Maternal Wellbeing and Lactation Flashcards
A G1P1 woman attends her postnatal visit 6-weeks after a normal delivery with an intact perineum. She complains of urinary incontinence when coughing or straining and her midstream urine is sterile. Which management is MOST appropriate?
a) Referral to physiotherapy for pelvic floor exercises
b) Prescribe vaginal oestrogen cream and refer to physiotherapy for pelvic floor exercises
c) Reassurance that urinary incontinence usually self-resolves in the first few months after birth
d) Referral to a specialist for urodynamic assessment
e) Prescribe oestrogen cream, insert a ring pessary and refer to a specialist for urodynamic assessment.
a) Referral to physiotherapy for pelvic floor exercises
A G1P1 woman is breastfeeding her 7-day old full term baby. She has grazed, bleeding, and painful nipples and her baby has lost 10% of his birthweight. What is the MOST LIKELY cause?
a) Bacterial infection of the nipples
b) Thrush infection of the nipples
c) Baby is not latching properly
d) Baby has ankyloglossia
e) Vasospasm of the nipples
c) Baby is not latching properly
A G1P1 woman has just given birth to a premature baby at 26-weeks’ gestation and asks you how often should express milk for optimal lactation. Which response is MOST appropriate?
a) It’s busy and stressful with a premature baby, so aim to express when you have time
b) Don’t worry about expressing until your milk ‘comes in’, then express at least 8-times in 24 hours
c) Start expressing within 6 hours of birth and express at least 8-times in 24 hours
d) Express 3-hrly during the day and take a break overnight as good sleep is important for new mothers
e) Your baby won’t need breastmilk for a while and we can get you expressing when baby is ready
c) Start expressing within 6 hours of birth and express at least 8-times in 24 hours
Mother of a thriving 6-week old breastfed baby is worried as her breasts have become softer and baby is feeding more often than usual. What is the MOST LIKELY cause?
a) Inadequate lactation and baby showing early signs of failure to thrive
b) Breasts need time to fill-up between feeds, so baby should be encouraged to feed less often
c) Switch from endocrine to autocrine control of lactation and baby having a growth spurt
d) Over-tired mother and more rest will help increase her milk supply
e) Mother needs to drink more fluids and eat more protein-rich food to boost her milk supply.
c) Switch from endocrine to autocrine control of lactation and baby having a growth spurt
Mother of a healthy 2-day old 4.5kg infant tells you her baby breastfed all night, she is exhausted and concerned that she hasn’t got enough milk. Which response is MOST appropriate?
a) Colostrum is only in small quantities, so offer formula after breastfeeds until your milk comes in
b) Colostrum is all baby needs right now, so let’s check baby is latching and feeding effectively
c) Colostrum won’t flow if you’re tired, so we’ll feed baby tonight and let you catch up on sleep
d) Colostrum quantity may not be enough to satisfy a big baby, so baby may need formula top-ups
e) Colostrum can take 3 days to come-in, so don’t worry and just keep feeding
b) Colostrum is all baby needs right now, so let’s check baby is latching and feeding effectively
Mother of a 6-week old thriving breastfed baby has unilateral mastitis and has commenced antibiotics/analgesia. She says she feels ‘flu-like’ and too unwell to continue breastfeeding. Which response is MOST appropriate?
a) It’s best to continue to breastfeed as efficient breast emptying helps resolution of mastitis
b) It’s best not to breastfeed as the mastitis infection goes through your milk into your baby
c) It’s best not to breastfeed as the antibiotics and analgesia goes through your milk to your baby
d) It’s best not to breastfeed when you are so unwell and I’ll give you medication to dry up your milk
e) It’s best to continue to breastfeed and you can just feed off the non-infected breast
a) It’s best to continue to breastfeed as efficient breast emptying helps resolution of mastitis
Which one of the following is true regarding antenatal screening for the prediction of postnatal depressive illness?
a) It is unlikely to reduce postnatal morbidity
b) It should be delayed until late pregnancy
c) It should include the Edinburgh Post Natal Depression score
d) It should include questions on Family History of bipolar Disorder
e) It will accurately predict the development of postnatal depression
c) It should include the Edinburgh Post Natal Depression score
Which of the following statements about post-natal psychiatric problems is true:
a) Post-natal psychosis usually starts within 5 to 6 days of delivery
b) 5% of women will develop clinically diagnosed depression within 6 months of childbirth
c) The Edinburgh Post-natal depression scale is a useful screening tool to aid in diagnosing post-natal depression, anxiety neuroses, phobias and puerperal psychosis
d) Third day blues can effect up to 30% of women
e) 2 per thousand women will develop puerperal psychosis
e) 2 per thousand women will develop puerperal psychosis
Which answer is true regarding Puerperal Psychosis?
a) Psychosis is experienced by 1-2% of postnatal women.
b) The risk of recurrence is >80%
c) It is commonly associated with poor social circumstances
d) In the vast majority of cases it presents with severe mood disturbance
e) Women with a family history should be treated with lithium post partum
d) In the vast majority of cases it presents with severe mood disturbance
A woman develops a fever of 38 degrees C post LSCS following poor progress in first stage. She had an uneventful pregnancy. Which of the following is not relevant to the possible diagnosis and your management?
a) MSU showing GBS in urine at 32 weeks
b) A history of prolonged ruptured membranes more than 20 hours before admission in labour
c) Prolonged urinary catheterisation post LSCS, because of persistent haematuria
d) Failure to give prophylactic antibiotics at the time of caesarean section
e) Estimated blood loss of 600mL at time of LSCS delivery
e) Estimated blood loss of 600mL at time of LSCS delivery
