Mother & Child In Post Partum Period

Question 1

What’s the APGAR score?

Answer 1

Activity
Pulse (HR)
Grimace (reflexes)
Appearance (skin colour)
Respiration (breathing effort)

2 points each = 10 in total

Question 2

When is the APGAR score done?

Answer 2

1 (how did baby tolerate birth process) and 5 (how is baby doing outside of uterus) minutes

Question 3

What is the APGAR score used to assess?

Answer 3

Physical condition of newborn
Health of baby post delivery
Need for resuscitation post delivery

Question 4

What % of newborns does neonatal respiratory distress affect? What are its 3 signs

Answer 4

7% of all term newborns

Tachypnoea (RR >60bpm) (triggered by excessive lung fluid)
Nasal flaring
Grunting

Question 5

Why is skin to skin contact done immediately after birth?

Answer 5

Babies can lose heat dramatically after birth
Placed in contact with mother/partners skin and dried with pre-warmed towels

Helps regulate temperature, breathing, heart rate and blood sugar

Question 6

When should breast feeding start, following birth?

Answer 6

Within 1 hour

Question 7

What’s moulding?

Answer 7

Overlapping of the bones of the foetal skull, self-removes over first 24-48 hours

Question 8

What’s caput?

Answer 8

Change in apparent shape of foetal head = subcutaneous collection of fluid with poorly defined margins caused by pressure on presenting part of head during birth

Self-resolves in first 24-36 hours

Question 9

What’s cephalohaematoma?

Answer 9

Subperiosteal haemorrhage often associated with instrumental delivery

May take few weeks to resolve and can cause jaundice (monitor bilirubin)

Question 10

What are the 2 types of flat head syndrome?

Answer 10

Plagiocephaly = head in parallelogram shape

Brachycephaly = back of the head becomes flattened, causing it to widen

Question 11

Why do flat head syndromes arise?

Answer 11

Bones of foetal skull in uterus are relatively soft and malleable, so can be shaped in restriction or positioning

Question 12

What’s the NIPE exam?

Answer 12

Carried out with 72 hours of birth

Looking at:
Eyes - opacities and red reflex
Testes - patency and undescended
Hips - check symmetry, Barlow & Ortolani manoeuvre
Heart - position, murmurs, femoral pulse volume

Question 13

What are some serious postnatal problems to mum?

Answer 13

Post-Partum haemorrhage
VTE
Anaemia
Post-Partum psychosis (1-2 per 1000 births, onset usually 2-3days)
5% suicide rate

Question 14

What’s lochia?

Answer 14

Endometrial slough (vaginal discharge) - when it starts to repair

Should be red days 1-3
Yellow by day 10
White until 6 weeks

Question 15

What are examinations of the newborn and when are they carried out?

Answer 15

Initial examination within first couple of hours

NIPE more detailed examination within 72 hours

Question 16

What should the initial examination of the newborn include?

Answer 16

Assess physiological adaptation to extra-uterine life: colour, tone, HR, breathing (basically APGAR)

Question 17

What are risk factors for post partum haemorrhage?

Answer 17

Having had one in previous pregnancy 
BMI >35
Carrying twins/triplets
Anaemia
Pre-eclampia/hypertension
Placental abruption (coming away early)
Induced labour
Caesarean section
Episotomy
Labour more than 12 hours

Question 18

What are anatomical changes to mum in the post partum period?

Answer 18

Peripheral oedema for a few days
Cervix firm by day 3
Lochia
Vaginal wall may be fragile 1-2 weeks (swollen/blue)
Uterus reduces by 1 finger breadth per day

Question 19

When in the post partum period do the internal and external os close?

Answer 19

Internal at day 3

External at week 3

Question 20

What is the puerperal (post partum) period?

Answer 20

Roughly 6 weeks after birth when reproductive organs return to non-pregnant condition

Question 21

What are some common puerperal problems?

Answer 21

Mastitis
Perineal pain/infection (from episiotomy or natural)
Pudenal nerve bruising = urinary retention and possible catheterisation
Constipation = use bowel softeners
Haemorrhoids causing pain
Backache
Psychological problems