Mother and Child in immediate postpartum Flashcards
How do newborns regulate body temp?
After birth the baby begins to lose heat
Receptors on the baby’s skin send messages to the brain the baby is cold
The baby’s body creates heat by burning stores of brown fat
What is the APGAR score?
Summarise health of newborn children: Appearance Pulse rate Grimace Activity Respiratory effort Score: 0-2 per category One min score ( how did baby tolerate birth process) Five min score ( how is baby doing outside of uterus)
What APGAR score is normal or abnormal?
Scores of 7,8,9…normal 10 is unusual…<7 needs support
What is the APGAR score used to assess?
the physical condition of the newborn.
health of the baby post delivery
need for resuscitation post-delivery
What is neonatal respiratory distress? Should the baby be suctioned?
Tachypnoea (RR greater than 60 bpm)
Nasal flaring
grunting
Routine suctioning of the newborn’s oral and nasal passages is not recommended as the baby is capable of clearing fairly large amounts of lung fluid
What is the meconium and what is it composed of?
newborn’s first stools
It is composed of amniotic fluid, mucus, lanugo, bile and cells that have shed from the skin and intestinal tract
What is meconium stained liquor?
Meconium in amniotic fluid
If meconium has been passed inutero it is a sign of fetal distress
What is the importance of skin to skin contact?
Placed in contact with the mother’s or partner’s skin and dried with pre-warmed towels. 1hr undisturbed.
Helps regulate temperature, breathing, heart rate and possibly blood sugar
What is moulding?
overlapping of the bones of the fetal skull. Self resolves quickly in the first 24/48 hours
What is caput?
change in the shape of the fetal head
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 first 24/36hrs
What is Cephalohaematoma? What is the recovery time?
Subperiosteal haemorrhage often associated with instrumental delivery
The haemorrhage is bound by the periosteum, therefore, the swelling does not cross suture lines (in contrast to a caput succedaneum).
May take longer to resolve (number of weeks)and cause jaundice - bilirubin should be monitored
What is plagiocephaly?
Type of flat head syndrome
head is flattened on one side, causing it to look asymmetrical; the ears may be misaligned and the head looks like a parallelogram when seen from above
What is Brachycephaly?
Type of flat head syndrome
back of the head becomes flattened, causing the head to widen, and occasionally the forehead bulges out.
Much more common - back to sleep campaign
When should you encourage breastfeeding?
Within the first hour
Why is vit K given to newborn babies?
Prevent haemorrhagic disease of the newborn
Required informed consent!! + explanation + education
1) Intramuscular injection 1mg
2) orally
What newborn examinations are carried out and when?
1) Initial general exam - within couple of hours of birth
2) NIPE (new born and infant physical examination) - within 72 hours
Describe the initial general examination of the newborn baby?
within couple of hours of birth
assessing physiological adaptation into extra-uterine life; colour, tone, heart rate and breathing
always be carried out in the mother’s, and if possible, father’s presence after obtaining consent - explain!!
Where are the results of the NIPE exam noted?
PHCR - parent health child records - red book
What does the NIPE examination entail? (name 4 areas)
Eyes
Testes
Hips
Heart
Describe what you could check for in the NIPE exam.
Eyes; check opacities and ‘red reflex’
Heart; check position, rate, rhythm and sounds, murmurs and femoral pulse volume
Abdomen; check shape and palpate to identify any organomegaly
Genitalia and anus; check for completeness and patency and undescended testes in males
Hips; check symmetry of limbs and skin folds; perform Barlow and Ortolani’s manoeuvres
What would you check for the immediate post-partum care of the mum?
Skin to skin Vital signs Bladder / bowels Perineum / Lochia / sutures Fundus Breasts Vital signs BP, pulse particularly
What is lochia?
Vaginal discharge after birth - includes endometrial slough/RBC/WBC
What anatomical changes occur in the mother after birth?
Uterus: Involutes 10kg -> 100g
CVS: reverts to normal within 2 weeks
Vaginal wall: regains tone (initially bluish/swollen), fragile for 1-2 weeks
Perineal oedema: persist for few days
Cervix: firm by day 3, Int OS closes - day 3, Ext OS closes - week 3
Lochia
What is puerperal?
during or relating to the period of about six weeks after childbirth during which the mother’s reproductive organs return to their original non-pregnant condition
What are common puerperal problems?
Mastitis
Perineum: Episiotomy - tear -> repair or Pain
Micturition: pudendal n bruising
Bowels: constipation, haemorrhoids
Backache
3rd blues - temporarily sad and emotional
PND
What are some serious postnatal problems?
Post Partum Haemorrhage Venous thrombo embolism Anaemia Postpartum Psychosis : rare psychiatric emergency- 1-2 per 1,000 births Onset usually 2-3 days postpartum; 5% suicide and 4% infanticide rate
What is post partum haemorrhage? What are its causes? (hint: 4 Ts)
loss of blood estimated to be more than 500ml from the genital tract
Primary PPH if in first 24 hours
Minor if less than 1000mls
Major if over 1,000mls
Tone: uterine atony
Trauma: lacerations of the uterus, cervix or vagina
Tissue: retained placenta or tissue or clots
Thrombin: pre-existing or acquired
What can you use to detect any retained products after birth?
Ultrasound
