Week Eight - Post Labour

PPH Definition

• defined as blood loss of 500ml or more during childbirth

Severe PPH

• more than 1500mls

Primary vs Secondary PPH

Primary: less than 24hrs from birth

Secondary: greater than 24hrs from birth

Causes of PPH

• large baby

• multiparity

• grand multi

• difficult labor

• induction

• full bladder

• etc..

Signs & Symptoms of a PPH

• uterus boggy/relaxed

• visible bleeding

• pallor

• tachycardia

• tachycardia

• hypotension

• VSS IS A LATE SIGN!

TONE: Reasons for PPH

• relaxed uterus

• most common cause

TISSUE: Reasons for PPH

• retained placenta

• tissue

TRAUMA: Reasons for PPH

• perineal tear/episostomy

THROMBIN: Reasons for PPH

• clotting disorders or DIC

PPH Management AV (FIRM UTERUS)

• assess SIZE, VSS & causes

• oxygen HIGH flow

• fluid replacement at 40ml/kg

• visible bleeds managed with laceration and firm pressure

PPH Management AV (BOGGY UTERUS)

• fundal massage if the placenta is out

• empty bladder

• breastfeed

• oxytocin 10IU IM repeat after 5 minutes

• TXA 1g to 100ml saline 3 drops/second/over 10min

• external abdo aortic compression if required

• MICA!

Antenatal Depression

depression that starts during a pregnancy

Postpartum Depression

depression that starts within 12 months of having a baby, 10-15% of all mums

The “pinks”

• 24-48 hours post delivery

• elevated mood, excitement

• difficulty sleeping

The “baby blues”

• from delivery to two weeks post delivery

• fatigue, short temper, depressed mood, tearful

• due to sudden fall in oestrogen and progestrone

Symptoms of Severe Post Natal Depression

• early morning waking

• poor appetitie

• mood variations

• low energy & libido

• loss of enjoyment

• lack of interest

• tearfulness

• feelings of guilt and failure

• thoughts of harm to self and baby

PND Risk Factors

• young

• smoker

• low SES

• high BMI

• emergency C section

• bereavment

• isolation

• hx of depression

Management of PND

• reasurrance

• history where possible

• position of comfort

• ensure safety of neonate

• manage as per depressive episodes

• transport

Puerperal/Postnatal Psychosis

• very severe postpartum psychiatric disorder

• agitation

• insomnia

• perplexity

• failure to eat and drink

• thoughts of self harm

• loss of insight

Puerperal/Postnatal Psychosis Management

• reassurance

• history where possible

• position of comfort

• piper for advice

• psychiatric assessment

• ensure safety of baby

Sudden unexpected death in infancy

is a broad term used to describe the sudden and unexpected death of a baby for which the cause is not immediately obvious. SUDI includes deaths from SIDS as well as death from other unexpected causes such as drowning.

Sudden Infant Death Syndrome

is defined as the sudden and unexpected death of an infant under one year of age with an onset of a fatal episode mainly occurring during sleep, that remains unexplained after a thorough investigation.

SUDI vs SIDS

SUDI can eventually be found to have a cause, SIDS will never have a cause.

SUDI/SIDS Risk Factors

INHERENT: <12 months, 2-4 months spec., male, premature, multiple birth

PREVENTATIVE: tummy/side sleeping, head covering, over heating, smoking, formula feeding, sleeping environment

Safe Sleeping Environment

• baby on back, face uncovered

• baby smoke free

• safe cot, bedding, matress

• baby in cot same room as caregiver first 6 months

• breastfeed baby

Major Causes of Infant Death in AUS

• perinatal conditions

• congenital abnormalities

• SIDS

Paramedic Role in SIDS

• attempt resus

• liase with clinician and DM and give information on what comes next

• support the family. they need your time, and compassion

• refer to the infant by name, let mum and dad hold them etc..

Police Role in SIDS

• SIDS is a reportable death

• may notifiy other sections of police (homicide, etc..)

• support familty

• complete appropriate forms

• notify coroner

Coroner Role in SIDS

• transport baby to mortuary

• autopsy within 48hrs

• provisional diagnosis given to family and then it is published

• event scene investigation