PN 5

Question 1

What monitoring is recommended in first 24 hrs routinely

Answer 1

bP first 6 hrs (PE can present for first time postpartum). If normal, don’t need to retest

First urine void- within 6 hrs

Question 2

How does BP change normally for women with Pe, postpartum

Answer 2

bP increases between day 3-5
Returns to normal day by day 16

Question 3

What is normal BP monitoring for woman with PE

Answer 3

If they have hypertension/ PE already, BP should be monitored regularly during PN - stay in hospital for 72hrs

Once BP stable, measure BP daily until day 7, then weekly for 6wks

Question 4

What are causes for urinary retention post Partum

Answer 4

Likely multi factorial
Psychological , mechanical, neurological

Question 5

When / why should women begin gentle mobilisation

Answer 5

Within first 24hrs
Avoid VTE (main direct cause of maternal death)

Question 6

What are signs of VTe

Answer 6

Swelling (usually unilateral, left)
Lower abdo pain
Low grade temp
Sob (dyspnoea)
Chest pain
Coughing up blood (haemoptysis)
Collapsr

Question 7

When is VTE at highest risk

Answer 7

Puerperium (6-8wks post partum)

Question 8

How do we diagnose VTe

Answer 8

Clinical diagnosis unreliable
Use Doppler ultrasound/ compression ultrasonography

Question 9

How long does a woman stay on anticoagulant therapy

Answer 9

6wks (calf pain thrombosis)
3mths (proximal dvt, PTE)

Stockings -2yrs after event

Question 10

When can you use warfarin

Answer 10

Not in pregnancy
Postpartum- 2-3 days after birth (avoid risk of PPH)

Question 11

What are common effects of secondary pph

Answer 11

Anaemia and iron deficiency

Question 12

When do most women present for secondary pph

Answer 12

2nd wk after birth

Question 13

What are clinical signs if secondary pph

Answer 13

Offensive smelling lochia
Abdo cramps
Uterine tenderness (esp with High/ deviated uterine fundus)
Pyrexia >37.5
Enlarged uterus

(Amount I’d bleeding is not what defines a secondary pph)

Question 14

What is antibiotics for secondary pph

Answer 14

Iv- febrile
Oral- afebrile

Anpicillin
Gentamicin
Metronidazole

Question 15

What is mgmt of secondary pph?

What is biggest risk?

Answer 15

Administer uterotonic

Antibiotics (most secondary PPh caused by rpoc or uterine infection)
Surgical - evacuation of uterus / repair of lacerations
(Uterine perforation)

Question 16

What are most common sites of infection postpartum

Answer 16

Uterine (endometritis)
Urinary tract
Resume (caesarean / epis/ perineal)
Breast
post aborption

Question 17

What is leading cause of sepsis

Answer 17

Group a strep
“puerparel fever” is Group A strep maternal sepsis

Question 18

What is neutropenia

Answer 18

Low wbc’s

Question 19

What are signs of group a strep

Answer 19

> 38 Pyrexia
Tender subinvoluted uterus
Chills/ general malaise
Lower abdo pain
Diarrhoea
Purulent dx
Vaginal bleeding
Hypothermi, tachyapnoea, neutropenia)
Signs of shock (hypotension, sustained tachycardia

Question 20

Group a strep

What is it
Common onset/ presentation

Answer 20

very Common bacteria (30% people) living in throat / skin (asymptomatic)

Onset- within few days of birth

risk factors
Upper respiratory tract infection
contact with children
winter/ early spring

initial presentation
Abdo pain (peritonitis)
Toxic shock
Painful skin infection (necrotising fasciitis)
mild GI symptoms (diarrhoea )
general malaize

classic signs of sepsis
- fever
- tender uterus / subinvoluted
- lower abdo pain
- purulent dx
- pv bleeding
- hypothermic
- tachyapnoic
- neutropenia (low WBC’s)
- signs of shock- hypotension, tachycardic

Treatment-
- blood cultures, high + low swabs, MSU, wound swabs
- aggressive AB’s immediately (After cultures)
- clindamtcin (broad spectrum ABs)

Question 21

what is endometritis

Answer 21

inflammation of uterine lining
usually due to an infection (GBS, STI)

Risk factors
- Caesarean section (esp Cat 3)
- prolonged labour
- PROM
- AN Infection
-PPH
Manual removal of placenta
mec liquor

Symptoms
- Fever 72hrs post partum
-abdo / pelvic pain
subinvolution
may be febrile or just have low grade temp
abnormal blood colour / smell
bowel / bladder function may be disturbed

Question 22

what is dyspareunia

Answer 22

painful intercourse

Question 23

what is diastasis of the rectus abdominis muscle (DRAM)

Question 24

what is difference between normal postpartum headache, and post-dural puncture headache?

Answer 24

post-dural puncture headache
-worse when sitting / standing
severe/ rapid onset

Question 25

what is epidural blood patch

Answer 25

indication- to treat post-dural puncture headache in postpartum

process- use patient’s blood to treat a CSF leak in the spine

Question 26

what is cause of diastasis of rectus abdominis

Answer 26

thinning/ stretching of linea alba
(connective tissue that sits in between abdo muscles)

Question 27

when is diastasis clinically meaningful

Answer 27

separation is >2.2-2.3cm

Question 28

what is stress incontinence

Answer 28

involuntary leakage on effort / exertion / sneezing/ coughing

Question 29

what is urge incontinence

Answer 29

leakage, then urgency to pee

Question 30

what are kaiatawhai

Answer 30

(Māori health workers)

Question 31

Describe the edinburgh perinatal depression scale

Answer 31

• Screening tool
• used during pregnancy and for first 12mths
• Recommendation is for all midwives to screen women around day 10-14 to assess whether ‘baby blues’ have resolved

10 questions- asking about last 7 days.
score is out of 30.
≥ 13 = high chance of depression
10-12= likely. repeat in 2- 4 days
≥ 9 = low chance depression

Question 32

Describe ‘baby blues’

Answer 32

peaks day 4-5, should resolve by day 10-12

signs
change in mood
irritable
insomnia
loss of appetite
crying /anxiety

Question 33

Describe postpartum psychosis

Answer 33

very severe / uncommon.
Emergency

usually appears within 2 wks.

Signs
- mood disturbance
- out of touch with reality (delusions/ hallucinations /increased talking/ not aware of child)

risk factor
past bipolar (but 50% of cases don’t have hx mental health issue)

Question 34

what is ictirus neonatorum

Answer 34

jaundice