Post-partum care

Question 1

what is the puerperium period?

Answer 1

start from delivery of the placenta and last until the reproductive organs have returned to their pre-pregnant state

about 6 weeks

Question 2

what is lochia

Answer 2

sloughed-off necrotic decidual layer mixed with blood
- initially red
- becomes paler as the bleeding is reduced
- finally becomes yellowish white
the flow of lochia may last for 3-6 weeks

Question 3

what are some postnatal care

Answer 3

Maternal observation
Pain relief - perineal trauma, LSCSs wound 
observe lochia and involution 
observe wounds - perineal of LSCS 
ensure urine is passed normally 
eating and drinking/flatus + stool 
VTE risk assessment encourage mobility-prevent VTE 
observe for signs of VTE 
HB check if signs of anaemia 
rubella vaccination - MMR 
anti-D for rhesus -ve women 
early neonatal feedin/neonatal care

Question 4

when does the breast become engorged?

Answer 4

between 2nd and 4th day
vascularity is increased
areolar pigment increases

lactation begins due to release of prolactin and oxytocin

Question 5

what are the different types of episiotomy carried out?

Answer 5

mediolateral episiotomy - extends from the vagina laterally (reduce the risk of anal sphincter injury)

midline episiotomy - extends from vagina posteriorly towards the anus not recommmended in the UK

Question 6

what is the indication for episiotomy

Answer 6

complicated vaginal delivery

• breech
• shoulder dystocia
• forceps
• ventouse

if extensive lower genital tract scarring

• FGM
• poorly healed 3rd or 4th degree tears

Question 7

what are the different types of perineal tears

Answer 7

1st degree - injury to the skin only

2nd degree - injury to the perineum involving perineal muscles (incl episiotomy)

3rd degree - injury to the perineum involving the anal sphincter complex

• 3a - < 50% of external anal sphincter thickness torn
• 3b - >50% of EAS thickness torn
• 3c - Internal anal sphincter torn

4th-degree tear
- injury to perineum involving the anal sphincter complex and the anal/rectal epithelium

Question 8

what are some RF for perineal tears?

Answer 8

forceps delivery 
nulliparious 
large baby > 4 kg 
 shoulder dystocia 
2nd stage > 1 hour 
persistent OP position 
midlein episiotomy 
epidural anaesthesia 
induction of labour

Question 9

management of perineal tears?

Answer 9

suture ASAp
PR examination to ensure there is no trauma to the anal sphincter complex
difficult trauma should be repair in theature

Question 10

what is the management of 3rd and 4th degree tears

Answer 10

formal repair in the theatre with regional or general anesthetics + IV abx

for future vaginal delivery –> 2nd tear will significantly worsen the faecal incontinence

physiotherapy for anal sphincter training