBAs A 23Y G3P1+1 attends at 41+3 for induction of labour. On examination, her cervix is difficult to reach and is very posterior. It is long, closed and firm to touch. What is the most appropriate initial intervention? A. Terbutaline B. Amniotomy C. IV oxytocin D. Vaginal prostaglandin E2 pessary E. IM corticosteroids Stages of Labour Post-partum infections Post-partum mental health MariaWhat we’ll talk aboutWhat we’ll talk about Things going wrong after delivery: Stages of labour Post-partum infections Post-partum mental healthStages of LabourStages of Labour Divided into 3 stages: 1) First stage a) Latent phase b) Active phase 2) Second Stage 3) Third stageStages of Labour 0 hr First Stage (Latent Phase) Cervical dilation from 0-3 cm Normally takes 6 hours Divided into 3 stages: ~ 6hr First Stage (Active Phase) 1) First stage Rapid cervical dilation from 3-10cm a) Latent phase Normally 1cm/hr b) Active phase 2) Second Stage 3) Third stageStages of Labour First Stage (Latent Phase) 0 hr Cervical dilation from 0-3 cm Normally takes 6 hours Divided into 3 stages: ~ 6hr First Stage (Active Phase) 1) First stage Rapid cervical dilation from 3-10cm a) Latent phase Normally 1cm/hr b) Active phase 2) Second Stage Second Stage 3) Third stage ~ 8-9hr Profession and expulsion of the foetus Prolonged Second Stage → Instrumental deliveryStages of Labour 0 hr First Stage (Latent Phase) Cervical dilation from 0-3 cm Normally takes 6 hours Divided into 3 stages: ~ 6hr First Stage (Active Phase) 1) First stage Rapid cervical dilation from 3-10cm a) Latent phase Normally 1cm/hr b) Active phase 2) Second Stage 3) Third stage ~ 8-9hr Second Stage Profession and expulsion of the foetus Prolonged Second Stage → Instrumental delivery Third Stage 5-10 min (active ~ 30 min (physiological) Delivery of the placenta either actively or physiologically Prolonged third stage (>30min) increases the risk of post-partum haemorrhage First stage of labour 0 hr First Stage (Latent Phase) Normally takes 6 hours Cervical dilation from 0-3 cm 1) Latent phase: Cervical dilation from 0-4 cm ○ ~ 8 hours for nulliparous; shorter for ~ 6hr First Stage (Active Phase) multiparous Rapid cervical dilation from 3-10cm ○ Interventions: Observation, hydration, and analgesia (e.g., paracetamol) Normally 1cm/hr First stage of labour 0 hr First Stage (Latent Phase) Cervical dilation from 0-3 cm Normally takes 6 hours 1) Latent phase: Cervical dilation from 0-4 cm ○ ~ 8 hours for nulliparous; shorter for ~ 6hr First Stage (Active Phase) multiparous Rapid cervical dilation from 3-10cm ○ Interventions: Observation, hydration, Normally 1cm/hr and analgesia (e.g., paracetamol) 2) Active phase: Rapid dilation from 4-10 cm ○ Strong contractions (~3-4 every 10 mins) ○ Fetal monitoring (CTG for distress) ○ Interventions: IV oxytocin or artificial rupture of membranes (ARM) for augmentation if progress is slow. First stage of labour 1) Latent phase: Cervical dilation from 0-4 cm ○ ~ 8 hours for nulliparous; shorter for multiparous ○ Interventions: Observation, hydration, and analgesia (e.g., paracetamol) 2) Active phase: Rapid dilation from 4-10 cm ○ Strong contractions (~3-4 every 10 mins) ○ Fetal monitoring (CTG for distress) ○ Interventions: IV oxytocin or artificial rupture of membranes (ARM) for augmentation if progress is slow. 0 hr First Stage (Latent Phase) Cervical dilation from 0-3 cm Normally takes 6 hours Second Stage ~ 6hr First Stage (Active Phase) Rapid cervical dilation from 3-10cm 1. Engagement: Fetal head enters the pelvic Normally 1cm/hr brim. 2. Descent and Flexion: Fetal head moves through the birth canal, flexing to present the ~ 8-9hr Second Stage smallest diameter. Profession and expulsion of the foetus 3. Internal Rotation: Head rotates to align with Prolonged Second Stage → Instrumental delivery the maternal pelvic outlet. 4. Extension: Baby’s head crowns and extends out of the vaginal opening. 5. Restitution: Head rotates to align with the shoulders. 6. Expulsion: Baby’s shoulders and body are delivered. 0 hr First Stage (Latent Phase) Cervical dilation from 0-3 cm Normally takes 6 hours Second Stage ~ 6hr First Stage (Active Phase) Rapid cervical dilation from 3-10cm 1. Engagement: Fetal head enters the pelvic brim. Normally 1cm/hr 2. Descent and Flexion: Fetal head moves through the birth canal, flexing to present the smallest diameter. ~ 8-9hr Second Stage 3. Internal Rotation: Head rotates to align with the maternal pelvic outlet. Profession and expulsion of the foetus 4. Extension: Baby’s head crowns and extends Prolonged Second Stage → Instrumental delivery out of the vaginal opening. 5. Restitution: Head rotates to align with the shoulders. 6. Expulsion: Baby’s shoulders and body are delivered. Interventions: Instrumental delivery (forceps/vacuum) for prolonged labor or fetal distress. Perineal support to prevent tears. 0 hr First Stage (Latent Phase) Cervical dilation from 0-3 cm Normally takes 6 hours Second Stage ~ 6hr First Stage (Active Phase) Rapid cervical dilation from 3-10cm Every New Family Is Really Excited! Normally 1cm/hr ~ 8-9hr Second Stage 1) Every: Engagement 2) New: Descent Prolonged Second Stage → Instrumental delivery 3) Family: Flexion 4) Is: Internal Rotation 5) Really: Restitution 6) Excited: Expulsion 0 hr First Stage (Latent Phase) Cervical dilation from 0-3 cm Normally takes 6 hours Second Stage ~ 6hr First Stage (Active Phase) Rapid cervical dilation from 3-10cm Normally 1cm/hr ~ 8-9hr Second Stage Profession and expulsion of the foetus Prolonged Second Stage → Instrumental delivery https://www.youtube.com/watch?v=2kM35XMMiPk Brilliant resource, ~ 3 mins 0 hr First Stage (Latent Phase) Cervical dilation from 0-3 cm Normally takes 6 hours Third Stage ~ 6hr First Stage (Active Phase) Rapid cervical dilation from 3-10cm - Active Management Normally 1cm/hr - Oxytocin 10 units IM after anterior shoulder delivery. ~ 8-9hr Second Stage - Controlled cord traction while supporting uterus to deliver the Profession and expulsion of the foetus Prolonged Second Stage → Instrumental delivery placenta. - Check placenta and membranes for completeness. 5-10 min (active Third Stage ~ 30 min (physiological) Delivery of the placenta either actively or physiologically Prolonged third stage (>30min) increases the risk of post-partum haemorrhage 0 hr First Stage (Latent Phase) Normally takes 6 hours Cervical dilation from 0-3 cm Third Stage ~ 6hr First Stage (Active Phase) Rapid cervical dilation from 3-10cm - Active Management Normally 1cm/hr - Oxytocin 10 units IM after anterior shoulder delivery. ~ 8-9hr Second Stage - Controlled cord traction while supporting uterus to deliver the Prolonged Second Stage → Instrumental delivery placenta. - Check placenta and membranes for completeness. 5-10 min (active Third Stage ~ 30 min (physiological) Delivery of the placenta either actively or physiologically Prolonged third stage (>30min) increases the risk of post-partum haemorrhage - Physiological Management - No uterotonics; placenta delivered by maternal effort. - Risk of increased postpartum hemorrhage (PPH).Post-partum infections Common post-partum infections Puerperal pyrexia Puerperal pyrexia may be defined as a temperature of > 38ºC in the first 14 days following delivery. 1) Endometritis (most common): Infection of uterine lining 2) Mastitis: Infection of breast tissue (usually Staphylococcus aureus) 3) Wound infections: After cesarean or episiotomy 4) Urinary tract infections (UTIs): Related to catheterization Common post-partum infections 1) Endometritis (most common): Infection of uterine lining – Risk factors: Cesarean delivery, prolonged rupture of membranes, retained products. – Symptoms: Fever, uterine tenderness, foul-smelling lochia. – Treatment: IV clindamycin + gentamicin + admission to hospital Common post-partum infections 2) Mastitis: Infection of breast tissue (usually Staphylococcus aureus) – Symptoms: Breast pain, erythema, fever. – Treatment: Antibiotics (e.g., flucloxacillin) and continued breastfeeding.Post-partum mental healthThe Edinburgh Postnatal Depression Scale may be used to screen for depression Baby blues ➔ Affects ~50-80% of women ➔ Symptoms: Mood swings, tearfulness, irritability; peak at 3–5 days postpartum, resolves within 2 weeks. ➔ Management: Reassurance and support. Baby blues Post-partum depression ➔ Affects ~50-80% of ➔ Affects ~ 10-15% of women women ➔ Symptoms: Mood ➔ Symptoms: swings, tearfulness, Persistent sadness, irritability; peak at fatigue, lack of 3–5 days interest in baby. postpartum, resolves ➔ Symptoms peak at 3 within 2 weeks. months ➔ Management: ➔ Management: CBT, Reassurance and antidepressants support. (e.g., sertraline, safe in breastfeeding). Baby blues Post-partum depression Post-partum psychosis ➔ Affects ~50-80% of ➔ Affects ~ 10-15% of ➔ Rare (0.1-0.2%) women women ➔ Psychiatric ➔ Symptoms: Mood ➔ Symptoms: emergency swings, tearfulness, Persistent sadness, ➔ Symptoms: irritability; peak at fatigue, lack of Hallucinations, 3–5 days interest in baby. delusions, confusion, postpartum, resolves ➔ Symptoms peak at 3 mania. within 2 weeks. months ➔ Requires urgent ➔ Management: ➔ Management: CBT, hospitalization and Reassurance and antidepressants treatment support. (e.g., sertraline, safe (antipsychotics, in breastfeeding). mood stabilizers).SBAs During the second stage of labour, which of the following correctly describes the sequence of events? A. Engagement → Restitution → Flexion → Expulsion B. Flexion → Engagement → Extension → Internal Rotation C. Engagement → Descent → Flexion → Internal Rotation → Extension → Restitution → Expulsion D. Flexion → Extension → Internal Rotation → Descent → Expulsion E. Engagement → Internal Rotation → Restitution → Expulsion → Extension Every New Family Is Really Excited! SBAs During the second stage of labour, which of the following correctly describes the sequence of events? A. Engagement → Restitution → Flexion → Expulsion B. Flexion → Engagement → Extension → Internal Rotation C. Engagement → Descent → Flexion → Internal Rotation → Extension → Restitution → Expulsion D. Flexion → Extension → Internal Rotation → Descent → Expulsion E. Engagement → Internal Rotation → Restitution → Expulsion → ExtensionSBAs Which of the following is the most common post-partum infection? A. Endometritis B. Mastitis C. Urinary tract infection (UTI) D. Cesarean wound infection E. Episiotomy site infection SBAs Which of the following is the most common post-partum infection? A. Endometritis B. Mastitis C. Urinary tract infection (UTI) D. Cesarean wound infection E. Episiotomy site infection fever, uterine tenderness, and foul-smelling lochia. Mastitis (B) is also common but less frequent than endometritis.th UTIs (C), cesarean wound infections (D), and episiotomy site infections (E) are less common overall.SBAs Which of the following statements about post-partum depression (PPD) is correct? A. It typically resolves within 2 weeks without treatment. B. It occurs in approximately 50% of post-partum women. C. It is associated with poor mother-infant bonding. D. It requires hospitalization in most cases. E. It is unrelated to a previous history of mental illness. SBAs Which of the following statements about post-partum depression (PPD) is correct? A. It typically resolves within 2 weeks without treatment. B. It occurs in approximately 50% of post-partum women. C. It is associated with poor mother-infant bonding. D. It requires hospitalization in most cases. E. It is unrelated to a previous history of mental illness. PPD is associated with poor mother-infant bonding, which can affect the child’s development. It requires treatment with therapy or medication and does not resolve spontaneously (A). PPD occurs in ~10–15% of women (not 50%, as stated in B). Most cases do not require hospitalization (D), and prior mental illness increases risk (E).SBAs What is the primary goal of a Mother-Baby Unit (MBU)? A. To separate the mother from her baby for intensive psychiatric treatment B. To provide specialised psychiatric care while supporting mother-infant bonding C. To manage medical complications of post-partum infections D. To provide family therapy for post-partum depression E. To exclusively treat neonatal medical conditions SBAs What is the primary goal of a Mother-Baby Unit (MBU)? A. To separate the mother from her baby for intensive psychiatric treatment B. To provide specialised psychiatric care while supporting mother-infant bonding C. To manage medical complications of post-partum infections D. To provide family therapy for post-partum depression E. To exclusively treat neonatal medical conditions MBUs are designed to support the mother’s psychiatric treatment while ensuring that the mother and baby remain together to promote bonding. Separating the mother and baby (A) is avoided unless absolutely necessary. While MBUs may address family dynamics (D) or medical issues in the mother (C), their primary goal is holistic care for the dyad. THANKS FOR WATCHIN G! Please fill out the feedback form on Medall and see you next week!