postnatal care Flashcards
what is the puerperium
the first six weeks after a baby is born
what visits happen during the pueperium
- midwife at home (9 - 10 days)
- referred to health visitor
- GP (postnatal check at 6 weeks)
what do the midwife and health visitor do when seeing the new mum
observe
- any abnormal bleeding
- any infection (wound, breast or endometritis)
- mental health
advise benefits of breast feeding
what are complications of breast feeding
- mastitis
- blocked milk ducts
- difficulty feeding
- skin irratation
what are common puerperium problems
- infant feeding
- bonding
- social (partner, other children or financial)
what are key postnatal conditions
- post-partum haemorrhage
- venous thromboembolism
- puerperal sepsis
- psychiatric disorders
- hypertensive disorders
describe post partum haemmorhage
primary (>500ml within 24hrs)
- cause: tone (atonic uterus), trauma (tears/ruptures), tissue (retained), thrombin (can’t clot)
secondary (>500ml after 24hrs - 6 wks)
- cause: tissue (retained), trauma (tear), endometritis (infection)
describe venous thromboembolic disease
DVT/PE
unilateral leg swelling/pain
SOB/chest pain
tachycardia
risk factors: immbolisation after spinal anaesthetic/caesarean section
investigation: d dimer (unreliable), ECG, leg doppler, CXR +/- VQ scan
treatment: LMWH, warfarin is TERATOGENIC
describe puerpeal sepsis
presentation: atypical
investigation: blood cultures, MSSU, LVS (lower vaginal swab), wound swabs
treatment: prompt IV antibiotics, antipyretics, IV fluids, referral to hospital
describe puerperal mental health
- baby blues
- postnatal depression
- puerperal psychosis
conditions common with personal or family history
describe puerperal hypertension
- eclamptic seizures
- pre-eclampsia
treatment: anti-hypertensives
