Post-partum Care

Question 1

What do we call the first 6 wks following delivery?

Answer 1

The Peurperium

Question 2

Who sees the mother during the Peurperium?

Answer 2

Midwife for the 1st 9-10 days

Then Health Visitor

Go to GP for 6wk postnatal check

Question 3

What do the midwife and health visitor do when seeing the new mum?

Answer 3

• Observe for signs of abnormal bleeding and infection (wound, breast or endometritis)
• Debrief the events of the birth especially if there was an emergency CS
• Also discussing family planning

Question 4

What are the common and fairly normal problems in the Peurperium?

Answer 4

• Feeding problems
• Bonding issues
• Social problems e.g. the partner, other children or financial

Question 5

What are the major dangers to the mother in the Post-partum period?

Answer 5

• Post-Partum Haemorrhage
• VTE
• Sepsis
• Post-natal Hypertensive disorders (pre-eclampsia)
• Psychiatric Disorders

Question 6

What are the types of PPH?

Answer 6

Primary

• >500ml within 24hrs of delivery
• Tone, trauma, tissue, thrombin (4 Ts)

Secondary

• >500ml after 24 hrs to the 6wk boundary

Question 7

What causes primary PPH?

Answer 7

Tone - e.g. Atonic Uterus

Trauma - e.g. tears or ruptures

Tissue - Retained

Thrombin - e.g. can’t clot

Question 8

What causes secondary PPH?

Answer 8

Retained tissue

Endometritis

Tears/trauma

Question 9

How do we reduce risk of a VTE?

Answer 9

A proper risk assessment and if necessary -> Thromboprophylaxis

Question 10

How might a VTE present in the Peurperium

Answer 10

• Unilateral Leg Swelling and/or pain
• SOB or Chest pain
• Unexplained Tachycardia

Question 11

How can we test for a VTE?

Answer 11

• ECG
• Doppler
• US
• CXR +/- VQ scan
• D-dimer isn’t useful in pregnant or post-partum women because they’re already hypercoagulable

Question 12

How do we treat a VTE in pregnancy?

Answer 12

LMWH

Warfarin can be used when breastfeeding but not during pregnancy

Question 13

Sepsis is the leading cause of direct maternal death in the UK, how do we test for it if suspicious?

Answer 13

Blood Culture

MSSU

Wound Swab

Lower Vaginal Swab (LVS)

Question 14

How do we manage a suspected case of post-partum sepsis?

Answer 14

• Promopt IV antibiotics
• Antipyretics
• IV fluids
• Refer to hospital

Question 15

What are the major psych disorders in post-partum women?

Answer 15

Baby blues

Postnatal Depression

Peurperal Psychosis

Question 16

What are the baby blues?

Answer 16

Hormonal changes cause the blues in many mothers 1-3 days PN. Doesn’t affect function and doesn’t require treatment

Question 17

What is postnatal depression?

Answer 17

Classic depressive symptoms that do affect function and bonding

Look for a history or family history of affective disorder

It does require specific treatment unlike baby blues

Question 18

How do we handle Peurperal Psychosis?

Answer 18

Much more serious, women can be a danger to themselves and babies.

So inpatient psych care is required

Look for a history/FH of affective disorder, bipolar or pyschosis

Question 19

What is Lochia?

Answer 19

• Vaginal discharge
• Normal for up to 3-4 weeks post-partum
• Should be like a period or less

Question 20

What are post-natal hypertensive disorders?

Answer 20

• Most eclamptic seizures occur in the postnatal period
• Pre-eclampsia can develop postnatally or may worsen several days following delivery