Postnatal care

Question 1

What is postpartum endometritis?

Answer 1

Inflammation of the endometrium usually caused by infection.

Question 2

Presentation of postpartum endometritis

Answer 2

Foul smelling discharge
Bleeding gets heavier and does not improve
Fever
Lower abdominal pain
Sepsis

Question 3

Diagnosis of postpartum endometritis

Answer 3

Vaginal swabs
Urine culture and sensitivities
USS

Question 4

Management of postpartum endometritis

Answer 4

Mild symptoms and no signs of sepsis - oral Abx in community
Sepsis - admission and Sepsis 6

Question 5

What is postpartum anaemia?

Answer 5

Haemaglobin <100 g/l in the postpartum period..

Question 6

Management of postpartum anaemia

Answer 6

Hb <100 - oral ferrous sulphate
Hb <90 - consider iron infusion - monofer
Hb <70 - blood transfusion and oral iron

Question 7

Why are iron infusions contraindicated in active infections?

Answer 7

Because IV iron can lead to proliferation of pathogen and worsening of infection.

Question 8

Duration of baby blues

Answer 8

First week or so after birth

Question 9

Postnatal depression duration

Answer 9

Three months after birth

Question 10

Puerperal psychosis duration

Answer 10

Few weeks after birth

Question 11

Baby blues management

Answer 11

Usually not treatment required

Question 12

Postnatal depression management

Answer 12

Mild cases - self help and follow up with their GP
Moderate - SSRI and CBT
Severe - psychiatry input

Question 13

What screening tool is used to assess for postnatal depression? What score is used to make a diagnosis?

Answer 13

Edinburgh postnatal depression scale - score of >10 suggests postnatal depression

Question 14

Puerperal psychosis management

Answer 14

Admission to mother and baby unit
CBT
Medications - SSRIs, antipsychotics, or mood stabilisers
ECT

Question 15

How would mastitis present?

Answer 15

Breast pain and tenderness (unilateral)
Local warmth and inflammation
Nipple discharge
Fever

Question 16

Management of mastitis

Answer 16

Conservative management with continued breastfeeding

If conservative management not effective, or infection is suspected, Flucloxacillin is first line.

Question 17

Complications of mastitis and management

Answer 17

Breast abscess - incision and drainage

Question 18

Treatment for candida of the nipple

Answer 18

Topical miconazole after each breastfeed
Treatment for the baby - e.g. nystatin

Question 19

What is postpartum thyroiditis

Answer 19

Changes in thyroid function within 12 months of delivery

Question 20

What are the stages of postpartum thyroiditis?

Answer 20

1. Thyrotoxicosis
2. Hypothyroid
3. Thyroid function gradually returns to normal (usually within one year)

Question 21

Management of postpartum thyroiditis

Answer 21

Management of thyrotoxicosis - symptomatic control - propanolol
Management of hypothyroidism - levothyroxine

Annual monitoring after resolution to identify development of long term hypothyroidism