Post Partum Care Flashcards
What is colostrum?
Yellow fluid secreted by breasts for 4-5 days post partum
Contains more minerals and protein than mature milk, but less sugar and fat
Contains high concentration of IgA
What are normal changes in the puerperium?
Bhcg levels fall
Uterus decreases in size
Vagina swollen initially, may be fragile
Cervix- gradually closes over 2 weeks
Perineum- oedema
Lochia- discharge, initially red then yellowish
Breast- become endorsed between 2nd and 4th days
What is in mature breast milk?
High concentration of lactose
Vitamins (except k)
Immunoglobulin
Antibodies
How much milk is produced?
Increases to 500ml at five days post partum
How should breast feeding be initiated and continued?
Initiation:
Skin to skin contact post delivery
Feed within first two hours of birth
Ensure babies head and body are inline
Support babies head and shoulders
Baby needs a mouthful of breast from underneath the nipple
Chin should touch breast
Continuation:
Feeds infrequent during first 24-48 hours, then increase gradually and peak at 5th day - around 3-6 hourly
Demand feeding should be encouraged- prevents engorgement
Cows milk is not suitable until a baby is 1 year - too much salt, not enough food
Can switch to solid food at 6 months
What are the advantages of breast feeding?
For infant: Reduced gastrointestinal infection Reduced UTIs Reduced respiratory infections Less atopic illness Reduced leukaemias
For mother: Prevents against breast, ovarian cancer, osteoporosis Amenorrhoea and contraception It's free - bottles cost 450 Promotes bonding
What are the disadvantages of breast feeding?
Inadequate milk supply - affects less than 1%, can be treated
Breast engorgement - treat by express milk, warm showers and cold compresses
mastitis, breast abscess - continue breastfeeding
Sore or cracked nipples - may be corrected by position - breastfeeding nurse
Transmission of drugs and infections
What drugs are generally contraindicated in breastfeeding?
Amiodarone Antineoplastic Chloramphenicol Ergotamine Cabergoline Ergot alkaloids Iodides Methotrexate Lithium Tetracycline Pseudoephedrine
How is puerperal pyrexia defined?
Defined as temperature >38 degrees in any occasion in first 14 days after delivery
Slight fever is not uncommon in 1st 24 hours
What are the genital causes of puerperal pyrexia?
Endometritis - associated with foul profuse and bloody discharge, with tender bulky uterus
Perineal wound infection- including episiotomy
What are the nongenital causes of puerperal pyrexia?
Mastitis, breast abscess
UTIS
Thrombophlebitis
Respiratory complications - usually after Caesarean section
Abdominal wound infection - usually post caesarean
How is puerperal pyrexia defined?
Defined as temperature >38 degrees in any occasion in first 14 days after delivery
Slight fever is not uncommon in 1st 24 hours
What are the genital causes of puerperal pyrexia?
Endometritis - associated with foul profuse and bloody discharge, with tender bulky uterus
Perineal wound infection- including episiotomy
What are the nongenital causes of puerperal pyrexia?
Mastitis, breast abscess - fluclox
UTIS
Thrombophlebitis
Respiratory complications - usually after Caesarean section
Abdominal wound infection - usually post caesarean
How should puerperal pyrexia be investigated?
FBC Blood cultures MSU Swabs from cervix and lochia for chlamydia and bacterial culture Wound swabs Throat swabs Sputum culture and chest radiographs
Aim to identify most likely source of infection
How should puerperal pyrexia be managed?
Supportive:
Analgesics and NSAIDS
Wound care in case of wound infection
Ice packs
Antibiotics:
Depends on source if infection
Surgical:
Incision and drainage of breast abscess
Secondary repair of wound
What other complications may occur in the postnatal period?
Pain - after pains from uterine contraction for 4 days
Urinary retention - following instrumental delivery
UTI
Constipation - osmotic stool softeners
Symphysis pubis discomfort - usually resolves in 6-8 weeks- can wear supportive belt
Maternal obstetric paralysis - foot drop due to lumbosacral nerve damage
How common is post partum psychosis?
Affects 1/2 in a 1000
What are risk factors for postpartum psychosis?
Past history of postpartum psychosis
Past history of bipolar disorder
Family history of postpartum psychosis or bipolar disorder
When postpartum psychosis present?
10-14 days postpartum
How should postpartum psychosis be managed?
Antipsychotic and or mood stabilising drug
Take into account breastfeeding
Education and supportive therapy
Admit to mother and baby unit
How often does postpartum psychosis recur?
20% will have further psychosis if they become pregnant again
50% will have another psychotic episode at another point in their life
How common are the baby blues?
Occur in greater than 50% of women
When do postnatal blues begin, peak and end?
Begins days 2-4
Peaks days 4-6
Lasts for 2-7 days
What are the symptoms of the baby blues?
Emotional lability Tearfulness Sadness Sleep disturbance Poor concentration Restlessness Headaches
Mother may feel vulnerable and rejected and may show undue concern for baby
How is baby blues managed?
Reassurance and support
Antenatal preparation may help
What is the onset of postnatal depression
10-25% of women in first postnatal year
What are the risk factors for postnatal depression?
Previous mental health problems Poor social support Poor relationship with partner Baby blues Recent major life events Unplanned pregnancy Not breastfeeding Unemployment Longer time to conception Substance abuse
How quickly do symptoms of postnatal depression appear and how long do they last?
Develop 2-3 months postpartum
Resolves slowly after 6-12 months
How does postnatal depression present?
Features of depression
Particularly: Irritability Tiredness Reduce libido Guilty feelings about parenting abilities Anxieties over babies health Feeling of inability to cope with baby
How is postpartum depression managed?
In 2/3rds, self limiting
In 1/3rd, severe or sustained disease
Management:
Reassurance
Mild
- self help/supportive care
- consider antidepressant if previous episode of depression
Moderate /severe
- CBT
- consider antidepressants
- consider admission to mother and baby unit
What is the prognosis of post natal depression?
Most cases resolve within 3-6 months
A quarter of women will still have symptoms a year later
Where should suspected endometritis be managed!
Admit to hospital for IV antibiotics
Clindamycin and gentamicin until a febrile for greater than 24 hours
