Postnatal care Flashcards
What is postpartum endometritis?
Inflammation of the endometrium usually caused by infection.
Presentation of postpartum endometritis
Foul smelling discharge
Bleeding gets heavier and does not improve
Fever
Lower abdominal pain
Sepsis
Diagnosis of postpartum endometritis
Vaginal swabs
Urine culture and sensitivities
USS
Management of postpartum endometritis
Mild symptoms and no signs of sepsis - oral Abx in community
Sepsis - admission and Sepsis 6
What is postpartum anaemia?
Haemaglobin <100 g/l in the postpartum period..
Management of postpartum anaemia
Hb <100 - oral ferrous sulphate
Hb <90 - consider iron infusion - monofer
Hb <70 - blood transfusion and oral iron
Why are iron infusions contraindicated in active infections?
Because IV iron can lead to proliferation of pathogen and worsening of infection.
Duration of baby blues
First week or so after birth
Postnatal depression duration
Three months after birth
Puerperal psychosis duration
Few weeks after birth
Baby blues management
Usually not treatment required
Postnatal depression management
Mild cases - self help and follow up with their GP
Moderate - SSRI and CBT
Severe - psychiatry input
What screening tool is used to assess for postnatal depression? What score is used to make a diagnosis?
Edinburgh postnatal depression scale - score of >10 suggests postnatal depression
Puerperal psychosis management
Admission to mother and baby unit
CBT
Medications - SSRIs, antipsychotics, or mood stabilisers
ECT
How would mastitis present?
Breast pain and tenderness (unilateral)
Local warmth and inflammation
Nipple discharge
Fever
Management of mastitis
Conservative management with continued breastfeeding
If conservative management not effective, or infection is suspected, Flucloxacillin is first line.
Complications of mastitis and management
Breast abscess - incision and drainage
Treatment for candida of the nipple
Topical miconazole after each breastfeed
Treatment for the baby - e.g. nystatin
What is postpartum thyroiditis
Changes in thyroid function within 12 months of delivery
What are the stages of postpartum thyroiditis?
- Thyrotoxicosis
- Hypothyroid
- Thyroid function gradually returns to normal (usually within one year)
Management of postpartum thyroiditis
Management of thyrotoxicosis - symptomatic control - propanolol
Management of hypothyroidism - levothyroxine
Annual monitoring after resolution to identify development of long term hypothyroidism
