postnatal care Flashcards
what is the postnatal period
aka puerperium
first 6wks after baby is born
who initially monitors the mum and baby
midwife at home for first 9-10 days
referred to health visitor thereafter
what are the midwife and health visitor monitoring for
observe for signs of abnormal bleeding
evidence of infection - wound (perineal/CS), endometritis, breast
debrief events around birth (esp if CS)
mental health
when is the postnatal check at the GP
what is covered
6wks
contraception
mental health/general wellbeing
common problems in the postnatal period
infant feeding
bonding
social issues - partner, other children, financial issues
common problems in the postnatal period
infant feeding
bonding
social issues - partner, other children, financial issues
breast feeding - what to cover
women should be advised re. benefits of breast feeding but supported whatever their feeding choice
prescribing in breast feeding
complications from breast feeding
mastitis
blocked milk ducts
difficulty feeding/baby latching
skin irritation (cracked nipples)
key postnatal conditions
PPH venous thromboembolism sepsis psychiatric disorder of the puerperium pre-eclampsia
what is lochia
the vaginal discharge you have after a vaginal delivery. It has a stale, musty odor like menstrual discharge.
Lochia for the first 3 days after delivery is dark red in color. A few small blood clots, no larger than a plum, are normal
how long is lochia normal for
3-4wks postnatal
should be like a period or less
thromoboemoblic disease - why does it occur
pregnancy and the immediate post partum period is a hypercoagulable state
pregnant women 6-10x more likely to develop DVT/PE
what helps reduce risk of thromboembolism
high quality risk assessment
appropriate thromboprophylaxis
when to be suspicious of thromboembolic disease
women w/ unilateral leg swelling/pain and women complaining of SOB/chest pain
sometimes the only sign of PE will be unexplained tachycardia
may present atypically in pregnancy/postnatally
ALWAYS HAVE HIGH INDEX OF SUSPICION FOR VTE IN PREGNANT/POSTNATAL WOMEN
when to be suspicious of thromboembolic disease
women w/ unilateral leg swelling/pain and women complaining of SOB/chest pain
sometimes the only sign of PE will be unexplained tachycardia
may present atypically in pregnancy/postnatally
ALWAYS HAVE HIGH INDEX OF SUSPICION FOR VTE IN PREGNANT/POSTNATAL WOMEN
what further increases risk of thromboembolism
immobilisation following spinal anaesthetic/CS
what value is unreliable in pregnancy regarding thromboembolism
D dimer
investigations for thromboembolism
ECG
leg dopplers
CXR +/- VQ scan or CTPA - NB radiation exposure during pregnancy/BF
treat w/ low molecular weight heparin
warfarin is teratogenic but can be used when BF
puerperal sepsis presentation
may present atypically
management of puerperal sepsis
in any woman w/ suspected sepsis - prompt IV abx (golden hour)
full septic screen - bloods, LVS, MSSU, wound swabs
antipyretic measures, IV fluids, referral to hospital if concerned re. sepsis
mortality with postnatal mental health
1/4 of women who died 6wks-1yr after pregnancy died from mental health related causes, 1/7 of these from suicide
suicide is the 2nd largest cause of direct maternal deaths during/wiithin the 42 days after birth
what are the baby blues
affects most women due to hormonal changes around time of birth - 1-3 days PN
doesn’t affect functioning
requires no specific treatment
postnatal depression
can continue from baby blues or start later
classical depressive symptoms
affects functioning, bonding and often requires treatment
who is at higher risk of postnatal depression
personal/FHx of affective disorder
puerperal psychosis
rare but serious
women can be a danger to themselves and their babies
requires inpatient psychiatric care
who is at higher risk of puerperal psychosis
personal/FHx of affective disorder, bipolar disorder or psychosis
post-natal hypertensive disorders
- when do eclamptic seizures occur
- development of pre-eclampsia
- treatment
most eclamptic seizures occur in the postnatal period
pre-eclampsia can develop postnatally or may worsen several days following delivery
women may be discharged on anti-hypertensives - follow up in community
