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Year 4 GOSH > Post-Partum Care > Flashcards

Post-Partum Care Flashcards

1
Q

What is the management of 1st and 2nd degree tears and uncomplicated episiotomies?

A

Sutured under local anaesthetic

Failure to suture reduces healing and may cause more pain

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2
Q

What is the management of 3rd and 4th degree tears?

A

Repaired in theatre under regional / GA

Post op broad-spectrum abx

Post op laxatives

Physiotherapy and pelvic floor exercises for 6-12wks post partum

Follow up with obstetrician 6-12wks later
- If incontinence or pain at follow up, refer to a specialist gynaecologist or colorectal surgeon for possible secondary sphincter repair

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3
Q

What is the prognosis of 3rd / 4th degree tears?

What is the risk of developing another 3rd or 4th degree tear in a subsequent delivery?

A

30% have complications
- Incontinence (faeces or flatus) or urgency

60-80% symptom free after 12 months

5-7% recurrence risk

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4
Q

What should be the labour management of women who have experienced a 3rd or 4th degree tear in a previous pregnancy?

A

If symptomatic / show anal sphincter defects on endoanal USS = counsel them about risks and offer option of elective CS

All other women = advise to have a vaginal delivery

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5
Q

What two hormones are involved in lactation?

A

Prolactin and oxytocin

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6
Q

Where is prolactin produced and what is its role?

A

Released from anterior pituitary gland

Stimulates milk secretion

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7
Q

Where is oxcytocin produced and what is its role?

A

Posterior pituitary gland

Stimulates milk ejection in response to nipple sucking

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8
Q

What is the physiology of lactation?

A

Oestrogen and progesterone antagonise prolactin

Their massive decrease in birth allows milk to be produced

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9
Q

How much breast milk can be produced / day?

A

Up to 1000ml depending on demand

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10
Q

What are some advantages of breast feeding? (4)

A

1) Protection against infection in neonate (IgA)
2) Bonding
3) Protection against cancer (maternal)
4) Cost saving

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11
Q

When should breast feeding be encouraged?

A

Asap (within 4 hours of birth)

But must not be abandoned if not successful initially, often it is not established until mother and baby are at home

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12
Q

What problems may be encountered in first week of breast feeding?

A

1) Engorged breasts
2) Cracked nipples
3) Excessive air swallowing by baby due to too rapid flow of milk

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13
Q

What medication can be given to women who do not wish to / cannot breastfeed but still produce milk?

A

Cabergoline = suppresses lactation

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14
Q

What virus may be vertically transmitted to newborn via breastfeeding?

A

HIV

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15
Q

What is lactation amenorrhoea?

A

aka postpartum infertility

Temporary period in which a postpartum woman is not menstruating

If meets these 3 criteria there is a 98% chance a woman will not get pregnant:

1) Baby <6mnths
2) Amenorrheic
3) Woman fully or nearly fully breastfeeding (ie if stopping night feeding doesn’t count)

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16
Q

What are options for postnatal contraception?

A

Usually start 4-6wks after delivery

COCP decreases lactation so is CI in breastfeeding

POP / depot / implant / IUD / IUS safe in breastfeeding

  • Intrauterine contraception may be inserted after 3rd stage of labour or 6 weeks after
  • Some women of high parity may undergo sterilisation during CS
17
Q

What can an interval of <12mnths between births increase risks of?

A

1) Preterm birth
2) SGA
3) Low birth weights

18
Q

What is lochia?

A

Contains blood, mucus and uterine tissue - is normal

19
Q

When should lochia be investigated?

A

If persists >6wks post partum

20
Q

What are ‘the baby blues’?

A

Approx 50% women feel tearful and depressed 3-5 days after delivery

Usually short lived

21
Q

What is the management of ‘the baby blues’?

A

Support and reassurance and assessment of mental state in case of more serious depression

22
Q

What factors may prolong ‘the baby blues’? (6)

A

1) Postparum pyrexia
2) Anaemia
3) Inadequate sleep
4) Delayed healing of episiotomy / CS wound
5) Delay in established breastfeeding
6) Lack of support

23
Q

What is postnatal depression?

A

Depression occurring within 1 year of giving birth

24
Q

How common is postnatal depression?

A

10% women

25
Q

What are some signs of postnatal depression? (6)

A

1) Tiredness
2) Sleeplessness even when the baby is sleeping
3) Weeping for no reason
4) Feelings of guilt and worthlessness
5) Failure to respond to the baby and its needs
6) Anxiety and withdrawal

26
Q

What are some risk factors for postnatal depression? (4)

A

1) Social or emotional isolation
2) Prev hx of postnatal depression / other mental health problems
3) FH
4) Complications in pregnancy

27
Q

What is the recurrence risk of postnatal depression?

A

Frequently recurs in later pregnancies

Associated with a 70% risk of depression later in life

28
Q

What is the management of postnatal depression?

A

Involve psychiatrist

  • ‘Watchful waiting’
  • Psychological eg CBT
  • Antidepressants
  • Combination
29
Q

What antidepressants can be used during breastfeeding?

A

None are specifically licensed for breastfeeding

Consider newborn
- Sick / low birthweight / premature infants should not be exposed via breastmilk

TCAs can be given safely
- Usually imipramine and nortiptyline

Preferred SRIs = sertraline and paroxetine

MAOIs (venlafaxine, duloxetine, St John’sWort) NOT recommended 1st line

30
Q

What antidepressants are preferred during pregnancy?

A

SSRIs eg fluoxetine

31
Q

How may puerperal psychosis present?

A

1) Abrupt onset of psychotic symptoms usually around the 4th day
2) Rejection of the baby
3) Delusions
4) Confusion and afitation

32
Q

How common is puerperal psychosis?

A

Rare

0.2% women

33
Q

In which women is puerperal psychosis more common?

A

Primigravida

Positive FH

34
Q

What is the treatment of puerperal psychosis?

A

Psych admission with 24hr supervision

Appropriate medication eg tranquillisers

Exclusion of organic illness

35
Q

What is the recurrence risk of puerperal psychosis?

A

10-20%

risk decreased by pregnancy gap >2yrs

36
Q

When is a postnatal visit usually carried out?

A

6 weeks postpartum

37
Q

Who usually carries out a postnatal visit?

A

GP or midwife

38
Q

What is included in a postnatal visit?

A

Review mood - any symptoms of depression?

Check health of woman and baby

Examination - weight, BP, urine dip, examine CS scar or perineal repair, incontinence

Arrange cervical smear - usually for 3 months after delivery if overdue

Check contraception arrangements / menstruation

Year 4 GOSH (16 decks)

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