Block 11 - part 2 Flashcards
Puerperium
Postnatal period of about 6-8 weeks where mother’s reproductive organs return to their non-pregnant condition
main aims of antenatal care
monitor progress of pregnancy to optimise maternal and foetal health, develop partnership between mother and health preofessional, exchange info that promotes choice, recognise deviations from the norm and refer, increase understanding of public health issues, provide opportunities to prepare for birth
6 key documents which influence antenatal care provisions
MBRRACE-UK (mothers and babies - reducing risk through audits and confidential enquiries across the UK),
NICE antenatal care guidelines 2008, mod 2014,
EB practise,
Local policy/guidelines,
Midwifery 2020,
National maternity review ‘better births’
7 key themes of national maternity review ‘better births’
Personalised care, continuity of carer, safer care, better postnatal and perinatal mental health care, multi-professional working, working across boundaries, a fairer payment system
Tests done at antenatal visit
Physical examination, bloods, psychosocial and emotional support
antenatal physical examination
weight, BP, urinalysis
antenatal bloods
FBC, antibodies, ABO and Rh, HIV
antenatal psychosocial assessment
general wellbeing, work, financial, anxiety
7 risk factors for adverse outcomes in pregnancy
chronic/acute disease, proteinuria, significant increase in BP, significant oedema, large/small uterus for gestational age, malpresentation, infection, sociological factors
4 different forms of pregnancy loss
spontaneous miscarriage,
ectopic pregnancy,
termination of pregnancy,
stillbirth
miscarriage
loss of pregnancy before 24 completed weeks
MBRRACE report (2014)
looked at standards of care and mortality and morbidity rates, 2/3 mothers dies from medicla and mental health problems, 1/3 from direct causes. 3/4 women who died had known mentla health problems
common causes of death in postnatal period
infection, haemorrhage, thrombosis, hypertensive disorders
physical health/wellbeing disorders a woman might experience postnatally (9)
perineal care, urinary retention, dyspareunia, headache, fatigue, backache, constipation, haemorrhoids, breast/nipples
Mental health problems experienced in the post natal period
50-80% - the blues
10-15% - postnatal depression
0.2% - puerperal psychosis
The blues
Very weepy over small things, time-limited, recovers very quickly, if continues then worry about postnatal depression
postnatal depression
tiredness, worthlesness, low mood
puerperal psychosis
severe episodes of mental illness that begins uddenly, mania, depression, confusion, hallucinations, delusions
main outcome of Peel committee report (1970)
Sufficient facilities should be made available for 100% of childbearing women to give birth in hospital
risks associated with caesarean section
general anaesthesia - Mendelsohn’s syndrome, paralytic ileus.
surgical technique - radical abdominal surgery, risk to other internal organs from surgical trauma.
childbearing risks for further births
medical model of birth
birth seen as a dangerous journey, only normal in retrospect, therefore assume the worse. Low threshold for intervention
social model of birth
birth seen as a normal physiological process, whcih women are uniquely designed to achieve
cultural issues during pregnancy
unintended pregnancy - delay in seeking prenatal care, higher levels of stress/depression.
Pregnancy may not fit with mothers plans.
Social disapproval for pregancny out of wedlock and teenagers.
Outcome of midwives’ act (1902)
established normality in childbearing as the midwife’s role - refer to doctors as soon as abnormality occurs. Ensures equal access to midwives and doctors for childbearing women of all socioeconomic standing
benefits of institutionalised childbirth (5)
standardisation of care, access to good facilities to support childbirth, availability of populations for childbearing women for healthcare training, faster access to emergency care, access of effective obstetric anaesthesia
risks of insitutionalised childbirth (5)
medicaisation, depersonalisation of birth, lack of privacy, inflexibility in labour and birth practices, limitation of resources
role of doctors in welfare
must consider safety and welfare of children and young people, regardless of if you routinely see them as patients.
identifying signs of abuse or neglect early and taking action quicly. knowing what to do if you are concerned that a child is at risk or or suffering abuse or neglect.
act on any concerns
indications of a successful breastfeed - baby
audibile and visible swallowing, sustained rhythmic suck, relaxed arms and head, moist mouth, regular soaked nappies
indications of a successful breastfeed - mother
breast softening, no compression of nipples at end of fees, relaxed/sleepy
problems that may occur with breastfeeding (6)
nipple pain, engorgement, mastitis, inverted nipple, ankylossia, sleepy baby
‘quality’ in relation to health care
the extent to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge
why is there a heavy emphasis on quality management in healthcare
quality management produces improved quality, reduced costs, increased productivity, increased market share
three deficiencies in medical practice internationally which make consumer protection necessary
medicine has weak evidence base, large variations in clinical practice, failure to measure success outcomes in healthcare
data available to improve patient safety
hospital episode statistics, patient reported outcome measurements, reference cost data
summary hospital level mortality indicator
ratio between actual number of patients who die within 30 days of discharge, compared with the number that would be expected to die on the basis of average
3 key consumer protection agencies
Care quality commission (CQC), NHS improvement (formerly monitor), National institute for health and clinical excellenece (NICE)
role of CQC in consumer protection
regualtes ‘quality’ and financial performance of all health and social care providers, public and private, provides regulatory framework, licenses all providers of health and social care
NHS improvement role in consumer protection
ensures financial obligations are met in terms of balancing income and expenditure
NICE role in consumer protection
set standards for treatment
Who enforced NICE guidlines?
royal colleges, GMC, professional audit
how can consumer protection be improved (5)
appraisal by peers, revalidation by GMC, compulsory medical audits, GP/consultant contracts transparency and accountability
clinical governance
framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care.
