Clin Wk 4

Question 1

How do we assess mum’s physical health in a postnatal interview? Link this to physiology

Answer 1

• ?Lochia (should be getting darker to lighter); shedding of endometrial lining post pregnancy
• Perineal/casesarean wound pain (?infection, damaged stitches)
• Uterine fundal height and position (should be decreasing as uterus returns to normal size)
• Blood pressure (check for return of BP in preeclampsia/gestational hypertension
• Temp (?infection, like endometritis)
• Breast exam if suspicious of mastitis

Question 2

What might we assess for to look for mum’s psychological health postnatally? What scale can we use?

Answer 2

• Supports in place?
• How is husband adjusting?
• Subjective emotional experience?
• Sleep/coping with baby’s needs? Any concerns?
• Edinburgh Postnatal Depression Scale can be used

Question 3

How do we treat postpartum depression

Answer 3

• Use Edinburgh Postpartum Depression Scale to assess level of depression
• Then, consider conservative vs referral vs more immediate escalation based on level of severity/urgency

Question 4

How soon after pregnancy can you get pregnant again? Why?

Answer 4

• Within the first 3 weeks, before first period (! no wonder fathers go bald)
• This is because ovulation resumes before menstruation

Question 5

What are Sauj’s 3 broad steps of paeds hx?

Answer 5

1. Before birth
2. During birth
3. After birth

Question 6

What is the acronym for a neonatal hx?

Answer 6

• AFACES
• Antenatal hx (complications, mode of delivery, time in NICU?, blue book, birth defects etc.)
• Feeding (What? How much formula/duration + frequency + alertness and contentment of breastfeeding)
• Alertness (are they waking each 2-4hrs to eat?)
• Crying (crying more than 1-3hrs/day; should peak ~6-8wks)
• Elimination (normal nappies?)
• Symptoms (Fever ALWAYS = sepsis)

Question 7

A newborn baby has a fever. All other family members have a viral cold. Management?

Answer 7

• In newborns, febrile baby ALWAYS rule out sepsis
• Send to ED

Question 8

What are significant/common physiological postpartum complications in the mother (incl. the short time period after birth)? How do we manage them?

Answer 8

• PPH (treat w/ fluid resus and surgery)
• Mastitis (antibiotics + pain relief)
• Perineal tears/episiotomy (pain management, watch for infection, wound care)
• Postpoartum thyroiditis (case-specific)
• DVT (mobilitisation +/- prophylactic anticoag)

Question 9

What imaging do we use to follow up abnormalities no breast exam?

Answer 9

• Mammogram (x ray)
• US/MRI
• ?Biopsy (such as is breast cancer diagnosis)

Question 10

List 5 components of postpartum care

Answer 10

1. Emotional support (Edinburgh screening, support systems)
2. Physical recovery (wound healing, mobilisation)
3. Screening for complications (what are these?)
4. Breastfeeding support (technique assistance/education)
5. Contraception (when can they become pregnant again?)