Perinatal Care Flashcards
Who should folate supplementation be recommended to?
- all women ages 12-45
What is a high risk pregnancy that requires a higher folate supplementation?
- previous pregnancy with a personal history of NTD
What is medium risk?
- folate inhibiting medictation: phenytoin, primidone, phenobarb, carbemazepine, valproic acid)
- 1st or 2nd relative or parents with a history of NTD
- GI malabsorption conditions
- kidney disease
- prior pregnancy with folate sensitive congenital abnormality
What is the upper limit of caffeine use in pregnancy?
- limit < 300 mg/day
In general _________ will reduce the risk of food borne illnesses
proper food handling and preparation
Where is listeria generally found in food?
- unpasteurized milk, soft ripened cheeses, deli meat
What should be done to food when listeria is a concern?
avoid the foods that generally carry it, reheat until steaming hot, wash the raw fruit/veggies well
What foods contain salmonella?
- raw seafood, raw eggs
What should be done to avoid salmonella in pregnancy?
- avoid raw or soft cooked eggs (raw cookie dough, homemade mayo)
- sushi is okay when it is cooked properly
What food is methyl mercury in?
- fish (shark, swordfish, mackerel, albacore tuna)
How much fish is safe to eat when pregnant?
- 2 servings of fish a week is okay
- choose fish lower in mercury (shrimp, salmon, canned light tuna)
Where is toxoplasmosis found? What can be done to avoid it?
- found as a parasite in raw meat, soil and dirty cat litter
- wear gloves id gardening, have someone else change the litter box, cook meat thoroughly
When is travelling safe in pregnancy?
- theoretically its safe up to 4 weeks before the expected date of delivery
What are the general risk of air travel when pregnant?
- immobilization (increase risk of VT) and so does pregnancy
- cabin hypoxemia (concern for those with CV disease and compromised uterine blood flow)
- cosmic radiation (not really an issue)
What can be done to decrease the risk of VT during pregnancy when air travelling?
- maintain hydration
- frequent walking
- stretching and isometric leg exercises
- compression stockings
What is the problem with using a hot tub during pregnancy?
- heat exposure early in pregnancy has been associated with neural tube defects and miscarriage
- associated with body temperatures as little as 2 degrees over the baseline
Is there a risk of hair treatments in pregnancy?
- use by pregnancy women 3-4 times is not considered to be of concern
- should be avoided if there are open wounds on the area to be treated
- occupational useL wear gloves, adequate ventilation
What are some of the most common prenatal discomforts?
- nausea and vomiting, heartburn, constipation and hemorrhoids
- leukorrhea (increased vaginal discharge)
- edema (hormone incduced Na retention and uterine compression of the IVC)
- varicose veins
- cutaneous changes: spiderangiomas, melasma, striae gravidarum
What is preclampsia?
- hypertension and protein in the urine
What are some of the other conditions that need to be ruled out when a woman as edema?
- preeclampsia, DVT and cellulitis
What are the typical signs of edema?
- symmetric, bilateral leg edea that lessens with recumbency
What are the typical signs of DVT?
- tender, unilateral swelling of a leg or calf, erythema and warmth
What are the typical signs of preeclampsia?
- hypertension and proteinuria, with or without significant nondependent edema - no warmth of tenderness
- sometimes headache or abdominal pain when case is severe / confusion
- blurry vison
- nausea and vomiting and jaundice, rash
What are the typical signs of cellulitis?
- tender, unilateral swelling in a leg or call, redness, warmth and sometimes fever
When should a pregnant woman be referred if she does have edema?
- for preeclampsia, DVT or cellulitis
- involvement extends beyond the feet and ankles, pitting edema (pressure of finder and thumb leaves a depression)
What are some of the varicose vein symptoms?
- edema and varicose veins can cause symptoms such as: numbness, milk pain, aching, or heavy feeling, itching, throbbing, or irrigation around the vein
- ## affect about 40% of pregnant women
What is the aetiology of varicose veins?
- progesterone relaxes the muscular walls of the blood vessels
- blood vessel valve weakens and blood stagnates in wins causing distension and ballooning
What are some of the self-management strategies for edema and varicose veins?
- compression stockings
- sleep in left side lying position (laying on left side opens up the VC and allows dealing of the blood)
- maintain adequate fluid intake
- avoid prolonged standing
- rest with legs elevated often
- do not sit with legs crossed
- maintain physical activity
What is melasma/cholasma?
- dark skin discolouration occurs on the sun’s exposed area
- generally affects the face often is symmetrical
- caused by excess melanin in skin
- risk factors: genetic predisposition, darker skin tones
- prevalence: 50-75% in pregnancy
Does melasma ever go away?
- it fades after delivery, 10-30% of cases persist
What is a spider angioma?
- central red pundit with radiating branches
- usually appear within the first 5 months of pregnancy
- most common around the eyes and areas drained by the SVC (neck, face, upper chest, arms and hands)
- vascular distention and prolifteration of blood vessel during pregnancy, increases risk
What are striae gravidarum?
- stretch marks
- red or purple lines or streaks that fate to pale lines. May be accompanied by pruritus
- ## abdomen, breasts and thighs are commonly affected
What are the risk factors of developing stretch marks?
- degree of abdominal distension, maternal weight gain, genetic predisposition, younger maternal age
- the mechanism is not well understood. Estrogen, adrenocortical hormone, and relaxin. Influence connective tissue formation (promotes seperation of the collagen fibrils), leading to the formation of striae when skin it stretched
- usually fade after post pardum
_____ is key in melasma
prevention
What can be used to prevent melasma?
- broad spectrum sunscreen
- hydroquinone, azelaic acid, tretinoin (do not use tretinoin in pregnancy)
- chemical peels, laster treatment
What is the treatment for angiomas?
- not required
- resolve in 3 months
- intense pulsed light source
What is used as treatment options for striae gravidarum?
- cocoa butter, hyaluronic acid, vitamin E, cantella asiatica extract, bitter almond oil
What is the MOA of different treatments for striae?
- stimulation of the fibroblastic activity leading to increased production of collagen
- increased blood perfusion through massaging of the area and potential anti-inflammatory effects
- increased skin hydration
What are the prenatal signs of potential complications that should be monitored for?
- severe vomiting
- signs of infection
- abdominal cramping
- vaginal bleeding
- sudden loss of fluid from the vagina or continued leakage of fluid from the vagina
- decreased fetal activity
- signs of preterm labour (low, dull backache, increased uterine activity, menstrual like cramps, increased pelvic pressure, vaginal leakage of clear fluid, spotting or bleeding, contractions)
What are some of the most common causes of breast pain?
- nipple trauma/injury
- engorgement and plugged ducts
- breast/nipple infections
What is considered “normal” nipple pain with breastfeeding?
- pain subsides within 30-60 seconds of initiation of feeding
- often peaks 3-6 days postpartum
- usually resolved in about 1 week
(should not be any cracks, fissures or bleeding)
What is a bleb?
- a shiny white bump at the tip of the nipple (blocked nipple pore)
- pinpoint pain on feeding
What can be recommended to women for nipple care?
- avoid harsh cleansers (wash with warm water when bathing)
- avoid excessive moisture (use breast pads, allow to air dry after each feeding)
- can use cool or warm compresses
- acetaminophen or ibuprofen
- use the principle of a moist healing environment- avoid vitamin E oils or creams (high amounts of vitamin E are toxic to the baby)
What should be used as management of a nipple bleb?
- warm soaks, frequent feedings
Mastitis is an ______ that shows as red, hot and swollen areas. There is typically a fever that goes along with it
infection
Are engorged nipples usually unilateral or bilateral?
bilateral
Is a plugged duct unilateral or bilateral?
- unilateral
Describe the management of an engorgement or plugged duct?
- optimize feeding techniques and encourage frequent feeding
- avoid tight or restrictive clothes (stop milk flow)
- warm compress or shower may enhance letdown and facilitate milk removal
- cool compresses between feeding to decrease swelling/discomfort
- analgesics (acetaminophen, ibuprofen)
- plugged ducts - massage the breasts from the affected area toward the nipple
What are the risk factors for mastitis?
- previous mastitis, engorgement, poor milk drainage, nipple damage
- most common pathogen is S. aureus
What are some of the management techniques for treating mastitis?
- supportive measures as for engorgement
- antibiotics indicated if fever is present or if sx do not improve within 12-24 hours with supportive measures
- cloxacillin or cephalexin qid
- tx duration of 10-14 days
What constitutes a diagnosis for nipple candidiasis?
- pain out of proportion to physical finding (often sharp, shooting pain)
- affective nipple appears pink/red and shiny or the skin may be flaky
- exclusion of other causes of breast pain
What are some of the management options of nipple candidiasis?
- mother and child should be treated simultaneously
- treatment duration: continue for 1 week after patient is symptom free
What should be used as pharmaceutical management of nipple candidiasis?
- topical antifungals (miconazole or clotrimazole is preferred over nystatin - this should be applied after each feeding)
- if fissures are present, then a topical Ab should be applied
- gentian violet 1% should be applied OD for 3-4 days.Used for a maximum of 1 week (whenever the mother has a candidal infection, the child should be treated ALWAYS)
what can be done when there is a difficultly to let down?
- gently massage the breasts before pumping
- apply a wet cloth to the breasts before pumping
- pump in a quiet, darkened room to avoid distractions
- look at a picture of your baby or small the baby’s blanket
What is lochia?
uterine discharge after childbirth
What is the normal appearance of lochia and what are the timeframes?
- day 2-3: bright red, small clots
- day 3-10: brown to punk
- day 10- 6 weeks: white or pale yellow
When should lochia be referred?
- bleeding beyond 6 weeks, increased bleeding or clots larger than a loonie should be referred
What are the symptoms of postpartum blues?
- duration is minimum 2 weeks
- minimal effect on the ability to function
- increased emotional response to stimuli, irritable, sleep and appetite disturbances
- up to 20% develop depression
What are the symptoms of postpartum depression?
- lasts over 2 weeks
- depressed mood, anhedonia, sleep and appetite disturbances, psychomotor retardation or agitation, feelings of guilt, worthlessness, diminished concentration, thoughts of death, self harm and suicide
What are the symptoms associated with postpartum psychosis?
- more common in family history of mood disorder
- rapid fluctuation in sx
- extreme depression or mania
- bizarre and disorganized behaviour
- delusions and hallucinations
What are the main postnatal red flags?
- abnormal vaginal bleeding
- malodorous vaginal discharge
- fever and chills
- painful urination
- increased pain, redness, swelling or leakage at the incision site of a C section
- signs of mastitis
- any worsening pain
- signs of depression
- signs of DVT
