PN 5 Flashcards
What monitoring is recommended in first 24 hrs routinely
bP first 6 hrs (PE can present for first time postpartum). If normal, don’t need to retest
First urine void- within 6 hrs
How does BP change normally for women with Pe, postpartum
bP increases between day 3-5
Returns to normal day by day 16
What is normal BP monitoring for woman with PE
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
What are causes for urinary retention post Partum
Likely multi factorial
Psychological , mechanical, neurological
When / why should women begin gentle mobilisation
Within first 24hrs
Avoid VTE (main direct cause of maternal death)
What are signs of VTe
Swelling (usually unilateral, left)
Lower abdo pain
Low grade temp
Sob (dyspnoea)
Chest pain
Coughing up blood (haemoptysis)
Collapsr
When is VTE at highest risk
Puerperium (6-8wks post partum)
How do we diagnose VTe
Clinical diagnosis unreliable
Use Doppler ultrasound/ compression ultrasonography
How long does a woman stay on anticoagulant therapy
6wks (calf pain thrombosis)
3mths (proximal dvt, PTE)
Stockings -2yrs after event
When can you use warfarin
Not in pregnancy
Postpartum- 2-3 days after birth (avoid risk of PPH)
What are common effects of secondary pph
Anaemia and iron deficiency
When do most women present for secondary pph
2nd wk after birth
What are clinical signs if secondary pph
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)
What is antibiotics for secondary pph
Iv- febrile
Oral- afebrile
Anpicillin
Gentamicin
Metronidazole
What is mgmt of secondary pph?
What is biggest risk?
Administer uterotonic
Antibiotics (most secondary PPh caused by rpoc or uterine infection)
Surgical - evacuation of uterus / repair of lacerations
(Uterine perforation)
What are most common sites of infection postpartum
Uterine (endometritis)
Urinary tract
Resume (caesarean / epis/ perineal)
Breast
post aborption
What is leading cause of sepsis
Group a strep
“puerparel fever” is Group A strep maternal sepsis
What is neutropenia
Low wbc’s
What are signs of group a strep
> 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
Group a strep
What is it
Common onset/ presentation
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)
what is endometritis
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
what is dyspareunia
painful intercourse
what is diastasis of the rectus abdominis muscle (DRAM)
what is difference between normal postpartum headache, and post-dural puncture headache?
post-dural puncture headache
-worse when sitting / standing
severe/ rapid onset
what is epidural blood patch
indication- to treat post-dural puncture headache in postpartum
process- use patient’s blood to treat a CSF leak in the spine
what is cause of diastasis of rectus abdominis
thinning/ stretching of linea alba
(connective tissue that sits in between abdo muscles)
when is diastasis clinically meaningful
separation is >2.2-2.3cm
what is stress incontinence
involuntary leakage on effort / exertion / sneezing/ coughing
what is urge incontinence
leakage, then urgency to pee
what are kaiatawhai
(Māori health workers)
Describe the edinburgh perinatal depression scale
- 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
Describe ‘baby blues’
peaks day 4-5, should resolve by day 10-12
signs
change in mood
irritable
insomnia
loss of appetite
crying /anxiety
Describe postpartum psychosis
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)
what is ictirus neonatorum
jaundice
