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4: Y4 - Obstetrics [13] > [47] Postnatal Clinical Review > Flashcards

[47] Postnatal Clinical Review Flashcards

1
Q

What should all women have in the postpartum period?

A

A 6 week postnatal check

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2
Q

What should the 6 week postnatal check be centred on?

A

The patient

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3
Q

What should the 6 week postnatal check cover?

A

Physical, psychological, and social aspects of having new baby

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4
Q

What are the components of the 6 week postnatal check?

A
  • History
  • Examination
  • Sex and contraception
  • Pelvic floor exercises
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5
Q

What are the components of the history in the 6 week postnatal check?

A
  • Physical
  • Psychological
  • Social
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6
Q

What needs to be included in the physical history at the 6 week postnatal check?

A
  • How the baby was delivered
  • Any particular worries about her own health
  • If perineum/C-section scar is healing well
  • If lochia is normal and/or if periods have resumed
  • Is she breast feeding
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7
Q

When does lochia normally cease?

A

By 6 weeks postnatally

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8
Q

When do periods resume after having a baby?

A

Not until breast-feeding ceases in the majority

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9
Q

What needs to be included in the psychological history at the 6 week postnatal check?

A
  • How the birth was, and if there are any issues that need to be talked through
  • How her mood is, and screen for post-natal depression
  • If she has any worries about her baby
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10
Q

What needs to be included in the social history at the 6 week postnatal check?

A
  • Is she well supported at home
  • How is she sleeping
  • Encourage any household smokers to quit
  • Provide opportunity to talk without partner to explore relevant issues such as domestic violence
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11
Q

How can you encourage any household smokers to quit?

A
  • Explain passive smoking increases the risk of sudden infant death syndrome and childhood asthma
  • Refer to smoking cessation clinic if required
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12
Q

What % of cases of domestic violence being in pregnancy?

A

30%

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13
Q

What should be included in the examination at the 6 week postnatal check?

A
  • Palpable abdomen
  • Check BP
  • Perform vaginal exam in some circumstances
  • Measure weight
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14
Q

What should be considered if you are able to palpate the uterus at the 6 week postnatal check?

A

Consider retained products of conception or endometritis (if tender)

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15
Q

When should you perform a vaginal exam at the 6 week postnatal check?

A
  • Problems with vaginal tears or episiotomy
  • Abnormal bleeding or vaginal discharge
  • Pain on intercourse
  • Urinary or faecal incontinence
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16
Q

What should happen with women with a BMI over 30 at the 6 week postnatal check?

A

They should be offered referral for advice on healthy eating and physical activity

17
Q

What should the woman be asked about regarding sex and contraception at the 6 week postnatal check?

A
  • If sex has resumed with he partner

- If contraception is required

18
Q

What should be done if the woman has not resumed sex with her partner at the 6 week postnatal check?

A

Reassure her that now is safe to try

19
Q

What contraception options are suitable at the 6 week postnatal check?

A
  • Condoms
  • Non-hormonal or progesterone-releasing IUD
  • Progesterone-only pills and implant
20
Q

Why are pelvic floor exercises important?

A

Many incontinence problems begin during the antenatal period

21
Q

What proportion of women experience problems with urinary incontinence after childbirth?

A

1/3

22
Q

What % of women experience problems with faecal incontinence after childbirth?

A

10%

23
Q

What does the evidence show regarding the effectiveness of pelvic floor exercises?

A

They can be helpful in the case of stress incontinence, particularly in those at higher risk of problems, e.g. instrumental delivery, third-degree tear

24
Q

What types of pelvic floor exercises should be done?

A
  • Slow contractions

- Quick contractions

25
Q

How are slow contraction pelvic floor muscle exercises performed?

A

Pulling up her pelvic floor muscles as though she were trying to stop herself urinating or passing wind, and holding for 10 seconds. Repeat 10 times

26
Q

How often should slow contraction pelvic floor muscle exercises be done?

A

3 times a day

27
Q

How are quick contraction pelvic floor muscle exercises performed?

A

Contract pelvic muscles and relax rapidly in succession 10 times

28
Q

How often should quick contraction pelvic floor muscle exercises be done?

A

3 times a day

29
Q

What advice can be given to help patients remember to do pelvic floor muscle exercises?

A

Associate with a regular activity to prompt remembering, e.g. with each feed, cup of tea, or meal

4: Y4 - Obstetrics [13] (61 decks)

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