Postnatal care Flashcards
mastitis
inflammation of breast tissue
common complication of breast-feeding
most common cause: staph-aureus
presentation of mastitis
breast pain and tenderness (unilateral) erythema in a focal area of breast tissue local warmth and inflammation nipple discharge fever
management of mastitis
Conservative management
- continue breastfeeding, expressing milk & breast massage.
- Heat packs, arm showers and simple analgesia
Infection suspected
- Antibiotics
- 1st line: flucloxacillin or erythromycin (pen. allergic)
candida of the nipple
candida infection of the nipple can occur- often after a course of antibiotics.
Can lead to recurrent mastitis, as it causes cracked skin on the nipple that create an entrance for infection.
Associated with oral thrush, candida nappy rash in infant.
presentation of candida of nipple
sore nipples bilaterally
nipple tenderness/ itching
cracked, flaky or shiny areola
symptoms in baby
- white patches in mouth and on tongue
- candidal nappy rash
candida of nipple treatment
topical miconazole after each breastfeed
baby blues
seen in majority of women in first week after birth.
symptoms usually mild and only last few days
resolve with 2 weeks of delivery
postnatal depression
peaks around 3 months after birth
symptoms last >2 weeks
postnatal depression symptoms
low mood
anhedonia
low energy
treatment of postnatal depression
Mild: additional support 7 self-help
Moderate: Antidepressant (SSRIs) and CBT
assessment of postnatal depression
Edinburgh postnatal depression scale.
Score of 10 or more suggests postnatal depression
puerperal psychosis
rare but severe illness that typically has an onset 2-3 weeks after delivery
presentation of puerperal psychosis
full psychotic symptoms delusions hallucinations depression mania confusion thought disorder
management of puerperal psychosis
urgent assessment and input from specialist mental health services
- admission to mother & baby unit
- CBT
- medications
- ECT
postpartum endometritis
inflammation of the endometrium, usually caused by infection
presentation of postpartum endometritis
foul-smelling discharge or loch bleeding (gets heavier or does not improve) lower abdo/ pelvic pain Fever Sepsis
Postpartum endometritis investigations
Vaginal swabs
Urine culture and sensitivities
US: rules our retained products of conception
management of postpartum endometritis
Mild
- oral antibiotics: Co-amoxiclav
Septic
- Hospital admission
- Clindamycin + gentamicin
postpartum thyroiditis
changes in thyroid function within 12 month of delivery affecting women with no history of thyroid disease.
postpartum thyroiditis features
Thyrotoxicosis (hyper)
- anxiety & irritability
- sweating and heat intolerance
- tachycardia
- weight loss
- fatigue
- frequent loose stools
hypothyroidism
- weight gain
- fatigue
- dry skin
- coarse hair and hair loss
- low mood
- fluid retention (oedema, pleural effusions, ascites)
- heavy or irregular periods
- constipation
Postpartum thyroiditis: Thyroid function tests
Thyrotoxicosis
- Raised T3 and T4
- Suprressed TSH
hypothyroidism
- Low T3 and T4
- Raised TSSH
Management of postpartum thyroiditis
Thyroid function tests performed 6-8 weeks after deliver
THyrotoxicosis
-symptomatic control (propranolol)
hypothyroidism
- levothyroxine
Monitoring: annual thyroid function tests
retained products of conception
pregnancy-related tissue remains in the uterus after delivery.
Can also occur after miscarriage or termination of pregnancy
presentation of retained products of conception
vaginal bleeding (gets heavier/ does not improve) Abnormal vaginal discharge lower abdo pain or pelvic pain fever
diagnosis of retained products of conception
ultrasound
management of retained products of conception
surgical removal of retained productions
- Evacuation of retained products of conception (ERPC)
key complications: endometritis and Asherman’s syndrome
Asherman’s Syndrome
Adhesions form within uterus.
Endometrial curettage can damage basal layer of endometrium, creating scar tissue connecting areas of the uterus that are not. generally connected.
May be adhesions binding uterine walls together, or within endocervix, sealing it shut.
Can lead to infertility.
Sheehan’s syndrome
rare complication of postpartum haemorrhage.
Drop in circulating blood volume leads to avascular necrosis of pituitary gland.
Leads to ischaemia in cells of the pituitary.
Sheehan syndrome only affects anterior pituitary gland.
hormones released by anterior pituitary gland (& affected by Sheehans)
Thyroid stimulating hormone (TSH) Adrenocorticotropic Hormone (ACTH) Follicle-Stimulating Hormone (FSH) Luteinising Hormone (LH) Growth hormone (GH) Prolactin
presentation of Sheehan’s syndrome
result of lack of hormones -reduced lactation (lack of prolactin) -amenorrhoea (lack of LH and FSH) - adrenal insufficiency and adrenal crisis, caused by lack of cortisol (lack of CTH) Hypothyroidism (lack of TSH)
management of Sheehan’s syndrome
Oestrogen and progesterone as HRT
Hydrocortisone (adrenal insufficiency)
Levothyroxine (hypothyroidism)
Growth hormone
