12) Postnatal Care - Other

Question 1

What to do if temp >38h postnatal?

Answer 1

Repeat 4-6h, if still >38 or other signs of sepsis then evaluate.

Question 2

What to do if diastolic BP >90 postnatal?

Answer 2

Repeat 4h and if doesn’t settle or if other symptoms of PET then evaluate.

Question 3

When to ask about resolution of baby blues?

Answer 3

10-14d

Question 4

Analgesia for perineal pain

Answer 4

(1) Topical cold therapy
(2) Paracetamol
(3) Oral/rectal NSAIDs if 1/2 ineffective

Question 5

When to ask about resumption of intercourse and dyspareunia?

Answer 5

2-6 weeks

Question 6

When should open bowels?

Answer 6

3 days

Question 7

When should pass urine?

Answer 7

6 hours

Question 8

When to initiate BF after delivery?

Answer 8

Ideally within 1 hour

Question 9

Indicators of good attachment during BF

Answer 9

Mouth wide open
Less areola visible underneath chin than above nipple
Chin touching breast, lower lip rolled down, nose free
No pain

Question 10

When does milk “come in”?

Answer 10

Day 3

Question 11

When should neonatal examination be completed?

Answer 11

Within 72h of birth

Question 12

When should newborn blood spot be done?

Answer 12

D5-D8

Question 13

When should hearing screen be done?

Answer 13

By discharge from hospital/week 4 hospital programme/week 5 community.

Question 14

When should jaundice be evaluated?

Answer 14

In first 24 hours.
Or if first develops after 7d or remains after 14d.
Or if unwell or significant jaundice.

Question 15

When should baby pass meconium

Answer 15

24h

Question 16

What is Ogilvie syndrome?

Answer 16

Acute colonic pseudo-obstruction (large bowel obstruction in absence of mechanical obstruction)

Question 17

Incidence of Ogilvie syndrome

Answer 17

1 in 1500 deliveries

Question 18

Things which suggest Ogilvie rather than other differentials

Answer 18

• Significant distension with minimal NG aspirates
• Some degree of bowel movement
• Mild pyrexia/rising CRP without obvious infection

Ileus is lesser distension and more likely no sounds/flatus.

Question 19

What is RIF tenderness a sign of in Ogilvie?

Answer 19

Impending caecal perforation

Question 20

What Caecal diameter is associated with a greater risk of perforation and mortality?

Answer 20

> 14cm

Question 21

Management of Ogilvie syndrome

Answer 21

(1) If signs suggestive of ischaemia/perforation OR if lactate >2, air under diaphragm or Caecal diameter >9cm then resuscitate and proceed to laparotomy.

If Caecal diameter >9cm but no evidence of ischaemic/perforation then colonoscopy +/- rectal tube placement.

(2) If none of the above then conservative measures 24-48h (NBM, NG tube on free drainage, fluid, mobilise). If no improvement then surgical review and consider neostigmine for 24-48h.
(3) If conservative measures or medical not worked then colonoscopy (+/- placement of rectal tube).

Question 22

When to be cautious with neostigmine?

Answer 22

Cardiac/asthma

Question 23

Incidence of postpartum ovarian vein thrombosis?

Answer 23

1 in 2000 (increased risk after CS and after twin CS)

0.02% NVD, 0.1% CS, 0.7% twin CS.

Question 24

Most common site for postpartum ovarian vein thrombosis

Answer 24

right ovarian vein (which drains directly into IVC)

Question 25

How do patients with postpartum ovarian vein thrombosis present?

Answer 25

Within 10d PN.
Abdominal pain and pyrexia that persists despite ABM.
Adnexal mass palpable in 50%

Question 26

Diagnosis of postpartum ovarian vein thrombosis

Answer 26

USS may detect anechoic tubular mass between adnexa/IVC with absent doppler.
CT/MRI better and will see inflammatory fat stranding around tubular structure.

Question 27

Management of ovarian vein thrombosis

Answer 27

7-10d ABM

3-6m anticoagulation

Question 28

Complications of ovarian vein thrombosis

Answer 28

Sepsis
Ovarian infarction
Extension into renal veins/IVC –> ureteric obstruction, hydronephrosis, renal failure
PE