O&G: Postnatal care Flashcards
Postnatal Depression
when is baby blues
seen in the majority of women in the first week or so after birth
Postnatal Depression
when do you get postnatal depression
seen in about one in ten women,
with a peak around three months after birth
Postnatal Depression
when do you get puerperal psychosis
seen in about one in a thousand women,
starting 2-3 weeks after birth
Postnatal Depression
how long may baby blues last
only a few days
Postnatal Depression
mnx of baby blues
none
Postnatal Depression
why may baby blues occur
- Significant hormonal changes
- Recovery from birth
- Fatigue and sleep deprivation
- The responsibility of caring for the neonate
- Establishing feeding
- All the other changes and events around this time
Postnatal Depression
classic triad
- low mood
- anhedonia
- low energy
Postnatal Depression
how long should sx last before it can be diagnosed
at least 2w
Postnatal Depression
trx in mild cases
additional support, self-help and follow up with their GP
Postnatal Depression
trx in moderate cases
antidepressants and CBT
Postnatal Depression
trx in severe cases
may need input from specialist psychiatry services
rarely inpatient care on the mother and baby unit
Postnatal Depression
what is the screening tool
The Edinburgh postnatal depression scale
can be used to assess how the mother has felt over the past week
Postnatal Depression
what score on the Edinburgh postnatal depression scale suggest postnatal depression
> 10
10q’s out of 30
Postnatal Depression
Puerperal Psychosis: what psychotic sx do women experience
- delusions
- hallucinations
- depression
- mania
- confusion
- thought disorder
Postnatal Depression
Puerperal Psychosis: trx
urgent assessment and input from specialist mental health services
- admission to mother and baby unit
- CBT
- antidepressants, antipsychotics, mood stabilisers
- ECT
Postnatal Depression
what is the mother and baby unit
for pregnant women and women that have given birth in the past 12 months
mother and baby can remain together and continue to bond.
while they get specialist treatment.
Postnatal Depression
mnx for women that have existing mental health concerns before or during pregnancy
referred to perinatal mental health services for advice and specialist input
followed up closely after delivery with help from midwives, health visitors, GPs, family and friends
Postnatal Depression
what can SSRIs taken during pregnancy lead to
neonatal abstinence syndrome (also known as neonatal adaptation syndrome)
Postnatal Depression
presentation of abstinence syndrome
irritability and poor feeding.
Retained Products of Conception
what is it
when pregnancy-related tissue (e.g. placental tissue or fetal membranes) remain in the uterus after delivery
it can also occur after miscarriage or termination of pregnancy
Retained Products of Conception
what is a significant risk factor
placenta accreta
Retained Products of Conception
presentation
- vaginal bleeding that does not improve with time
- abdo vaginal discharge
- lower abdo or pelvic pain
- fever (if infection occurs)
Retained Products of Conception
diagnostic inx
US
Retained Products of Conception
mnx
- evacuation of retained products of conception
Retained Products of Conception
complications of evacuation of retained products of conception
- endometritis
- Asherman’s syndrome
Retained Products of Conception
what is Asherman’s syndrome
adhesions form within the uterus –> infertility
Postpartum Endometritis
what is it
inflammation of the endometrium, usually caused by infection.
It can occur in the postpartum period, as infection is introduced during or after labour and delivery.
Postpartum Endometritis
when does it present
from shortly after birth to several weeks postpartum
Postpartum Endometritis
presentation
- Foul-smelling discharge or lochia
- Bleeding that gets heavier or does not improve with time
- Lower abdominal or pelvic pain
- Fever
- Sepsis
Postpartum Endometritis
inx
- vaginal swabs
- urine C+S
- US: rule out retained products of conception
Postpartum Endometritis
milder sx and signs of sepsis mnx
broad spectrum abx: co-amoxiclav
