Postnatal Care Flashcards
What is the postnatal period also known as?
Also known as puerperium, is the first 6 weeks after the baby is born
How often are medical staff seen in standard postnatal care?
- See midwife at home for first 9-10 days, after referred to health visitor
- Look for signs of abdominal bleeding, infection, mental health issues
- 6 week postnatal check at GP
- Contraception, mental health/general wellbeing
What are some common problems in the postnatal period?
- Infant feeding
- Bonding
- Social issues
- Partner, other children, financial issues
What are possible complications of breast feeding?
- Mastitis
- Blocked milk ducts
- Difficulty feeding/baby latching
- Skin irritation – “cracked nipples”
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 are risk factors for thromboembolic disease?
- Pregnancy 6-10x more likely
- Immediately post-partum period is hypercoagulable state
- Immobilisation following spinal anaesthetic/caesarean section
What is the presentating 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 mangement of thromboembolic disease?
- Thromboprophylaxis and risk assessment to avoid
- Low molecular weight heparin
- Warfarin is teratogenic, but can be used when breast feeding
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”
- 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