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Year 4 - Reproductive Health > 2.04 - Postnatal Care > Flashcards

2.04 - Postnatal Care Flashcards

1
Q

In the days after delivery, what routine care is offered to women?

A

Midwife led care:
- analgesia as required
- help establishing breast or bottle feeding
- VTE risk assessment
- monitoring for PPH
- monitoring for sepsis
- monitoring BP (after pre-eclampsia)
- monitoring recovery after caesarean or perineal tear

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2
Q

What is covered at the six-week postnatal check?

A
  • general wellbeing
  • mood and depression
  • bleeding and menstruation
  • scare healing after episiotomy or caesarean
  • contraception
  • breastfeeding
  • fasting blood glucose
  • blood pressure
  • urine dipstick for protein
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3
Q

Shortly after birth, is vaginal bleeding normal?

A

Dark red bleeding is common for six weeks after birth, which will settle over this time.

Tampons should be avoided during this period, as they carry a risk of infection.

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4
Q

Why do women bleed more during episodes of breastfeeding?

A

Breastfeeding releases oxytocin, which can cause the uterus to contract.

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5
Q

How long after birth will bottle-feeding women begin having menstrual periods?

A

3 weeks after birth - however, this is unpredictable and periods can be delayed or irregular at first.

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6
Q

How long after birth does fertility return?

A

21 days if bottle feeding.

6 months if breast feeding (lactational amenorrhoea).

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7
Q

What are the options for contraception after childbirth?

A

POP and implant are safe in breastfeeding and can be started any time after birth (UKMEC1).

COCP should be avoided in breastfeeding (UKMEC4 before 6 weeks, UKMEC2 after 6 weeks).

IUS or IUD can be inserted either within 48 hours of birth, or more than four weeks after birth (UKMEC1).

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8
Q

What is endometritis?

A

Inflammation of the endometrium, caused by infection that in introduced during or after labour and delivery.

The process of delivery opens the uterus to allow bacteria from the vagina to travel upwards and infect the endometrium.

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9
Q

How is the risk of endometritis reduced after caesarean section?

A

Prophylactic antibiotics are given during caesarean.

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10
Q

Presentation of postpartum endometritis.

A

Presents shortly after birth to several weeks postpartum:
- foul-smelling discharge or lochia
- bleeding that gets heavier or doesn’t improve with time
- lower abdominal or pelvic pain
- fever
- sepsis

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11
Q

How is endometritis diagnosed?

A
  • vaginal swabs (incl. chlamydia and gonorrhoea)
  • urine culture and sensitivities
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12
Q

Management of endometritis.

A

Mild: management in the community with oral antibiotics.

Septic patients will need hospital admission and the septic six.

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13
Q

What is retained products of conception?

A

When pregnancy-related tissue (ie. placental tissue or fetal membranes) remain in the uterus after delivery.

It can also occur after miscarriage or termination of pregnancy.

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14
Q

Presentation of retained products of conception.

A
  • vaginal bleeding
  • abnormal vaginal discharge
  • lower abdominal or pelvic pain
  • fever
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15
Q

How is retained POC diagnosed?

A

Ultrasound

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16
Q

Management of retained POC.

A

Evacuation of retained products of conception (ERPC).

The cervix is dilated, and the retained products are manually removed using vacuum aspiration and curettage.

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17
Q

What are the key complications of ERPC?

A
  • endometritis
  • Asherman’s syndrome
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18
Q

What is Asherman’s syndrome?

A

Adhesions form within the uterus, which can bind the walls together, or seal the cervix shut.

This can lead to infertility.

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19
Q

Define postpartum anaemia.

A

Hb <100g/L

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20
Q

A FBC is checked the day after delivery for postpartum anaemia if there has been:

A
  • PPH >500ml
  • caesarean section
  • antenatal anaemia
  • symptoms of anaemia
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21
Q

Treatment of postpartum anaemia:

a) Hb <100g/L

b) Hb <90g/L

c) Hb <70g/L

A

a) start oral iron (e.g. ferrous sulphate 200mg TDS 3/12)

b) consider iron infusion in addition to oral iron

c) blood transfusion in addition to oral iron

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22
Q

When is an iron transfusion considered in postpartum women?

A

Hb <90g/L

or

Hb <100g/L AND:
- poor adherence to oral treatment
- cannot tolerate oral iron
- fail to respond to oral iron
- cannot absorb oral iron (e.g. IBD)

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23
Q

Risks of iron infusions.

A

Anaphylactic reaction

Use in caution in patients with a history of allergy or asthma.

24
Q

Contraindication of iron infusion.

A

Active infection - pathogens feed on iron, meaning infusion could lead to proliferation of the pathogen and worsening infection.

25
Q

What are the baby blues?

A

Affecting >50% of women in the first week of birth, it presents with symptoms such as:
- mood swings
- low mood
- anxiety
- irritability
- tearfulness

26
Q

Causes of baby blues.

A

A combination of:
- significant hormonal changes
- recovery from birth
- fatigue and sleep deprivation
- establishing feeding

27
Q

Presentation of postnatal depression.

A

Around three months after birth, depressive symptoms arise and persist for two weeks or more:
- low mood
- anhedonia
- low energy

28
Q

How is postnatal depression screened for?

A

Edinburgh postnatal depression scale assesses how the mother has felt over the past week.

A score >10 suggests postnatal depression.

29
Q

Treatment of

a) mild

b) moderate

c) severe

postnatal depression.

A

a) additional support, self-help and follow up with GP.

b) antidepressant medications (e.g. SSRIs) and cognitive behavioural therapy.

c) input from psychiatry services - sometimes inpatient care on the mother and baby unit.

30
Q

What is puerperal psychosis?

A

A rare but severe illness that has onset between two to three weeks after delivery.

Women experience full psychotic symptoms:
- delusions
- hallucinations
- depression
- mania
- confusion
- thought disorder

31
Q

Management of puerperal psychosis.

A

Urgent assessment and input from specialist mental health services:
- admission to mother and baby unit
- CBT
- medications
- ECT

32
Q

What is the mother and baby unit?

A

A specialist unit for pregnant women and women that have given birth in the last 12 months.

They are designed so that the mother and baby can remain together and continue to bond. Mothers are supported to continue caring for their baby while they get specialist treatment.

33
Q

How are women that have existing mental health concerns before or during pregnancy managed?

A

Referral to perinatal mental health services for advice and specialist input on:

  • use of psychiatric medications
  • postnatal follow up plan
34
Q

What is neonatal abstinence syndrome?

A

When SSRI antidepressants are taken during pregnancy, the baby will present with withdrawal symptoms of SSRIs after birth:
- irritability
- poor feeding

Supportive management is usually all that is required.

35
Q

What is mastitis?

A

Inflammation of the breast tissue, caused by:
- obstruction in the ducts and accumulation of milk
- infection

36
Q

Presentation of mastitis.

A

Unilateral breast pain and tenderness:
- erythema
- local warmth and inflammation
- nipple discharge
- fever

37
Q

Management of mastitis caused by blockage of the ducts.

A
  • continue breastfeeding
  • expressing milk
  • breast massage
  • heat packs
  • warm showers
  • simple analgesia
38
Q

Management of mastitis caused by infection.

A

Staphylococcus aureus most common cause.

Treat with Flucloxacillin first line, or erythromycin if allergic to penicillin.

Sample of milk can be sent to the lab for culture and sensitivities.

39
Q

Complications of untreated mastitis.

A

Breast abscess - may need surgical incision and drainage.

40
Q

What is candida of the nipple?

A

Following a course of antibiotics, candida infection of the nipple can present with:
- sore nipples bilaterally
- nipple tenderness and itching
- cracked, flaky or shiny aerola
- candida symptoms in baby (e.g. white patches in mouth and on tongue)

41
Q

Management of candida of the nipple.

A

Topical miconazole 2% after each breastfeed.

Treatment for the baby (e.g. miconazole gel).

42
Q

Pathophysiology of postpartum thyroiditis.

A

Pregnancy has an immunosuppressant effect on the mother’s body, to prevent her from rejecting the fetus.

Once delivery has occured, there is an exaggerated rebound effect with increased immune system activity.

This can cause inflammation of the thyroid gland, leading to over or under activity.

43
Q

Stages of postpartum thyroiditis.

A

Months 1-3: thyrotoxicosis

Months 3-6: hypothyroid

Months 6-12: thyroid function returns to normal

44
Q

Signs and symptoms of thyrotoxicosis.

A
  • anxiety and irritability
  • sweating and heat intolerance
  • tachycardia
  • weight loss
  • fatigue
  • frequent loose stools
45
Q

Signs and symptoms of hypothyroidism.

A
  • weight gain
  • fatigue
  • dry skin
  • coarse hair and hair loss
  • low mood
  • fluid retention
  • heavy or irregular periods
  • constipation
46
Q

TFT results of hyperthyroidism.

A

TSH: low

T3/T4: high

47
Q

TFT results of hypothyroidism.

A

TSH: high

T3/T4: low

48
Q

How long after delivery are TFTs performed?

A

6-8 weeks to screen for postpartum thyroiditis.

Also if presenting with postnatal depression as differential.

49
Q

Treatment of postpartum thyroiditis.

A

Thyrotoxicosis: symptomatic control (e.g. propanolol).

Hypothyroidism: levothyroxine.

Symptoms and TFTs are monitored, and treatment is titrated as condition changes and improves.

50
Q

What is Sheehan’s syndrome?

A

A rare complication of post-partum haemorrhage, where the drop in circulating blood volume causes AVN of the anterior pituitary gland.

51
Q

Blood supply of the anterior pituitary.

A

Hypothalamo-hypophyseal portal system - susceptible to rapid drops in blood pressure.

The posterior pituitary gland gets a good blood supply from various arteries, and so is not susceptible to ischaemia where there is a drop in blood pressure.

52
Q

What hormones are released by the anterior pituitary?

A
  • TSH
  • ACTH
  • FSH
  • LH
  • GH
  • prolactin
53
Q

What hormones are released by the posterior pituitary?

A
  • oxytocin
  • ADH
54
Q

Presentation of Asherman’s syndrome.

A

Lack of hormones produced by the anterior pituitary:
- reduced lactation (low prolactin)
- amenorrhoea (low FSH / LH)
- adrenal insufficiency / adrenal crisis (lack of ACTH)
- hypothyroidism (low TSH)

55
Q

Management of Sheehan’s syndrome.

A

Guidance of specialist endocrinologist:
- oestrogen and progesterone as HRT
- hydrocortisone for adrenal insufficiency
- levothyroxine for hypothyroidism
- growth hormone

Year 4 - Reproductive Health (12 decks)

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