Post-natal Care

Question 1

What is the first bit of breast milk to be produced over the first 3 days called?

Answer 1

Colostrum

Question 2

What chemical changes initiate the release of prolactin from anterior pituitary?

Answer 2

Fall in oestrogen

Question 3

How does oestrogen, progesterone and oxytocin levels affect lactation?

Answer 3

Oestrogen stimulates duct growth and drop in oestrogen stimulates prolactin production
Progesterone stimulates areolar growth
Oxytocin is needed for milk ejection

Question 4

When would we expect menstruation to start again in non-lactating mothers?

Answer 4

Around 8 weeks after birth

Question 5

What percentage of women develop mental health problem during pregnancy or in the year after childbirth?

Answer 5

1 in 5

Question 6

What are some factors that affect the selection of perinatal mental health conditions?

Answer 6

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

Question 7

What questions can be asked in a brief screen for depression?

Answer 7

• 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

Question 8

What two questions can you ask to do a brief screen for anxiety?

Answer 8

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?

Question 9

What are risk factors for peri-natal mental health problems?

Answer 9

Prior diagnosis of mental health illness, FHx of severe perinatal mental health, unplanned/unwanted pregnancy, pregnancy complications/traumatic birth, neonatal/fetal loss

Question 10

What previous mental health illnesses are linked with post-natal depression?

Answer 10

Prev. Severe depression and bipolar disorder

Question 11

How does baby blues typically present?

Answer 11

Symptoms of tearfulness, low mood, irritability and feeling anxious starting within 3/4 days

Question 12

What is the management for baby blues?

Answer 12

Reassurance and support. Typically self limiting by around 14 days

Question 13

How does postnatal depression typically present?

Answer 13

Typical depression symptoms within 1-2 months of giving birth, difficulty bonding with baby, felling inadequate as mother, may struggle to care for baby

Question 14

How do we manage severe postnatal depression?

Answer 14

Referral to specialist perinatal mental healt services. SSRIs or TCAs

Question 15

What topics are covered at a 6 week post-natal check up?

Answer 15

General wellbeing, mood, bleeding/menstruation, scar healing, contraception, breastfeeding

Question 16

What products are recommended for collecting Lochia?

Answer 16

Sanitary pads
Tampons not advised as carry risk of infection

Question 17

Why might there be slightly more bleeding during breastfeeding, is this normal?

Answer 17

This is normal as oxytocin increases while breastfeeding, this also causes uterine contraction leading to slightly more bleeding

Question 18

When can different forms of contraception be started after childbirth?

Answer 18

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

Question 19

Is endometriosis more common after vaginal delivery or C-section?

Answer 19

C-section

Question 20

What is endometritis?

Answer 20

Inflammation of the endometrium usually caused by infection

Question 21

How does endometritis present?

Answer 21

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

Question 22

What investigations could help establish the diagnosis of endometritis?

Answer 22

Vaginal swabs, urine cultures and sensitivities
US can rule out retained products of conception

Question 23

What is meant by the term ‘retained products of conception’?

Answer 23

When pregnancy related tissues remain in the uterus after delivery/termination/miscarriage

Question 24

How does ‘retained products of conception’ present?

Answer 24

Can be asymptomatic
Vaginal bleeding that gets heavier or does not improve with time, abnormal vaginal discharge, lower abdo pain
Fever if infected

Question 25

what investigation is used to diagnose retained products of conception?

Answer 25

Ultrasound

Question 26

What is the standard management of postpartum retained products of conception?

Answer 26

ERPC (evacuation of retained products of conception)- involving dilating the cervix and using vacuum aspiration or curettage to remove the retained products

Question 27

What are the two key complications of ERPC procedure?

Answer 27

Endometritis and asherman’s syndrome

Question 28

What is asherman’s syndrome?

Answer 28

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

Question 29

What placental abnormality is a significant risk factor for retained products of conception?

Answer 29

Placenta accreta

Question 30

When would you perform a FBC the day after delivery?

Answer 30

PPH over 500ml, C-section, antenatal anaemia, symptoms of anaemia

Question 31

How would you treat a post-natal anaemia of less than (a) 100g/l, (b) 90g/l, (c) 70g/l

Answer 31

(A) oral ferrous sulphate
(B) iron infusion in addition to oral iron
(C) blood transfusion in addition to oral iron

Question 32

How would you treat a post-natal anaemia of less than (a) 100g/l, (b) 90g/l, (c) 70g/l

Answer 32

(A) oral ferrous sulphate
(B) iron infusion in addition to oral iron
(C) blood transfusion in addition to oral iron

Question 33

If a woman is anaemic and requiring an iron tranfusion but currently have an active infection how would you proceed?

Answer 33

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

Question 34

What is the most common organism associated with infection in mastitis?

Answer 34

Staph aureus

Question 35

Is mastitis an infection?

Answer 35

No its inflammation of breast tissue which can occur with or without infection

Question 36

how does mastitis present?

Answer 36

Breast pain, warm localised erythema, nipple discharge, fever

Question 37

Should women with mastitis and suspected infection continue to breast feed, is this safe for baby?

Answer 37

Yes women should be encouraged to keep breastfeeding even when infection is suspected. This will not harm the baby.

Question 38

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?

Answer 38

Candida of the nipple
Topical miconazole after each breast feed, baby will also need treatment

Question 39

What is sheehans syndrome?

Answer 39

Rare complication of PPH, where drop in circulating blood volume leads to avascular necrosis of the anterior pituitary gland

Question 40

Which pituitary hormones’ production are affected in sheehans syndrome, which ones are spared?

Answer 40

Affected: TSH, ACTH, growth hormone, prolactin, LH, FSH
Unaffected: ADH, oxytocin