Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Yr4: Obstetrics & Gynaecology > Obstetrics: Post-Natal Care > Flashcards

Obstetrics: Post-Natal Care Flashcards

1
Q

Define the immediate post-natal period

A

Birth → 6 weeks post-partum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What routine care (in regards to monitoring, investigation & treatment) may a woman have following delivery

A
  • Analgesia as required
  • Help establishing breast or bottle-feeding
  • Venous thromboembolism risk assessment
  • Monitoring for postpartum haemorrhage
  • Monitoring for sepsis
  • Monitoring blood pressure (after pre-eclampsia)
  • Monitoring recovery after a caesarean or perineal tear
  • Full blood count check (after bleeding, caesarean or antenatal anaemia)
  • Anti-D for rhesus D negative women (depending on the baby’s blood group)
  • Routine baby check
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

After initial post-natal period women will have routine follow up with midwife to discuss various things; state some things that will be discussed

A
  • General wellbeing
  • Mood and depression
  • Bleeding and menstruation
  • Urinary incontinence and pelvic floor exercises
  • Scar healing after episiotomy or caesarean
  • Contraception
  • Breastfeeding
  • Vaccines (e.g. MMR)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

GP’s will commonly offer a 6 week post-natal check (usually done at same time as 6 week newborn baby check); what topics will be covered/explored in 6 week post-natal check

A
  • General wellbeing
  • Mood and depression
  • Bleeding and menstruation
  • Scar healing after episiotomy or caesarean
  • Contraception
  • Breastfeeding
  • Fasting blood glucose (after gestational diabetes)
  • Blood pressure (after hypertension or pre-eclampsia)
  • Urine dipstick for protein (after pre-eclampsia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Discuss what bleeding is normal following delivery

A
  • Vaginal bleeding is normal after delivery
  • Endometrium is breaking down
  • Bleeding will be a mix of blood, endometrial tissue & mucus; called lochia
  • Three types of lochia
    • Lochia rubra
    • Lochia serosa
    • Lochia alba
  • Initially be dark red then over time turn brown and become lighter in flow & colour
  • Bleeding should settle in 6 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Should you advise women with lochia to use tampons?

A

NO, advise not to use tampons as carry infection risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why might breastfeeding women experience more post-natal bleeding/lochia during episodes of breast feeding?

A
  • Breastfeeding release oxytocin
  • Oxytocin causes uterus to contract
  • Cause slightly more bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Discuss when women can expect to start menstruating again following delivery

*HINT: think about differences between breast and bottle fed babies

A
  • Breastfeeding → may not have menstrual periods for 6 months or longer (unless stop breastfeeding) “lactational amenorrhoea”
  • Bottle feeding → may begin to have periods from 3 weeks onwards (but this is unpredictable and periods can be delayed or irregular at first)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Explain why lactational amenorrhoea occurs

A
  • Suckling causes oxytocin and prolactin release
  • Hyperprolactinaemia reduces GnRH secretion leading to decrease in levels of LH and FSH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When, following delivery, is fertility considered to return?

A

21 days after giving birth (contraception not required up to this point as risk of pregnancy before 21 days is very low. After 21 days considered fertile and need contraception)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

State some options for contraception in post-partum period

A
  • Lactational amenorrhoea
  • Progesterone only pill
  • Progesterone implant
  • Combined oral contraceptive pill
  • IUD
  • IUS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

For lactational amenorrhoea, discuss:

  • How long can be used as contraception for
  • Criteria
  • Effectiveness
A
  • Up to 6 months after birth
  • Must be:
    • Fully or nearly fully breastfeeding (that is, the baby is getting 85% or more of its feeds as breast milk)
    • Have complete amenorrhoea
    • Less than 6 months postpartum
  • 98% effective
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When, following birth, can you start the progestogen-only pill or progestogen implant?

Are the above safe in breastfeeding?

A

Can start any time after birth

Safe in breastfeeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When can the IUD or IUS be inserted following birth?

A
  • Can be inserted either within 48hrs of birth or >4 weeks after birth (UKMEC 1)
  • CANNOT be inserted between 48hrs and 4 weeks of delivery (UKMEC 3)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When can you start COCP following birth?

Is it safe to breastfeed?

A
  • If not breastfeeding, start on day 21 post-partum. If past 21 days post-partum, start as you would for other women (day 5)
  • If breastfeeding, CANNOT START BEFORE 6 WEEKS POST-PARTUM (UKMEC 4 before 6 weeks, UKMEC 2 after 6 weeks). Then start as you would for other breastfeeding women
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is post-partum endometritis?

A

Inflammation of endometrium usually caused by infection that is introduced during or after labour and delivery (process of delivery opens up uterus to allow bacteria from vagina to travel upwards & infect endometrium)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Endometritis is more common with vaginal delivery than caesarean section; true or false?

A

FALSE; postpartum endometritis more common after caesarean section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is given during caesarean section to reduce risk of postpartum endometritis?

A

Prophylactic abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which organisms cause postpartum endometritis?

A

Endometritis can be caused by a large variety of gram-negative, gram-positive and anaerobic bacteria. It can also be caused by sexually transmitted infections such as chlamydia and gonorrhoea.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe typical presentation of postpartum endometritis

A

Can present shortly after birth to several weeks postpartum:

  • Foul-smelling discharge or lochia
  • Bleeding that gets heavier or does not improve with time
  • Lower abdominal or pelvic pain
  • Fever
  • Sepsis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What investigations are done to help establish diagnosis of postpartum endometritis?

A
  • Vaginal swabs (including for chlamydia & gonorrhoea if there are risk factors)
  • Urine culture & sensitivities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Discuss the management of postpartum endometritis

A

If endometritis is suspected the patient should be referred to hospital for intravenous antibiotics (clindamycin and gentamicin until afebrile for greater than 24 hours)

*NOTE: endometritis due to other causes/not post-partum may be treated orally in community but for post partum endometritis admission for IV abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is meant by retained products of conception?

A

Pregnancy related tissue (e.g. placental tissue or fetal membranes) remain in uterus after delivery, miscarriage or termination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

State some risk factors for retained products of conception- highlight key one

A
  • Placenta accreta
  • Hx retained products conception
  • Increasing maternal age
  • Scarring of uterus (e.g. past surgery)
  • Failure to progress
  • Instrumental delivery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Describe typical presentation of retained products of conception

A
  • Vaginal bleeding that gets heavier or does not improve with time
  • Abnormal vaginal discharge
  • Lower abdominal or pelvic pain
  • Fever (if infection occurs)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How is retained products of conception diagnosed?

A

Ultrasound pelvis (think transvaginal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Discuss the management of retained products of conception

A

Evacuation of retained products of conception (ERPC)

  • Under GA
  • Cervix gradually widened using dilators
  • Vacuum aspirate or curettage to remove retained products (“Dilation & curettage”)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

State 2 key complications of retained products of conception

A
  • Endometritis
  • Asherman’s syndrome

**NOTE FROM ZtoF: Asherman’s syndrome is where adhesions (sometimes called synechiae) form* *within the uterus. Endometrial curettage (scraping) can damage the basal layer of the endometrium**. This damaged tissue may heal abnormally, creating scar tissue (adhesions) connecting areas of the uterus that are generally not connected. There may be adhesions binding the uterine walls together, or within the endocervix, sealing it shut. This can lead to infertility.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Anaemia is common after delivery; true or false?

A

True; most women lose some blood and in complicated deliveries, C-sections or PPH can lose upwards of 1.5L. Hence why we must optimise treatment of anaemia in pregnancy

30
Q

Define postpartum anaemia (in terms of Hb level)

A

<100g/L

31
Q

An FBC is checked the day after delivery in certain circumstances; state these

A
  • Postpartum haemorrhage over 500ml
  • Caesarean section
  • Antenatal anaemia
  • Symptoms of anaemia
32
Q

Treatment of anaemia based on individual factors & preferences alongside guidelines. Guidelines vary but state a rough guide for the management of the following:

  • Hb <100g/L
  • Hb <90g/L
  • Hb <70g/L
A
  • Hb under 100 g/l – start oral iron (e.g. ferrous sulphate 200mg three times daily for three months)
  • Hb under 90 g/l – consider an iron infusion in addition to oral iron (e.g. Monofer, CosmoFer or Ferinject)
  • Hb under 70 g/l – blood transfusion in addition to oral iron
33
Q

Alongside when Hb is <90g/L, when else would you consider Fe infusion in postpartum anaemia?

A
  • May have poor adherence or oral treatment
  • Cannot tolerate oral iron
  • Fail to respond to oral iron
  • Cannot absorb oral iron (e.g. inflammatory bowel disease)
34
Q

Active infection is a contraindication to Fe infusion; true or false?

A

True; many pathogens feed on Fe so IV Fe can lead to proliferation of pathogen and worsening of infection

35
Q

State some side effects of ferrous sulphate

A
  • Dark stool
  • Constipation
  • Diarrhoea
  • Gastrointestinal discomfort
  • Nausea
  • *NOTE: ADRs are dose-related*
  • *NOTE: take on empty stomach*
36
Q

Postnatal mental health is a spectrum; state 3 conditions ‘on this spectrum’

A
37
Q

For baby blues, discuss:

  • When it usually presents
  • How common it is
  • Symptoms
  • Contributing factors
A
  • First week (commonly 2nd or 3rd postnatal day and resolving in a few days)
  • >50% women (more common in first time mothers)
  • Presentation:
    • Mood swings
    • Low mood
    • Anxiety
    • Irritability
    • Tearfulness
    • Insomnia
    • Impaired concentration
  • Contributing factors:
    • 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
  • Management: reassurance
38
Q

For postnatal depression, discuss:

  • When it usually presents
  • How common it is
  • How it presents
A
  • Peak around 3/12 after birth
  • 1 in 10 women
  • Presentation, symptoms of following for 2 weeks:
    • Core symptoms depression (low mood, anhedonia, low energy) *AT LEAST 2
    • Cognitive symptoms (impaired concentration, hopelessness, guilt)
    • Physical symptoms (decreased appetite, early morning wakening, decreased libido, diurnal variation)
39
Q

Discuss the management of postnatal depression

A

Treatment is similar to depression at other times:

  • Mild cases may be managed with additional support, self-help (low intensity psychological interventions) and follow up with their GP
  • Moderate cases may be managed with antidepressant medications (e.g. SSRIs) and cognitive behavioural therapy (high intensity psychological interventions)
  • Severe cases may need input from specialist psychiatry services, and rarely inpatient care on the mother and baby unit
40
Q

What scale can be used as a screening tool for postnatal depression?

What score suggests postnatal depression?

A
  • Edinburgh Postnatal Depression Scale
    • 10 questions
    • Score /30
  • Score of ≥10 suggests PND
41
Q

What is puerperal psychosis?

When does it typically present?

How common is it?

A
  • Acute onset of a manic or psychotic episode following child birth (usually takes form of mania or severe depression with psychosis)
  • Few weeks after birth
  • 1 in 1000
42
Q

State some risk factors for puerperal psychosis

A
  • Existing mental health disorder such as bipolar or schizophrenia
  • FH of mental illness- particularly PPP
  • Previous PPP after previous preganancy
43
Q

Describe typical presentation of puerperal psychosis

A
  • Delusions
  • Hallucinations
  • Depression
  • Mania
  • Confusion
  • Thought disorder
44
Q

Discuss the management of puerperal psychosis

A

Women with puerperal psychosis need urgent assessment and input from specialist mental health services.

Treatment is directed by specialist services, and may involve:

  • Admission to the mother and baby unit
  • Cognitive behavioural therapy
  • Medications (antidepressants, antipsychotics or mood stabilisers)
  • Electroconvulsive therapy (ECT)
45
Q

Briefly outline what the mother & baby unit is

A

The mother and baby unit is a specialist unit for pregnant women and women that have given birth in the past 12 months. They are designed so that the mother and baby can remain together and continue to bond. Mothers are supported to continue caring for their baby while they get specialist treatment.

46
Q

Who should you refer women with existing mental health problems or concerns before or during pregnancy to?

A

Perinatal mental health services for advice and specialist input e.g.:

  • Decisions about psychiatric medications
  • Plan following delivery that includes close follow up

*REMEMBER: SSRIs in pregnancy can cause neonatal abstinence syndrome- see Neonates FC for more

47
Q

How long does puerperal psychosis usually last?

A

The most severe symptoms tend to last 2 to 12 weeks, and it can take 6 to 12 months or more to recover completely from the condition

48
Q

What is mastitis?

A

Inflammation of the breast tissue which can occur with or without associated infection. Common complication of breastfeeding

49
Q

Discuss the pathophysiology of mastitis

A

Can be caused by either:

  • Obstruction in ducts & accumulation of milk (regular expressing can help prevent this)
  • Infection: bacteria enter nipple and back-track into ducts causing infection & inflammation
50
Q

If mastitis is caused by infection, what is the most common causative organism?

A

Staphylococcus aureus

51
Q

Describe typical presentation of mastitis

A
  • Breast pain and tenderness (unilateral)
  • Erythema in a focal area of breast tissue
  • Local warmth and inflammation
  • Nipple discharge
  • Fever
52
Q

Discuss the management of mastitis

A

If caused by duct blockage:

  • Treating/preventing obstruction:
    • Continue breastfeeding- start feeds with sore breast first but make sure still use other to prevent same occurring in other side
    • Express milk
    • Breast massage
  • Managing symptoms:
    • Heat packs
    • Warm showers
    • Simple analgesia

When above conservative management fails or infection suspected:

  • Antibiotics
    • First line= flucloxacillin
    • If penicillin allergic= erythromycin
  • Sample of milk send for culture & sensitivities
  • Fluconazole may be used for suspected candida infections
  • Advise to continue breastfeeding- even when infection suspected as won’t harm baby and will help to clear mastitis by encouraging milk flow. Can also express milk
53
Q

State a potential complication of mastitis

A

Breast abscess

(may need incision & drainage)

54
Q

When does candida of the nipple often occur?

Why is it a problem?

What is it associated with in the infant?

A
  • Candida infection of nipple often occurs after antibiotics
  • Can lead to recurrent mastitis as the cracked skin on nipples allow bacteria to enter and cause infection
  • Infant may have oral thrush and candidal nappy rash
55
Q

Describe typical presentation of candida of the nipple

A
  • Sore nipples bilaterally, particularly after feeding
  • Nipple tenderness and itching
  • Cracked, flaky or shiny areola
  • Symptoms in the baby, such as white patches in the mouth and on the tongue, or candidal nappy rash
56
Q

Discuss the management of candida of the nipple

A

Both mother & baby need treatment to prevent recurrence:

  • Treatment for mother: topical miconazole 2% after each breastfeed
  • Treatment for baby: e.g. miconazole gel or nystatin
57
Q

What is postpartum thyroiditis?

A

Changes in thyroid function within 12 months of delivery in women without hx of thyroid disease; can be hyperthyroidism, hypothyroidism or both

58
Q

Discuss the pathophysiology of postpartum thyroiditis

A

The cause of postpartum thyroiditis is not clear. The leading theory is that pregnancy has an immunosuppressant effect on the mother’s body, to prevent her from rejecting the fetus. Once delivery has occurred, there can be an exaggerated rebound effect, with increased immune system activity and expression of antibodies. This may include antibodies that affect the thyroid gland, for example, thyroid peroxidase antibodies. These antibodies cause inflammation of the thyroid gland, leading to over or under activity.

59
Q

There is a typical 3 stage pattern to postpartum thyroiditis; describe this

A
  1. Thyrotoxicosis (usually in the first three months)
  2. Hypothyroid (usually from 3 – 6 months)
  3. Thyroid function gradually returns to normal (usually within one year)

*NOTE: not all women follow this pattern

60
Q

Remind yourself of signs & symptoms of hyperthyroidism

A
  • Anxiety and irritability
  • Sweating and heat intolerance
  • Tachycardia
  • Weight loss
  • Fatigue
  • Frequent loose stools
61
Q

Remind yourself of signs & symptoms of hypothyroidism

A
  • Weight gain
  • Fatigue
  • Dry skin
  • Coarse hair and hair loss
  • Low mood
  • Fluid retention (oedema, pleural effusions, ascites)
  • Heavy or irregular periods
  • Constipation

NOTE: if woman presenting with postnatal depression be sure to check thyroid function

62
Q

Discuss the management of postpartum thyroiditis

A

If have symptoms, do TFTs (usually 6-8 weeks after delivery as this is when levels should be returned to normal). Recheck LFTs 4-8 weeks after hyperthyroid stage to test for hypothyroid or sooner if symptoms develop. Pharmacological management:

  • Thyrotoxicosis: symptomatic management with propranolol
  • Hypothyroidism: levothyroxine

Symptoms and thyroid function tests are monitored, and treatment is altered or stopped as the condition changes and improves.

*NOTE: fine to breastfeed when taking levothyroxine- actually a normal part of breast milk!

63
Q

What monitoring is required in women with postpartum thyroiditis?

A

Annual monitoring of TFTs even after condition resolved to identify those that go on to develop long-term hypothyroidism

64
Q

Discuss the prognosis of postpartum thyroiditis

A

Over time the thyroid function returns to normal, and the patient will become asymptomatic again. A small portion of women will remain hypothyroid and need long-term thyroid hormone replacement.

65
Q

What is Sheehan syndrome? Include pathophysiology

A

Sheehan’s syndrome is a rare complication of post-partum haemorrhage, where the drop in circulating blood volume leads to avascular necrosis of the pituitary gland. Low blood pressure and reduced perfusion of the pituitary gland leads to ischaemia in the cells of the pituitary, and cell death.

Sheehan’s syndrome only affects the anterior pituitary gland. Therefore, hormones produced by the posterior pituitary are spared.

66
Q

Why is the anterior pituitary susceptible to rapid drops in BP but posterior pituitary is not?

A
  • The anterior pituitary gets its blood supply from a low-pressure system called the hypothalamo-hypophyseal portal system. This system is susceptible to rapid drops in blood pressure.
  • The posterior pituitary gets a good blood supply from various arteries, and is therefore not susceptible to ischaemia when there is a drop in blood pressure.
67
Q

Describe typical presentation of Sheehan’s syndrome

A
  • Reduced lactation (lack of prolactin)
  • Amenorrhea (lack of LH and FSH)
  • Adrenal insufficiency and adrenal crisis, caused by low cortisol (lack of ACTH)
  • Hypothyroidism with low thyroid hormones (lack of TSH)
68
Q

Discuss the management of Sheehan’s syndrome

A

Sheehan’s syndrome will be managed under the guidance of a specialist endocrinologist. It will involve replacement for the missing hormones:

  • Oestrogen and progesterone as hormone replacement therapy for the female sex hormones (until menopause)
  • Hydrocortisone for adrenal insufficiency
  • Levothyroxine for hypothyroidism
  • Growth hormone
69
Q

Describe the suckling reflex

A
70
Q

State some maternal & baby benefits of breastfeeding

A

Maternal

  • Decreased risk breast & ovarian cancer
  • Decreased risk osteoporosis
  • Decreased risk obesity
  • Decreased risk CVD

Baby

  • Immunity
  • Better cognitive development
  • Reduced risk SIDS
  • Reduced risk obesity
  • Reduced risk CVD in adulthood

Yr4: Obstetrics & Gynaecology (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions