Postnatal Care Flashcards
How long is postnatal period (puerperium)
6 weeks
What are possible complications of breast feeding?
- Mastitis - infection
- Blocked milk ducts
- Difficulty feeding/baby latching
- Skin irritation – “cracked nipples”
What healthcare professionals usually see the mother during post natal period
Health visitor (usually comes 2x in 9-10 days)
6 weeks after GP checks
What do healthcare professionals assess for during the post natal period
- Wound healing
- Mental health
- Infant feeding
- Bonding
- Social issues
- Partner, other children, financial issues
Signs of mastitis
Red hot tender breast + systemic signs of infection
What are some key postnatal conditions?
- Post-partum haemorrhage
- Venous thromboembolism
- Sepsis
- Psychiatric disorders of the puerperium
- Pre-eclampsia
What are the different categories of PPH?
- Primary
- Blood loss of >500ml within 24 hours of delivery
- Secondary
- Blood loss >500ml from 24 hours post partum to 6 weeks
What is lochia & how long does it last
Post natal bleeding
3-4 weeks after birth
Should be like period or less
Causes of secondary PPH
- Retained tissue
- Endometritis (infection)
- Tears/trauma
What are the 4 Ts of PPH (
Tone
Trauma
Tissue (retained placenta/membrane → increased bleeding/contraction to expel the extra tissue)
Thrombin (infection)
Why is risk of thromboembolic diseases higher during pregnancy + post partum
- Pregnancy and post partum period are hypercoagulable states
- Immobilisation following spinal anaesthetic/caesarean section
Presentation of thromboembolic disease?
- Unilateral leg swelling and/or pain
- Shortness of breath
- Chest pain
- Tachycardia
What investigations are done for thromboembolic disease?
- D-dimer unreliable in pregnancy
- ECG
- Leg dopplers
- Chest x-ray with or without VQ scan
What investigation, normally used for thromboembolic disease, is not reliable during pregnancy/postnatal?
D-dimer
What is the management of thromboembolic disease?
- Thromboprophylaxis and risk assessment to avoid
- Low molecular weight heparin
- Warfarin is teratogenic, but can be used when breast feeding
Causative organism of puerpegral sepsis
Group A Streps usually (the ones causing sore throats)
What is puerpergal sepsis?
Infection of the genital tract occurring at any time between the onset of rupture of membranes or labour, and the 42nd day postpartum
What investigations are done for puerpergal sepsis?
- Perform full septic screen
- Blood cultures, LVS, MSSU, wound swabs
What is the management of puerpergal sepsis?
- Prompt IV administration – “golden hour” (within 1 hr of presentation)
- Antipyretic measures
- IV fluids
What is the incidence of mental health issues postnatally?
- 25% of woman who die between 6 weeks and 1 year after pregnancy died from mental health related causes
- 1/7 of those is suicide
What team is used to manage postnatal mental health issues?
Peri-natal mental health team is used to manage this
What are some postnatal mental health issues?
- Baby blues
- Postnatal depression
- Puerperal psychosis
What is the aetiology of baby blues?
- Affects most woman due to hormonal changes around the time of birth
What is the management of baby blues?
- No specific treatment as does not affect functioning
When can postnatal depression continue from?
Can continue from baby blue or start sometime later
What are risk factors for postnatal depression?
- Personal or family history of affective disorder
What is the presentation of postnatal depression?
- Classical depressive symptoms
- Affects functioning and bonding, requiring treatment
What is puerperal psychosis?
Mental disorder occurring after childbirth, characterised by deep depression, delusions of childs death and homicidal feelings towards child
What are risk factors for puerperal psychosis?
- Personal or family history of affective disorder, bipolar disorder or psychosis
Is the incidence of puerperal psychosis common or rare?
Rare
What is the management of puerperal psychosis?
- Inpatient psychiatric care
- Woman is a danger to themselves and their baby
What is pre-eclampsia?
Pre-eclampsia = causes hypertension during pregnancy and after labour
What is the management of pre-eclampsia?
- Discharge on antihypertensive
- Follow up in community
