postnatal

Question 1

1st degree perineal tear

Answer 1

superficial skin tear

Question 2

mx 1st degree tear

Answer 2

none

Question 3

second degree tear

Answer 3

damage to perineal muscle (levataor ani) but not anal sphincter

Question 4

mx 2nd degree tear

Answer 4

suture by midwife or doctor on ward

Question 5

3rd degree tear

Answer 5

3a = <50% external anal sphincter // 3b = >50% external anal sphincter // 3c = internal anal sphincter torn

Question 6

mx 3rd degree tear

Answer 6

repair in theatre

Question 7

4th degree tear

Answer 7

tear down into rectal mucosa

Question 8

mx 4th degree tear

Answer 8

repair in theatre

Question 9

RF perineal tear

Answer 9

prim // macrosomnia // fast labour // shoulder dystocia // forceps

Question 10

what is Puerperal pyrexia

Answer 10

temp >38C in first 14 days post delivery

Question 11

causes Puerperal pyrexia

Answer 11

endometritis // UTI // wound infection // mastitis // VTE

Question 12

mx Puerperal pyrexia

Answer 12

admit + IV abx (clindamycin and gent)

Question 13

what is lochia

Answer 13

vaginal blood, mucous, tissue 6 weeks after childbirth

Question 14

stages of Postpartum thyroiditis

Answer 14

1 = thyrotoxis (hyper) // 2 = hypo // 3 = normal

Question 15

antibodies Postpartum thyroiditis

Answer 15

TPO

Question 16

mx Postpartum thyroiditis

Answer 16

thyrotoxic = propranolol // hypothyroid = thyroxine

Question 17

common cause nipple pain breastfeeding

Answer 17

poor latch, milk bleb, candidiasis

Question 18

what is a milk bleb + mx

Answer 18

blocked duct // continue breast feeding // massage and check technique

Question 19

mx nipple candidiasis breastfeeding

Answer 19

miconazole for mum and nystatin for baby

Question 20

when does mastitis require abx

Answer 20

systemically unwell // fissure // symptoms continue after 12-24 hours milk removal // culture

Question 21

mx mastitis

Answer 21

fluclox 10-14 days // continue breastfeeding

Question 22

symptoms breast engorgement

Answer 22

bost breasts // days after birth // tender, swollen, mild fever // baby cannot latch as easy

Question 23

what is reynauds of nupple

Answer 23

intermittent pain after feeding // blanching, cyanosis, erythema, pain

Question 24

what weight gain in 1st week of life needs referral

Answer 24

baby loses >10% weight

Question 25

how to start suppressing lactation

Answer 25

stop breast feeding // analgesia + bra support // cabergoline

Question 26

non-drug contraindication to breastfeeding

Answer 26

galactosaemia // viral infection

Question 27

antibiotics not safe in breastfeeding

Answer 27

cipro // tetracyclines eg doxy // chloramphenicol // sulphonamide

Question 28

psychiatric drugs not safe in breastfeeding

Answer 28

lithium, benzos

Question 29

cardiac drugs not safe in breastfeeding

Answer 29

aspirin, amiodarone

Question 30

endocrine and rheum drugs not safe in pregnancy (3)

Answer 30

carbimazole, SUR, methotrexate

Question 31

what screening tool is used for postpartum depression

Answer 31

edinburgh scale

Question 32

onset, symptoms, mx baby blues

Answer 32

3-7 days postpartum // anxious, tearful, irritable // reassurance and support

Question 33

mx postnatal depression

Answer 33

CBT, sertraline, paroxetine

Question 34

symptoms puerperal psychosis

Answer 34

2-3 weeks post birth // severe mood swings, delusions, auditory hallucinations

Question 35

mx Puerperal psychosis

Answer 35

admit to mother baby

Question 36

recurrence Puerperal psychosis

Answer 36

25-50%