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Post-natal Care Flashcards

1
Q

What is postpartum endometritis

A

Infection of endometrium after delivery

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2
Q

Causes of postpartum endometritis

A

Large variety of orgnisms such as gram negative, gram positive and anaerobic bacteria. Also by STIs such as chlamydia and gonorrhoea

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3
Q

Presentation of post partum endometritis

A

Shortly after birth up to several weeks postpartum, foul smelling discharge or lochia. Bleeding that gets heavier and does not improve with time. Lower abdominal or pelvic pain. Fever, sepsis.

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4
Q

Diagnosis and management of postpartum endometritis

A

Vaginal swabs
Urine culture and sensitivities
Admission to hospital if septic
Often clindamycin and gentamicin
Oral abx such as co-amoxiclav if milder symptoms

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5
Q

When can retained products of conception occur

A

Pregnancy related tissue can remain in the uterus after delivery, miscarriage or termination of pregnancy

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6
Q

Risk factor for retained products of conception

A

Placenta accreta

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7
Q

Presentation of retained products of conception

A

Vaginal bleeding which is not improving, abnormal vaginal discharge, lower abdominal or pelvic pain, fever if infection occurs

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8
Q

How are retained products diagnosed

A

USS

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9
Q

Management of retained products of conception

A

Surgical removal using GA or LA, vacuum aspiration and curettage, complications of endometritis and ashermans syndrome

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10
Q

What type of delivery does post partum endometritis occur more commonly in

A

Caeserean

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11
Q

Cause of post partum anaemia

A

Hb is less than 100g/L in postpartum period which is common after delivery due to blood loss

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12
Q

Management of postpartum anaemia

A

Oral iron - ferrous sulfate 200mg 3x daily for 3 months
IV iron
Blood transfusion

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13
Q

When is more than just oral iron used in postpartum anaemia

A

IV iron if Hb is below 90 and blood transfusion if Hb is below 70, fail to respond to iron and cannot absorb iron (IBD)

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14
Q

When is IV iron contraindicated

A

IF there is active infection

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15
Q

What is the difference between baby blues and postnatal depression

A

Majority of women have baby blues which present in the first week or so after birth, but in depression there is a peak of around 3 months (1 in 10) and does not resolve

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16
Q

What is peurperal psychosis

A

Symptoms of psychosis starting a few weeks after birth (1 in 1000)

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17
Q

Symptoms of baby blues

A

Mood swings
Low mood
Anxiety
Irritability
Tearfulness

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18
Q

Cause of baby blues

A

Hormonal changes, recovery, fatigue, sleep deprivation, responsibility, establishing feeds, change

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19
Q

Symptoms of postnatal depression

A

Low mood, anhedonia, low energy

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20
Q

How is mild postnatal depression managed

A

Additional support, self help and follow ups with GP

21
Q

How are moderate cases of postnatal depression managed

A

SSRIs and CBT

22
Q

How are severe cases of postnatal depression managed

A

Input from specialist services and rarely inpatient care

23
Q

What scoring system is used to grade postnatal depression

A

Edinburgh postnatal depression scale - above 10 suggestive

24
Q

Symptoms of peurperal psychosis

A

Deslusions, hallucinations, depression, mania, confusion, thought disorder

25
Treatment of peurperal psychosis
Admission to mother and baby unit, CBT, medications, ECT
26
Cause of mastitis
Obstruction in he ducts and accumulation of milk, also cause by infection as bacteria enter nipple and travel back into the ducts causing inflammation
27
What can help prevent mastitis
Regularly expressing mill
28
Presentation of mastitis
Unilateral breast pain and tenderness, erythema, local warmth and inflammation, nipple discharge, fever
29
Management of mastitis
Conservative - continuous breastfeeding, expressing milk, massage, heat packs, analgesia Abx if sign of infection - flucloxacillin or erythromycin
30
When can candida of the nipple occur
After course of antibiotics
31
Symptoms of candida of the nipple
Sore nipples bilaterally especially after feeding. Nipple tenderness and itching. Cracked, flakey or shiny areola Associated with oral thrush or nappy rash
32
Treatment of candida of the nipple
Topical miconazole 2% after each breast feed and treatment of baby with miconazole gel or nystatin
33
What is postpartum thyroiditis
Changes of thyroid functino within 12 months of delivery - involving thyrotoxicosis, hypothyroidism or both
34
Leading theory of the cause of postpartum thyroiditis
Pregnancy has immunosuppressive effect on mothers body to prevent it from rejecting fetus, so after delivery there is a rebound effect with increased immune activity and expression of antibodies
35
Typical pattern of postpartum thyroiditis
Thyrotoxicosis - first 3 months Hypothyroidism - 3-6 months Thyroid function then gradually returns to normal
36
Signs and symptoms of first stage of thyroiditis (hyperthyroidism)
Anxiety, irritable, sweating and head intolerance, weight loss, tachycardia, fatigue, frequent loose stools
37
Signs and symptoms of second stage of thyroiditis (hypothyroidism)
Weight gain, fatigue, dry skin, coarse hair and hair loss, low mood, heavy or irreg periods, fluid retention, constipation
38
Blood results in thyoiditis
Thyrotoxicosis - Raised T3/4 and low TSH Hypothyroidism - Low T3/T4 and raised TSH
39
Management of postpartum thyrotoxcosis
TFTs in symptomatic women 6-8 weeks post delivery Symptomatic control in stage 1 with beta blockers Levothyroxine in stage 2 There is also annual monitoring
40
What is routinely monitored after delivery
VTE risk PPH Sepsis BP after pre-eclampsia After caesarean or perineal tear FBC check Anti D for rhesus D negative woman
41
What is checked up on in the midwife routine follow up
General wellbeing and mood, Bleeding, urinary incontinence, pelvic exercises, scar healing, breastfeeding, contraception, vaccines
42
What is lochia
Mixture of blood, endometrial tissue and mucus, which is initially dark after delivery but gets lighter in colour and flow over time
43
When will bottle feeding women resume their menstrual cycle
May start from 3 weeks postpartum
44
When is fertility consider to return postpartum
21 days after giving birth
45
What is lactational amenorrhoea
When fully breastfeeding women will not have menstrual cycles and will remain 98% covered by contraception for up to 6 months after
46
When are the POP and implant safe to use after birth
Started any time after birth
47
When should the COCP be safe to use after birth
SHould be avoided in breaastfeeding women
48
When can copper coils or IUS be inserted after birth
Within 48 hours of birth or more than 4 weeks after birth

Obstetrics (8 decks)

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