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Obstetrics > Post-natal Care > Flashcards

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
Q

Treatment of peurperal psychosis

A

Admission to mother and baby unit, CBT, medications, ECT

26
Q

Cause of mastitis

A

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
Q

What can help prevent mastitis

A

Regularly expressing mill

28
Q

Presentation of mastitis

A

Unilateral breast pain and tenderness, erythema, local warmth and inflammation, nipple discharge, fever

29
Q

Management of mastitis

A

Conservative - continuous breastfeeding, expressing milk, massage, heat packs, analgesia
Abx if sign of infection - flucloxacillin or erythromycin

30
Q

When can candida of the nipple occur

A

After course of antibiotics

31
Q

Symptoms of candida of the nipple

A

Sore nipples bilaterally especially after feeding.
Nipple tenderness and itching.
Cracked, flakey or shiny areola
Associated with oral thrush or nappy rash

32
Q

Treatment of candida of the nipple

A

Topical miconazole 2% after each breast feed and treatment of baby with miconazole gel or nystatin

33
Q

What is postpartum thyroiditis

A

Changes of thyroid functino within 12 months of delivery - involving thyrotoxicosis, hypothyroidism or both

34
Q

Leading theory of the cause of postpartum thyroiditis

A

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
Q

Typical pattern of postpartum thyroiditis

A

Thyrotoxicosis - first 3 months
Hypothyroidism - 3-6 months
Thyroid function then gradually returns to normal

36
Q

Signs and symptoms of first stage of thyroiditis (hyperthyroidism)

A

Anxiety, irritable, sweating and head intolerance, weight loss, tachycardia, fatigue, frequent loose stools

37
Q

Signs and symptoms of second stage of thyroiditis (hypothyroidism)

A

Weight gain, fatigue, dry skin, coarse hair and hair loss, low mood, heavy or irreg periods, fluid retention, constipation

38
Q

Blood results in thyoiditis

A

Thyrotoxicosis - Raised T3/4 and low TSH
Hypothyroidism - Low T3/T4 and raised TSH

39
Q

Management of postpartum thyrotoxcosis

A

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
Q

What is routinely monitored after delivery

A

VTE risk
PPH
Sepsis
BP after pre-eclampsia
After caesarean or perineal tear
FBC check
Anti D for rhesus D negative woman

41
Q

What is checked up on in the midwife routine follow up

A

General wellbeing and mood, Bleeding, urinary incontinence, pelvic exercises, scar healing, breastfeeding, contraception, vaccines

42
Q

What is lochia

A

Mixture of blood, endometrial tissue and mucus, which is initially dark after delivery but gets lighter in colour and flow over time

43
Q

When will bottle feeding women resume their menstrual cycle

A

May start from 3 weeks postpartum

44
Q

When is fertility consider to return postpartum

A

21 days after giving birth

45
Q

What is lactational amenorrhoea

A

When fully breastfeeding women will not have menstrual cycles and will remain 98% covered by contraception for up to 6 months after

46
Q

When are the POP and implant safe to use after birth

A

Started any time after birth

47
Q

When should the COCP be safe to use after birth

A

SHould be avoided in breaastfeeding women

48
Q

When can copper coils or IUS be inserted after birth

A

Within 48 hours of birth or more than 4 weeks after birth

Obstetrics (8 decks)

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