Mother and baby in postpartum period Flashcards
What is an APGAR score?
Used to assess the physical condition and health of the newborn post delivery and to identify need for resuscitation - scored at 1 min + 5 mins post birth
5 categories (each can achieve a score of 2 maximum): Appearance (skin/ colour) Pulse rate Grimace (reflexes) Activity (muscle tone) Respiratory effort
What AGPAR score indicates baby needs assistance post birth?
Less than 7
Is suctioning baby’s oral/ nasal passage routine after delivery?
No - babies fairly capable of clearing large amounts of lung fluid
How is respiratory distress identified in a neonate?
1 or more of:
Tachypnea (>60 bpm)
Nasal flaring
Grunting
What is respiratory distress typically caused by in neonates?
Excessive lung fluid
What is the importance of skin-to-skin in the immediate postpartum period?
Helps regulate temperature, breathing, heart rate and possibly blood sugar
Positive effects on the initiation and duration of breastfeeding
[Nb. 1st hour key - should be uninterrupted where possible]
What is moulding?
Overlapping of the bones of the foetal skull - usually self resolves in first 24-48 hours
What is caput?
Characteristic change in the apparent shape of the foetal head caused by a subcutaneous collection of fluid with poorly defined margins (often crossing suture lines) caused by the pressure on the presenting part of the head during birth - self resolves in 24-36 hours
What is a cephalohaematoma?
Subperiosteal haemorrhage often associated with instrumental delivery - haemorrhage bound by periosteum so swelling does not cross suture lines (unlike a caput) - can take weeks to resolve and cause jaundice so bilirubin must be monitored
What is plagiocephaly?
Type of ‘flat head syndrome’ where head is flattened on one side causing it to appear asymmetrical and ears may be misaligned
What is brachycephaly?
Type of ‘flat head syndrome’ where back of the head becomes flattened causing the head to widen and occasionally the forehead bulges out
Why are babies susceptible to ‘flat head syndrome’ in early life?
Bones of the foetal skull in utero and early life are relatively soft and malleable so they can be shaped by restriction or positioning
When should feeding method be discussed?
After skin-to-skin contact has been started
Breastfeeding should be initiated within 1st hour
What examinations should be carried out on newborns?
- Initial examination (general examination within couple of hours of birth) - recorded in hospital postnatal notes
- Newborn and infant physical examination (NIPE) within 72 hours (more detailed exam with four areas - eyes, testes, hips, heart) - recorded in red book
What information must be given to parents before administration of Vitamin K?
Explanation/ education regarding Vitamin K deficiency bleeding and its signs and symptoms
INFORMED CONSENT !
What are the priorities for assessing mum in the postpartum period?
Skin-to-skin Vital signs (esp. BP and pulse) Bowel/ bladder Perineum/ lochia/ sutures Fundus Breasts
What are the serious postnatal problems to be aware of in mum?
Postpartum haemorrhage
Venous Thromboembolism
Anaemia
Postpartum psychosis (1 or 2: 1000)
What are the suicide and infanticide rates for postpartum psychosis?
5% suicide
4% infanticide
What are some risk factors pre-birth that increase likelihood of a postpartum haemorrhage?
PPH in previous pregnancy BMI >35 4+ previous children Twins/ triplets South Asian ethnicity Low lying placenta (placenta praevia) Placental abruption (placenta coming away early) Pre-eclampsia/ high BP Anaemia
What are some risk factors during birth that increase likelihood of a postpartum haemorrhage?
C-Section Induction of labour Retained placenta Episiotomy Forceps/ ventouse delivery Labour of 12+ hours Big baby (4kg/ 9lbs +) First baby when over 40 years old
How does the uterus change after labour?
Involutes from 1kg to 100g
Returns to pelvic organ within 10 days
How does the cardiovascular system change after labour?
Returns to normal within 2 weeks
What happens to the vaginal wall after labour?
Initially swollen and bluish
May be fragile for 1-2 weeks
How does the cervix change after labour?
Firm by day 3
Internal Os closes at day 3
External Os closes by week 3
How does lochia change in the postpartum period?
Red for days 1-3
Yellow by day 10
White until 6 weeks
What is mastitis and how is it treated?
Staph Aureus infection of the breast tissue
Treated using Flucloxacillin and analgesia
How might the perineum be damaged during labour and how is this treated?
Tear (or episiotomy) - may require repair
Pain relief and infection prevention
How can micturition be affected by labour?
Bruising of the pudendal nerve can result in retention which may require catheterisation
What bowel problems can occur after labour?
Constipation (may require stool softeners)
Haemorrhoids (may require anusol or ice pack)
What can be done to help relieve backache following labour?
Analgesia
Support when sitting
Physiotherapy
Gentle exercise (e.g. swimming)
How common is low mood or postnatal depression in the postpartum period?
“blues” affects a large proportion of women who become temporarily sad and emotional
PND affects approx. 10% of women
What might indicate neonatal hypotonia?
Ventral suspension - rag doll position
Vertical suspension - baby would slip through arms
More head lag than normal
