Leg vein & pelvic vein is one of the
complication in western countries.
However the prevalence is low in Asians
In normal pregnancy there is rise in
concentration of coagulation factors 1, 2,
7, 8, 9, 10, 12. plasma fibrinolytic inhibitors
produced by placenta.
Alteration in blood constituents- increased
number of platelet & their adhesiveness.
Venous stasis is increased due to
compression of gravid uterus to IVC & iliac
veins. This stasis cause damage to
Thrombophilias are the genetic condition
associated with deficiencies of
antithrombin3 protein C .
Acquired thrombophilias are due to
presence lups anticoagulant &
Advanced age & parity
Anemia & heart disease.
Trauma to venous vessel wall.
C/F: Asymptomatic,pain in calf muscle,
edema of leg, rise skin temperature.
Duplex Doppler ultrasound.
C/F:usually develop after 2nd
Fever with chills & rigors.
Feature of toxemia i.e. headache, malaise
& rising pulse.
Affected leg is painful, swollen & cold.
Polymorph nuclear leucocytosis.
Prophylaxis for VTEPreventive measures.
low & high risk woman.
bed rest & foot is raised.
Gentle movements of the leg after relief of
Vena caval fillers
It is leading cause of maternal death.
Because of decline of maternal mortality
due to hemorrhage, hypertension &
Death occurs with in short time from shock
& vagal inhibition.
Sudden collapse, acute chest pain & air
hunger these are classical symptoms of
massive pulmonary embolism.
pain, cough , tachycardia, haemoptysis &
rise in temperature > 37 degree Celsius
X-ray of the chest shows decreased
vascular marking in area of infraction,
elevation of dome of diaphragm & often
It is useful to rule out
Doppler ultrasound : ? DVT.
Lung scan : ? Area of diminished blood
flow.Diminised in perfusion with
maintenance ventilation indicate PE.
MRI: risk of radiation is absent.
Pulmonary angiography: most accurate
method of diagnosis.
• The commonest form of palsy
encountered in puerperium is FOOT
• It is usually unilateral & appears shortly
after the delivery.
• Streching of the lumbo-sacral trunk by
prolapsed inter vertebral disc b/w L5&s1.
• Backward rotation of the sacrum during
• Direct pressure by fetal head or by
forceps blade on lumbosacral cord.
2.Flacidity & wasting of muscle.
• Bed rest for 6 wks.
• A splint is applied to prevent damage of
over stretch muscle.
• Massage & electric stimulation of the
1st 3 month after delivery the incidence of
mental illness is high.
Overall incidence is 15-20%
Past H/O: mental illness, puerperal
Family H/O: psychiatric illness, marital
Present pregnancy: Caesarean section,
difficult labour, neonatal complication.
It is transient state of mental illness observed 4-5
days after delivery & it last for few days.
50% of the postpartum women suffer from
Depression, anxiety, tearfulness, insomnia,
helplessness & negative feelings towards infant.
No specific metabolic or endocrine abnormalities
have been detected. But lowered tryptophan level
It suggest altered neurotransmitter function.
Treatment reassurance & psychological support
by the family.
It is seen 10-20% of mothers.
It is more gradual onset, occurs 1st
months after delivery or abortion.
Changes in HypoThalamopitutaryarenal
axis may the cause.
Manifested by loss appetite, insomnia,
social withdrawal, irritability & even
Risk of recurrence is high (50-100%) in
subsequent pregnancy .
Fluoxetin or paroxetine.
General support is essential.
Overall prognosis is good.
About 1in 500-1000 mothers.
Seen in woman with past H/O psychosis or with
positive family H/o.
Relatively sudden in onset with in 4 days after
Fear, restless, confusion followed by
hallucination, delusion and disorientation.
Suicidal, infanticidal impulse may be present.
Risk of recurrence in subsequent pregnancy is
Psychiatrist consulted urgently.
Chlorpromazine 150mg stat & 50-150mg
ECT: needed if unresponsive case.
Lithium is indicated in manic depressive
psychosis & breast feeding
Psychological response to
Most perinatal events are joyful.
But when perinatal death occurs special
attention must given to grieving patient &
Perinatal grieving may also be due to
unexpected hysterectomy, birth
malformed, critically ill infant.
Obstetrician, nurse & attending staff must
understand the patient reaction.
Facilitating the grieving process, support &
Supporting the couple in holding or taking
photograph of the infant .
Requesting for autopsy .
Follow up visits & plan for subsequent