Mother and Child in immediate postpartum

Question 1

How do newborns regulate body temp?

Answer 1

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

Question 2

What is the APGAR score?

Answer 2

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)

Question 3

What APGAR score is normal or abnormal?

Answer 3

Scores of 7,8,9…normal 10 is unusual…<7 needs support

Question 4

What is the APGAR score used to assess?

Answer 4

the physical condition of the newborn.
health of the baby post delivery
need for resuscitation post-delivery

Question 5

What is neonatal respiratory distress? Should the baby be suctioned?

Answer 5

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

Question 6

What is the meconium and what is it composed of?

Answer 6

newborn’s first stools

It is composed of amniotic fluid, mucus, lanugo, bile and cells that have shed from the skin and intestinal tract

Question 7

What is meconium stained liquor?

Answer 7

Meconium in amniotic fluid

If meconium has been passed inutero it is a sign of fetal distress

Question 8

What is the importance of skin to skin contact?

Answer 8

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

Question 9

What is moulding?

Answer 9

overlapping of the bones of the fetal skull. Self resolves quickly in the first 24/48 hours

Question 10

What is caput?

Answer 10

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

Question 11

What is Cephalohaematoma? What is the recovery time?

Answer 11

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

Question 12

What is plagiocephaly?

Answer 12

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

Question 13

What is Brachycephaly?

Answer 13

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

Question 14

When should you encourage breastfeeding?

Answer 14

Within the first hour

Question 15

Why is vit K given to newborn babies?

Answer 15

Prevent haemorrhagic disease of the newborn
Required informed consent!! + explanation + education
1) Intramuscular injection 1mg
2) orally

Question 16

What newborn examinations are carried out and when?

Answer 16

1) Initial general exam - within couple of hours of birth

2) NIPE (new born and infant physical examination) - within 72 hours

Question 17

Describe the initial general examination of the newborn baby?

Answer 17

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!!

Question 18

Where are the results of the NIPE exam noted?

Answer 18

PHCR - parent health child records - red book

Question 19

What does the NIPE examination entail? (name 4 areas)

Answer 19

Eyes
Testes
Hips
Heart

Question 20

Describe what you could check for in the NIPE exam.

Answer 20

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

Question 21

What would you check for the immediate post-partum care of the mum?

Answer 21

Skin to skin
Vital signs
Bladder / bowels
Perineum / Lochia / sutures
Fundus
Breasts
Vital signs
BP, pulse particularly

Question 22

What is lochia?

Answer 22

Vaginal discharge after birth - includes endometrial slough/RBC/WBC

Question 23

What anatomical changes occur in the mother after birth?

Answer 23

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

Question 24

What is puerperal?

Answer 24

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

Question 25

What are common puerperal problems?

Answer 25

Mastitis
Perineum: Episiotomy - tear -> repair or Pain
Micturition: pudendal n bruising
Bowels: constipation, haemorrhoids
Backache
3rd blues - temporarily sad and emotional
PND

Question 26

What are some serious postnatal problems?

Answer 26

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

Question 27

What is post partum haemorrhage? What are its causes? (hint: 4 Ts)

Answer 27

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

Question 28

What can you use to detect any retained products after birth?

Answer 28

Ultrasound