Post-natal Care Flashcards
What is the first bit of breast milk to be produced over the first 3 days called?
Colostrum
What chemical changes initiate the release of prolactin from anterior pituitary?
Fall in oestrogen
How does oestrogen, progesterone and oxytocin levels affect lactation?
Oestrogen stimulates duct growth and drop in oestrogen stimulates prolactin production
Progesterone stimulates areolar growth
Oxytocin is needed for milk ejection
When would we expect menstruation to start again in non-lactating mothers?
Around 8 weeks after birth
What percentage of women develop mental health problem during pregnancy or in the year after childbirth?
1 in 5
What are some factors that affect the selection of perinatal mental health conditions?
Patient factors: stigma, fear of being seen as bad mother or having baby taken away
Health professional factors: not asking, time constraints, not recognising red flags or risk factors, lack of access to specialist services
What questions can be asked in a brief screen for depression?
- during the past month have you been bothered by feeling down, depressed or hopeless
- during the past month have you often been bothered by having little interest or pleasure in doing things
What two questions can you ask to do a brief screen for anxiety?
During the past month have you been feeling nervous, anxious or on the edge?
During the past month have you not been able to stop or control worrying?
What are risk factors for peri-natal mental health problems?
Prior diagnosis of mental health illness, FHx of severe perinatal mental health, unplanned/unwanted pregnancy, pregnancy complications/traumatic birth, neonatal/fetal loss
What previous mental health illnesses are linked with post-natal depression?
Prev. Severe depression and bipolar disorder
How does baby blues typically present?
Symptoms of tearfulness, low mood, irritability and feeling anxious starting within 3/4 days
What is the management for baby blues?
Reassurance and support. Typically self limiting by around 14 days
How does postnatal depression typically present?
Typical depression symptoms within 1-2 months of giving birth, difficulty bonding with baby, felling inadequate as mother, may struggle to care for baby
How do we manage severe postnatal depression?
Referral to specialist perinatal mental healt services. SSRIs or TCAs
What topics are covered at a 6 week post-natal check up?
General wellbeing, mood, bleeding/menstruation, scar healing, contraception, breastfeeding
What products are recommended for collecting Lochia?
Sanitary pads
Tampons not advised as carry risk of infection
Why might there be slightly more bleeding during breastfeeding, is this normal?
This is normal as oxytocin increases while breastfeeding, this also causes uterine contraction leading to slightly more bleeding
When can different forms of contraception be started after childbirth?
POP and implant can be started anytime after birth
Coils can be put in within 48 hours of birth, otherwise its after 4 weeks
COCP not started until 6 weeks after childbirth in women breastfeeding
Is endometriosis more common after vaginal delivery or C-section?
C-section
What is endometritis?
Inflammation of the endometrium usually caused by infection
How does endometritis present?
Shortly after birth to several weeks postpartum with foul smelling discharge/lochia, bleeding that gets heavier or doesnt improve with time, lower abdominal/pelvic pain, fever, sepsis
What investigations could help establish the diagnosis of endometritis?
Vaginal swabs, urine cultures and sensitivities
US can rule out retained products of conception
What is meant by the term ‘retained products of conception’?
When pregnancy related tissues remain in the uterus after delivery/termination/miscarriage
How does ‘retained products of conception’ present?
Can be asymptomatic
Vaginal bleeding that gets heavier or does not improve with time, abnormal vaginal discharge, lower abdo pain
Fever if infected
what investigation is used to diagnose retained products of conception?
Ultrasound
What is the standard management of postpartum retained products of conception?
ERPC (evacuation of retained products of conception)- involving dilating the cervix and using vacuum aspiration or curettage to remove the retained products
What are the two key complications of ERPC procedure?
Endometritis and asherman’s syndrome
What is asherman’s syndrome?
Where adhesion from in the uterus, this may bind areas of the uterine wall together or within the endocervix which would seal it shut and lead to infertility
What placental abnormality is a significant risk factor for retained products of conception?
Placenta accreta
When would you perform a FBC the day after delivery?
PPH over 500ml, C-section, antenatal anaemia, symptoms of anaemia
How would you treat a post-natal anaemia of less than (a) 100g/l, (b) 90g/l, (c) 70g/l
(A) oral ferrous sulphate
(B) iron infusion in addition to oral iron
(C) blood transfusion in addition to oral iron
How would you treat a post-natal anaemia of less than (a) 100g/l, (b) 90g/l, (c) 70g/l
(A) oral ferrous sulphate
(B) iron infusion in addition to oral iron
(C) blood transfusion in addition to oral iron
If a woman is anaemic and requiring an iron tranfusion but currently have an active infection how would you proceed?
Wait until the infection has resolved to give the infusion
Many pathogens feed on iron and so this could lead to proliferation of the pathogen and worsening of infection
What is the most common organism associated with infection in mastitis?
Staph aureus
Is mastitis an infection?
No its inflammation of breast tissue which can occur with or without infection
how does mastitis present?
Breast pain, warm localised erythema, nipple discharge, fever
Should women with mastitis and suspected infection continue to breast feed, is this safe for baby?
Yes women should be encouraged to keep breastfeeding even when infection is suspected. This will not harm the baby.
A breast feeding mum has finished a course of antibiotics and come in noticing white patches in babies mouth. Mum also notices sore, itchy nipples after feeding which look a little racked and flaky. What is the likely diagnosis? How do we treat this?
Candida of the nipple
Topical miconazole after each breast feed, baby will also need treatment
What is sheehans syndrome?
Rare complication of PPH, where drop in circulating blood volume leads to avascular necrosis of the anterior pituitary gland
Which pituitary hormones’ production are affected in sheehans syndrome, which ones are spared?
Affected: TSH, ACTH, growth hormone, prolactin, LH, FSH
Unaffected: ADH, oxytocin
