Block 11 - part 2

Question 1

Puerperium

Answer 1

Postnatal period of about 6-8 weeks where mother’s reproductive organs return to their non-pregnant condition

Question 2

main aims of antenatal care

Answer 2

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

Question 3

6 key documents which influence antenatal care provisions

Answer 3

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’

Question 4

7 key themes of national maternity review ‘better births’

Answer 4

Personalised care, continuity of carer, safer care, better postnatal and perinatal mental health care, multi-professional working, working across boundaries, a fairer payment system

Question 5

Tests done at antenatal visit

Answer 5

Physical examination, bloods, psychosocial and emotional support

Question 6

antenatal physical examination

Answer 6

weight, BP, urinalysis

Question 7

antenatal bloods

Answer 7

FBC, antibodies, ABO and Rh, HIV

Question 8

antenatal psychosocial assessment

Answer 8

general wellbeing, work, financial, anxiety

Question 9

7 risk factors for adverse outcomes in pregnancy

Answer 9

chronic/acute disease, proteinuria, significant increase in BP, significant oedema, large/small uterus for gestational age, malpresentation, infection, sociological factors

Question 10

4 different forms of pregnancy loss

Answer 10

spontaneous miscarriage,
ectopic pregnancy,
termination of pregnancy,
stillbirth

Question 11

miscarriage

Answer 11

loss of pregnancy before 24 completed weeks

Question 12

MBRRACE report (2014)

Answer 12

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

Question 13

common causes of death in postnatal period

Answer 13

infection, haemorrhage, thrombosis, hypertensive disorders

Question 14

physical health/wellbeing disorders a woman might experience postnatally (9)

Answer 14

perineal care, urinary retention, dyspareunia, headache, fatigue, backache, constipation, haemorrhoids, breast/nipples

Question 15

Mental health problems experienced in the post natal period

Answer 15

50-80% - the blues
10-15% - postnatal depression
0.2% - puerperal psychosis

Question 16

The blues

Answer 16

Very weepy over small things, time-limited, recovers very quickly, if continues then worry about postnatal depression

Question 17

postnatal depression

Answer 17

tiredness, worthlesness, low mood

Question 18

puerperal psychosis

Answer 18

severe episodes of mental illness that begins uddenly, mania, depression, confusion, hallucinations, delusions

Question 19

main outcome of Peel committee report (1970)

Answer 19

Sufficient facilities should be made available for 100% of childbearing women to give birth in hospital

Question 20

risks associated with caesarean section

Answer 20

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

Question 21

medical model of birth

Answer 21

birth seen as a dangerous journey, only normal in retrospect, therefore assume the worse. Low threshold for intervention

Question 22

social model of birth

Answer 22

birth seen as a normal physiological process, whcih women are uniquely designed to achieve

Question 23

cultural issues during pregnancy

Answer 23

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.

Question 24

Outcome of midwives’ act (1902)

Answer 24

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

Question 25

benefits of institutionalised childbirth (5)

Answer 25

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

Question 26

risks of insitutionalised childbirth (5)

Answer 26

medicaisation, depersonalisation of birth, lack of privacy, inflexibility in labour and birth practices, limitation of resources

Question 27

role of doctors in welfare

Answer 27

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

Question 28

indications of a successful breastfeed - baby

Answer 28

audibile and visible swallowing, sustained rhythmic suck, relaxed arms and head, moist mouth, regular soaked nappies

Question 29

indications of a successful breastfeed - mother

Answer 29

breast softening, no compression of nipples at end of fees, relaxed/sleepy

Question 30

problems that may occur with breastfeeding (6)

Answer 30

nipple pain, engorgement, mastitis, inverted nipple, ankylossia, sleepy baby

Question 31

‘quality’ in relation to health care

Answer 31

the extent to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge

Question 32

why is there a heavy emphasis on quality management in healthcare

Answer 32

quality management produces improved quality, reduced costs, increased productivity, increased market share

Question 33

three deficiencies in medical practice internationally which make consumer protection necessary

Answer 33

medicine has weak evidence base, large variations in clinical practice, failure to measure success outcomes in healthcare

Question 34

data available to improve patient safety

Answer 34

hospital episode statistics, patient reported outcome measurements, reference cost data

Question 35

summary hospital level mortality indicator

Answer 35

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

Question 36

3 key consumer protection agencies

Answer 36

Care quality commission (CQC), NHS improvement (formerly monitor), National institute for health and clinical excellenece (NICE)

Question 37

role of CQC in consumer protection

Answer 37

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

Question 38

NHS improvement role in consumer protection

Answer 38

ensures financial obligations are met in terms of balancing income and expenditure

Question 39

NICE role in consumer protection

Answer 39

set standards for treatment

Question 40

Who enforced NICE guidlines?

Answer 40

royal colleges, GMC, professional audit

Question 41

how can consumer protection be improved (5)

Answer 41

appraisal by peers, revalidation by GMC, compulsory medical audits, GP/consultant contracts transparency and accountability

Question 42

clinical governance

Answer 42

framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care.