Mother and baby in postpartum period Flashcards

1
Q

What is an APGAR score?

A

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
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2
Q

What AGPAR score indicates baby needs assistance post birth?

A

Less than 7

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3
Q

Is suctioning baby’s oral/ nasal passage routine after delivery?

A

No - babies fairly capable of clearing large amounts of lung fluid

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4
Q

How is respiratory distress identified in a neonate?

A

1 or more of:

Tachypnea (>60 bpm)
Nasal flaring
Grunting

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5
Q

What is respiratory distress typically caused by in neonates?

A

Excessive lung fluid

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6
Q

What is the importance of skin-to-skin in the immediate postpartum period?

A

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]

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7
Q

What is moulding?

A

Overlapping of the bones of the foetal skull - usually self resolves in first 24-48 hours

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8
Q

What is caput?

A

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

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9
Q

What is a cephalohaematoma?

A

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

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10
Q

What is plagiocephaly?

A

Type of ‘flat head syndrome’ where head is flattened on one side causing it to appear asymmetrical and ears may be misaligned

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11
Q

What is brachycephaly?

A

Type of ‘flat head syndrome’ where back of the head becomes flattened causing the head to widen and occasionally the forehead bulges out

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12
Q

Why are babies susceptible to ‘flat head syndrome’ in early life?

A

Bones of the foetal skull in utero and early life are relatively soft and malleable so they can be shaped by restriction or positioning

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13
Q

When should feeding method be discussed?

A

After skin-to-skin contact has been started

Breastfeeding should be initiated within 1st hour

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14
Q

What examinations should be carried out on newborns?

A
  1. Initial examination (general examination within couple of hours of birth) - recorded in hospital postnatal notes
  2. Newborn and infant physical examination (NIPE) within 72 hours (more detailed exam with four areas - eyes, testes, hips, heart) - recorded in red book
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15
Q

What information must be given to parents before administration of Vitamin K?

A

Explanation/ education regarding Vitamin K deficiency bleeding and its signs and symptoms
INFORMED CONSENT !

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16
Q

What are the priorities for assessing mum in the postpartum period?

A
Skin-to-skin 
Vital signs (esp. BP and pulse) 
Bowel/ bladder
Perineum/ lochia/ sutures 
Fundus
Breasts
17
Q

What are the serious postnatal problems to be aware of in mum?

A

Postpartum haemorrhage
Venous Thromboembolism
Anaemia
Postpartum psychosis (1 or 2: 1000)

18
Q

What are the suicide and infanticide rates for postpartum psychosis?

A

5% suicide

4% infanticide

19
Q

What are some risk factors pre-birth that increase likelihood of a postpartum haemorrhage?

A
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
20
Q

What are some risk factors during birth that increase likelihood of a postpartum haemorrhage?

A
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
21
Q

How does the uterus change after labour?

A

Involutes from 1kg to 100g

Returns to pelvic organ within 10 days

22
Q

How does the cardiovascular system change after labour?

A

Returns to normal within 2 weeks

23
Q

What happens to the vaginal wall after labour?

A

Initially swollen and bluish

May be fragile for 1-2 weeks

24
Q

How does the cervix change after labour?

A

Firm by day 3
Internal Os closes at day 3
External Os closes by week 3

25
Q

How does lochia change in the postpartum period?

A

Red for days 1-3
Yellow by day 10
White until 6 weeks

26
Q

What is mastitis and how is it treated?

A

Staph Aureus infection of the breast tissue

Treated using Flucloxacillin and analgesia

27
Q

How might the perineum be damaged during labour and how is this treated?

A

Tear (or episiotomy) - may require repair

Pain relief and infection prevention

28
Q

How can micturition be affected by labour?

A

Bruising of the pudendal nerve can result in retention which may require catheterisation

29
Q

What bowel problems can occur after labour?

A

Constipation (may require stool softeners)

Haemorrhoids (may require anusol or ice pack)

30
Q

What can be done to help relieve backache following labour?

A

Analgesia
Support when sitting
Physiotherapy
Gentle exercise (e.g. swimming)

31
Q

How common is low mood or postnatal depression in the postpartum period?

A

“blues” affects a large proportion of women who become temporarily sad and emotional
PND affects approx. 10% of women

32
Q

What might indicate neonatal hypotonia?

A

Ventral suspension - rag doll position
Vertical suspension - baby would slip through arms
More head lag than normal