Postnatal Care Flashcards
What is another name for the postnatal period?
Puerperium
When does the postnatal period take place?
It takes place the first six weeks after a baby is born
What support do patients receive postnatally?
During the first ten days, a midwife will conduct several home visits
At six weeks, a postnatal GP appointment is offered
What postnatal advice is discussed during the midwife postnatal home visits?
Contraception
Breastfeeding
Menstruation
Incontinence
Vaccines
What three things do midwives observe for at the postnatal home visits?
Infection
Abnormal bleeding
Postnatal depression
What occurs at the GP six-week postnatal appointments?
During this appointment, similar topics to those discussed at midwife home visits are discussed
In addition to this, any complications encountered during the pregnancy are reviewed, such as gestational diabetes, gestational hypertension and pre-eclampsia
What normally occurs in the postnatal period?
Vaginal bleeding
How long does postnatal vaginal bleeding usually settle?
Six weeks
What is postnatal vaginal bleeding referred to as?
Lochia
What three things make up lochia?
Blood
Endometrial tissue
Mucus
What increases postnatal vaginal bleeding? Why?
Breastfeeding episodes
Breastfeeding releases oxytocin, which causes the uterus to contract
How do we distinguish between lochia and postpartum haemorrhage?
The bleeding associated with lochia should be described by patients as a period or less
The bleeding associated with postpartum haemorrhage should be described as heavy and full of clots
What is lactational amenorrhoea?
This is the absence of periods related to breastfeeding
When do menstrual periods resume in women that decide to bottle-feed?
Three weeks post-delivery
How long after childbirth is contraception required?
21 days
What are four contraceptive methods are available after birth?
Lactational Amenorrhoea
Progesterone-Only Contraception
Combined Hormonal Contraception
Intrauterine Contraception
How effective is lactational amenorrhoea?
98%
How long does lactational amenorrhoea persist for?
Six months
How often do patients need to breastfeed for lactational amenorrhoea to be reliable?
They must nurse at least every four hours during the day and every six hours at night
In addition to frequent breastfeeding, what else is required for lactational amenorrhoea to be reliable?
Amennorrhoeic state
Are progesterone only contraceptive methods safe during breastfeeding? When can they be started after birth?
Yes
They can be started at any time after birth
When are combined hormonal contraceptive methods considered safe in women that are breastfeeding?
After six weeks of childbirth
When can intrauterine contraceptive methods be inserted after birth?
They can be inserted within 48 hours of birth OR more than four weeks after birth
They cannot be inserted during this period
What bacteria group cause maternal sepsis in the postnatal period?
Group A streptococcus
Which bacteria is most commonly associated with maternal sepsis?
E.Coli
What two infections are commonly associated with maternal sepsis?
Chorioamnionitis
Urinary tract infections
What is chorioamnionitis?
It is an infection of the chorioamniotic membranes and amniotic fluid
When does chorioamnionitis tend to occur?
Late pregnancy
Labour
What are the two main clinical features of sepsis in the mother?
Fever
Raised neutrophils
How do we treat maternal sepsis?
We prescribe IV antibiotics in the ‘golden hour’
What are the two complications of maternal sepsis in the neonate?
Intrauterine death
Cerebral palsy
How does maternal sepsis cause brain damage in the neonate?
The neutrophils produce a cytokine storm
This activates certain brain cells, which then get damaged by normal hypoxia of labour
What is the single leading direct cause of maternal death in the UK?
Thromboembolic disease
