7- Postnatal period Flashcards
management of women in the first few days after delivery
routine midwife- led care
- Analgesia as required
- Help establishing breast or bottle-feeding
- Venous thromboembolism risk assessment
- Monitoring for postpartum haemorrhage
- Monitoring for sepsis
- Monitoring blood pressure (after pre-eclampsia)
- Monitoring recovery after a caesarean or perineal tear
- Full blood count check (after bleeding, caesarean or antenatal anaemia)
- Anti-D for rhesus D negative women (depending on the baby’s blood group)
- Routine baby check
postnal discussions with new mother
- General wellbeing
- Mood and depression
- Bleeding and menstruation
- Urinary incontinence and pelvic floor exercises
- Scar healing after episiotomy or caesarean
- Contraception
- Breastfeeding
- Vaccines (e.g. MMR)
postnal discussions with new mother
- General wellbeing
- Mood and depression
- Bleeding and menstruation
- Urinary incontinence and pelvic floor exercises
- Scar healing after episiotomy or caesarean
- Contraception
- Breastfeeding
- Vaccines (e.g. MMR)
when is the next postnatal check
six- wee postnatal check
six-week postnatal check
A routine six-week postnatal appointment is commonly offered by GP practices to check how the mother is doing. It is usually done at the same time as the six-week newborn baby check.
The topics that are covered at the six-week check include:
General wellbeing
Mood and depression
Bleeding and menstruation
Scar healing after episiotomy or caesarean
Contraception
Breastfeeding
Fasting blood glucose (after gestational diabetes)
Blood pressure (after hypertension or pre-eclampsia)
Urine dipstick for protein (after pre-eclampsia)
six-week postnatal check
A routine six-week postnatal appointment is commonly offered by GP practices to check how the mother is doing. It is usually done at the same time as the six-week newborn baby check.
The topics that are covered at the six-week check include:
- General wellbeing
- Mood and depression
- Bleeding and menstruation
- Scar healing after episiotomy or caesarean
- Contraception
- Breastfeeding
- Fasting blood glucose (after gestational diabetes)
- Blood pressure (after hypertension or pre-eclampsia)
- Urine dipstick for protein (after pre-eclampsia)
six-week postnatal check
A routine six-week postnatal appointment is commonly offered by GP practices to check how the mother is doing. It is usually done at the same time as the six-week newborn baby check.
The topics that are covered at the six-week check include:
General wellbeing
Mood and depression
Bleeding and menstruation
Scar healing after episiotomy or caesarean
Contraception
Breastfeeding
Fasting blood glucose (after gestational diabetes)
Blood pressure (after hypertension or pre-eclampsia)
Urine dipstick for protein (after pre-eclampsia)
bleeding after given birth is called
lochia
lochia
In the period shortly after birth, there will be vaginal bleeding as the endometrium initially breaks down, then returns to normal over time. This is a mix of blood, endometrial tissue and mucus, and is called lochia. Initially, it will be a dark red colour and over time will turn brown, and become lighter in flow and colour.
- Tampons should be avoided during this period, as they carry a risk of infection.
- Bleeding should settle within six weeks.
why may women experience more bleeding during epidoses of breastfeeding
Breastfeeding releases oxytocin, which can cause the uterus contract,
when will periods return as normal in breastfeeding women
may not have a return to regular menstrual periods for six months or longer (unless they stop breastfeeding).
The absence of periods related to breastfeeding is called lactational amenorrhoea.
when will periods return in bottle-feeding women
will begin having menstrual periods from 3 weeks onwards. This is unpredictable, and periods can be delayed or irregular at first.
when does fertility return after giving birth
21 days- up to this point not contraception required
- after 21 days women considered fertile and will need contraception
forms of contraception in the post natal period
- lactational amenorrhea
- progesterone-only pill
- combinec contraceptive pill
- copper or intrauterine coil
lactational amenorrhea as a form of contraceptive
98% effective as contraception for up to 6 months after birth.
Women must be fully breastfeeding and amenorrhoeic (no periods).
The progestogen-only pill and implant as a contraceptive
considered safe in breastfeeding and can be started at any time after birth
combined contraceptive pill as a form of contraceptives postnatally
should be avoided in breastfeeding
(UKMEC 4 before six weeks postpartum, UKMEC 2 after six weeks).
Copper coil or intrauterine system in the postnatal period
can be inserted either within 48 hours of birth or more than four weeks after birth (UKMEC 1), but not inserted between 48 hours and four weeks of delivery (UKMEC 3).
postpartum endometritis
inflammation of the endometrium
- can occur in postpartum period
-usually caused by infection
why are women vulnerable to endometritis after giving birth
- as infection is 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.
when is endometritis more likely after caesarean section or vaginal delivery
Endometritis occurs more commonly after caesarean section compared with vaginal delivery.
Prophylactic antibiotics are given during a caesarean to reduce the risk of infection.
which bacteria causes endometritis
a large variety of gram-negative, gram-positive and anaerobic bacteria. It can also be caused by sexually transmitted infections such as chlamydia and gonorrhoea.
When endometritis occurs unrelated to pregnancy and delivery, it is usually part of
pelvic inflammatory disease
ashermans syndrome
is where adhesions (sometimes called synechiae) form within the uterus.
Endometrial curettage (scraping) can damage the basal layer of the endometrium. This damaged tissue may heal abnormally, creating scar tissue (adhesions) connecting areas of the uterus that are generally not connected. There may be adhesions binding the uterine walls together, or within the endocervix, sealing it shut. This can lead to infertility.
