Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Obstetrics > Post Natal Care > Flashcards

Post Natal Care Flashcards

1
Q

Puerperium

A

Begins with Delivery of Placenta and lasts until Reproductive Organs return to Pre-Pregnant
state, which lasts about 6/52

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Hormone Levels in Puerperium

A

Oestrogen and Progesterone fall to Pre-Pregnancy levels by day 7; HPL and β-hCG levels fall
rapidly; Should not be detectable by day 10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Uterine Change in Puerperium

A

Uterus undergoes rapid involution; Weight decreases from 1kg Post-delivery to 500g; By 2/52, returns to pelvis and no longer abdominally palpable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Vagina Changes in Puerperium

A

– Rapidly regains tone but fragile for 1 – 2/52; Vascularity and Oedema decrease, and
rugae re-appear by 4/52; Cervical Os gradually closes after delivery
o Lochia – Sloughed-off Necrotic Decidual Layer mixed with blood; Initially red (Lochia
Rubra) and becomes paler (Lochia Serosa), finally becoming yellow-white (Lochia
Alba); Flow might last 3 – 6/52

• Perineal Oedema persists for up to week; Longer if Prolonged Second Stage, Operative
Delivery, Perineal Tears requiring repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Breast Changes in Puerperium

A

Between days 2 – 4, become Engorged; Vascularity increases and Areolar Pigmentation increases; Enlargement of Lobules due to Alveolar number and size

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cardiovascular Changes in Puerperium

A

CO initially increases due to return of blood from Contracted Uterus; Rapidly
decreases due to Diuresis and returns to normal by 2 – 3/52
o HR returns to Pre-pregnancy rate; Changes in blood volume due to loss in delivery
and reduction in Plasma volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Main causes of morbidity postnatally

A

Secondary Post-Partum Haemorrhage, Venous

Thromboembolism and Puerperal Pyrexia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Post Partum Haemorrhage

A

Abnormal bleeding occurring up to 6/52 post-natal; 2% admitted, 50% requiring surgery; Major cause of death in developing countries
o Caused by Retained products, Endometritis or Tear
o Management similar to Massive Obstetric Haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

VTE

A

Second major cause of direct maternal death; May be asymptomatic until presenting with PE but DVT symptoms might precede; High level of suspicion in Post-natal
o 0.1-0.2% of pregnancies; Venous Stasis, Possible Pelvic Venous Trauma and
Hypercoagulable state of pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

VTE Prevention

A 
LMWH to post-partum 6 weeks or more; Higher doses required if
Antithrombin Deficiency (Plus Anti-Xa monitoring)
▪ If no previous Hx but ≥3 risk factors – For 5/7 post-partum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

VTE Management

A

o Management similar to Standard VTE, except V/Q Scanning should be used instead of CTPA due to Radiation risk where possible
▪ Treat as PE even if imaging negative in high clinical suspicion; Repeat in 1/52
▪ LMWH as effect as UFH, with lower side effects; Titrate based on aPTT for
UFH or Anti-Xa for LMWH; If Haemorrhage risk should use UFH (Shorter half-
life, easier to complete reversal)

o Treat for at least 6/12 (or 6/52 post-natal); Should be stopped at Onset of Labour;
Warfarin can be used post-natal and is safe during breastfeeding
o Percutaneous Thrombus Fragmentation or Surgical Embolectomy might be required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Puerperal Pyrexia

A

Postnatal Sepsis was most common cause historically, >40% of deaths; Use of Antibiotics has
curbed incidence; Recent resurgence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Puerperal Pyrexia: Risk Factors

A

Anaemia, Prolonged ROM, Prolonged Labour, Bacterial Contamination during
examination, Instrumentation, Trauma, Haematoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Puerperal Pyrexia: Aetiology

A

Endometritis (CS, PROM, Chorioamnionitis, Prolonged Labour, Foetal Monitoring),
Perineal Wound Infection, Breast Abscess/Mastitis, UTI, Thrombophlebitis (High risk of VTE; Should always be considered in DDx), Respiratory Complications (Usually within first 24h;
Invariably in CS delivery; Atelectasis, Aspiration, Pneumonia), Abdominal Wound Infection (6%
after CS; <2% if IV Abx used)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Management of Puerperal Pyrexia

A

• FBC, BC, MSU, Swabs of Cervix and Lochia, Wound Swabs, Throat Swabs, Sputum Culture, CXR
• Supportive Management – Analgesia, NSAIDs, Wound care, Ice packs if Perineal/Mastitis
• Antibiotics – Need to cover for Penicillin-resistant Anaerobes (e.g. Bacteroides); Tetracycline
should be avoided if breastfeeding
o Involvement of Microbiology if failure to respond
• Interventions – I+D of breast abscess, Secondary Repair of Dehiscence, Drainage and Pelvic
Haematoma and Abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Prevention of Puerperal Pyrexia

A

• If suspected UTI in Antenatal period, Investigate and Treat promptly
• Advice regarding Breastfeeding and Breast Care given during Antenatal visits
• Prevention and Treatment of Pre-existing Anaemia
• Rigid Antiseptic Measures – Handwashing, Alcohol Hand Gel, Sterility of Instruments,
Antiseptic Creams and Lotions; Cath under sterile conditions, and only when indicated
• Prophylactic Antibiotics during Caesarean section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Pain in Puerperium

A

After Pains can occur due to Uterine Contraction in first 3-4 days; More common and severe if Instrumental delivery, Episiotomy or Perineal Tears
o Increasing pain might be sign of infection; Antibiotics for treatment
o Paracetamol and NSAIDs are as effective as Opioids; Topical agents might be of use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Urinary Retention

A

Common with Epidural use; Catheterisation might be required to protect
from over-distention; best to leave indwelling for 24 – 48hrs
o An indwelling catheter should be used after Spinal Anaesthetic, until full sensation
returns, to protect against over-distention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

UTI

A

Low Threshold for suspicion; Confirm with MSU and treat with Abx and oral fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Constipation

A

Lack of fluid and food, and dehydration in labour; Pain and fear of wound
disruption, or Opioid Analgesia can contribute
o Dietary advice, Osmotic Laxatives; Stool softeners for women with 3-4 deg tears

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Symphysis Pubic Discomfort

A

Severe Pubic and Groin pain exacerbated by weight bearing;

Most cases resolve 6 – 8/52; Rest, Belt, assistance and analgesia; Rarely surgery

22
Q

Obstetric Paralysis

A

Intrapartum foot drop due to Lumbosacral trunk compression; Lithotomy
without protection at head of fibula also can lead to Fibular nerve palsy

23
Q

Mental Health in Puerperium

A

• Lack of Social and Psychological support is a common problem; 7 – 30% of women in

developed countries; Mental Wellbeing should be carefully and continually assessed in Post-
natal period, especially if at risk (E.g. Psychiatric Hx)

• One of the leading causes of Maternal Death in the UK; Majority due to suicide; Over half
occur between 6 weeks prenatal to 12 weeks postnatal

24
Q

Postnatal Depression

A

10% of women; No evidence that it is different to depression at any other time; Key features
of Tearfulness, Irritability, Anxiety and Poor Sleep;

25
Q

Postnatal Depression: Screening Questions

A

Antenatal at 4-6/52, and 3-4/12 Postnatal; Feeling down/hopeless,
little pleasure in doing things, if there is something they need/want help with

26
Q

Postnatal Depression: Mild to Moderate

A

Mild-moderate responds to Self-help and Listening-visits by Health visitor; Moderate-severe
requires Antidepressants and/or CBT
o Drugs with low secretion in breast milk e.g. Sertraline are preferred

27
Q

Postnatal Depression: Risk factors

A

Higher lifetime risk of further depression (>70%) and 25% risk of PND with subsequent
delivery; Closer post-natal follow up indicated

28
Q

Baby Blues

A

50% encounter brief period of emotional instability, after 3/7 after delivery,
resolving spontaneously within 10/7; Usually responds with support and reassurance

29
Q

Post Natal Psychosis

A

Range of Psychotic Psychiatric Conditions; Most are episodes of Bipolar Affective Disorder;
Can also be Severe Unipolar Depression, Schizophrenic or Organic Illness

30
Q

Post Natal Psychosis : Presentation

A

Presents rapidly (within 2/52 delivery) – Associated rate of suicide 5% and infanticide 4%
o RF: Bipolar Hx, Previous PNP, FH of Bipolar or PNP
o High risk patients should be referred to Specialist Perinatal Mental Health services so
appropriate care plan can be developed, and consider use of Prophylactic medication

31
Q

Post Natal Psychosis : Management

A

Urgent Psychiatric Assessment and Treatment; Needs admission into specialist mother-and-
baby-unit; Any decision to admit must be child centred

o Treatment may involve Antidepressants, Antipsychotics, Mood Stabilisers and ECT
o Many make full recovery, but 10yr recurrence up to 80% and readmission 60%

32
Q

Colostrum

A

Colostrum – Thick, yellow fluid produced around 20/40 Gestation; High concentration of SIgA;
Rich in proteins which play important part of GI maturation and Infant Immunity, produced in
small quantities post-natal

33
Q

Initiation of Breast Feeding

A

• Skin-to-skin contact as soon as possible after delivery; Kangaroo-care at birth
o Early contact increases breastfeeding within first 2h of birth; Increases duration
• Frequency varies widely; Demand feeding is encouraged; Median 8 (6 in day and 2 at night)
o Frequent feeding associated with lower Hyperbilirubinaemia; Frequency increases
gradually and peaks at around day 5
o Demand feeding prevents engorgement, and establishes breast feeding more easily

34
Q

Benefits of Breastfeeding: GI

A

Less morbidity from GI infections and Giardia Infections;

35
Q

Benefits of Breastfeeding: GU

A

Contributes to immunity;

36
Q

Benefits of Breastfeeding: Resp

A

Protective against chest infections

37
Q

Benefits of Breastfeeding: Atopic Illness

A

Reduced likelihood of Eczema and Asthma

38
Q

Benefits of Breastfeeding: Neoplasm

A

Reduced risk of Childhood Acute Leukaemia, ALL, Hodgkin’s and Neuroblastoma

39
Q

Benefits of Breastfeeding:

A

Helps Uterine Involution and reduced risk of PPH
o Lactational Menorrhoea as a form of Contraception – 97% effective at 12/12; Can be helpful for Anaemic mothers in developing countries
o Also, protective against Pre-Menopausal Ca Breast, Ca Ovarian and Osteoporosis

40
Q

Inadequate Milk Supply

A

<1% Physiologically incapable; Adequate fluids, Nutrition, Secure
and Private Environment, Dopamine Antagonists (Allows Prolactin to rise), TRH and Oxytocin
can be used in management
o Drugs that might reduce – Progestins, Oestrogens, Tamoxifen, Ethanol, Bromocriptine
and Cabergoline, Ergotamine, Pseudoephedrine

41
Q

Engorgement

A

Limit Frequency and Duration; Resolve any issues with positioning of baby
(Unrestricted access is most effective)

42
Q

Non Infective Mastitis

A

Due to obstruction of milk; Swollen, red painful area on

breast with systemic features; Resolved by continuing to feed with repositioning

43
Q

Infective Mastitis

A

Progressed from Non-infective; S aureus most common; Breast

feeding should be continued while on antibiotic treatment

44
Q

Sore or Cracked Nipples

A

Could be due to incorrect attachment; Rest breast and express manually until crack has healed

45
Q

Drugs and Breastfeeding

A

Most drugs pass into breast milk; Effect depends on degree of passage, absorption and
effects on the infant when ingested
o Prescribed where absolutely indicated; Shorter half-life, lower toxicity and commonly
used drugs with reduced bioavailability where possible
o Low risk – Heparin, Insulin, Aminoglycosides, Third gen Cephalosporins, PPIs, Inhaled
Steroids and Beta Agonists

46
Q

Contraindicated drugs in Breastfeeding

A

Drugs generally Contraindicated – Amiodarone, Antineoplastic, Chloramphenicol, Ergotamine,
Cabergoline, Ergots, Iodides, Methotrexate, Lithium, Tetracycline, Pseudoephedrine
o Avoid ACEIs (except Captopril), Alcohol, Caffeine, Fluoxetine (Sertraline instead),
Sulfonamide antibiotics where possible

47
Q

Breastmilk Transmission: HIV

A

Risks include Maternal viral load, Duration of breast feeding and Open lesions

48
Q

Breastmilk Transmission: HTLV

A

Are likely to be infected, especially if prolonged

49
Q

Breastmilk Transmission: HBV

A

Can be breastfed; Vaccination at birth and Active Immunisation (HBIg); Breast feeding
does not appear to increase rate of infection

50
Q

Breastmilk Transmission: HSV

A

If no breast lesions, breastfeeding encouraged; VZV – Continue; Maternal Antibodies might confer immunity to baby; CMV – No serious illness or clinical symptoms reported

Obstetrics (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions