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3a > Postnatal care > Flashcards

Postnatal care Flashcards

1
Q

how long after birth are women not considered fertile

A

21 days

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2
Q

give 4 methods of contraception following birth

A

-lactational ammenorrhea for 6 mnths
-progesterone-only pill and implant are safe and started any time after birth
-COCP avoided in breastfeeding and not started before 6 wks after birth
-copper coil or intrauterine system inserted within 48hrs after birth or >4wks

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3
Q

what is lactational amenorrhea

A

absence of periods related to breastfeeding
can be used as contraception for 6mnths after birth - women must be fully breastfeeding and amenorrhoeic

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4
Q

what is postpartum endometritis and when is it more common

A

infection of the endometrium following labour and delivery
more common in c sections, prophylactic abx are usually given

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5
Q

shortly after birth
foul smelling discharge or lochia
bleeding getting heavier and not improving with time
lower abdo/pelvic pain
fever
sepsis

A

endometritis

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6
Q

how is endometriosis diagnosed?

A

vaginal swabs (including chlamydia and gonorrhoea as these are RF)
urine culture and sensitivities

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7
Q

what abx are used in endometriosis both in community and in hospital

A

-mild case -> community oral abx -> co-amoxiclav
-septic -> inpatient -> sepsis 6 -> clindamycin and gentamicin

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8
Q

how does retained products of conception present and how is it diagnosed

A

vaginal bleeding getting heavier
abnormal vaginal discharge
low abdo or pelvic pain
fever (if infected)

USS = diagnosis

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9
Q

how is retained products of conception (ERPC) managed

A

evacuation of retained products of contraception under general anaesthetic = dilation and curettage

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10
Q

give 2 SE of dilation and curettage in (ERPC)

A

endometritis
asherman’s = adhesions form within uterus

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11
Q

what is defined as postpartum anaemia

A

Hb : <100g/l

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12
Q

when is a FBC done the day after delivery

A

PPH >500ml
c section
antenatal anaemia
symptoms of anaemia

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13
Q

how is postpartum anaemia with Hb of <100g/l managed

A

oral iron

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14
Q

how is postpartum anaemia with Hb of <90g/l managed

A

consider iron infusion in addition to oral iron

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15
Q

How is postpartum anaemia with Hb of <70g/l managed

A

blood transfusion in addition to oral iron

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16
Q

what is a CI to an iron infusion

A

active infection !

17
Q

give 2 risks of iron infusions

A

allergic and anaphylactic reactions

18
Q

define the spectrum of postpartum mental health illness

A

baby blues -> within a week
postnatal depression -> peaks around 3 mnths after birth
puerperal psychosis -> few weeks after birth

19
Q

give 5 symptoms of baby blues

A

mood swings
low mood
anxiety
irritability
teearfulness

20
Q

what is the classic triad of postnatal depression and when is it diagnosed

A

low mood
anhedonia
low energy

needs to last at least 2 weeks for diagnosis

21
Q

give a screening tool used for postnatal depression

A

Edinburgh postnatal depression scale

22
Q

what are the treatment options for peurperal psychosis managed

A

admission to mother and baby unit
CBT
medications (antidepressants, antipsychotics and mood stabilisers

23
Q

what is a risk of SSRIs in pregancy

A

neonatal abstinence syndrome : irritability and poor feeding shortly after birth

24
Q

what is mastitis and 3 causes

A

inflammation of breast tissue
causes : breastfeeding, duct obstruction, infection

25
Q

what bacteria most commonly caises mastitis

A

staph aureus

26
Q

how does matitis present

A

unilateral breast pain and tenderness
erythema in a focal area of breast tissue
local warmth and inflammation
nipple discharge
fever (if infected)

27
Q

how is mastitis manged if duct obstruction is the cause ?

A

conservative : continued breatfeeding, expressing milk and breast massage

28
Q

what is the 1st line Abx for mastitis if infection is suspected

A

flucloxacillin (erythromycin if penicillin allergic)

29
Q

what is candida of the nipple and when does it often occur

A

candidal infection of the nipple -> can lead to recurrent mastitis
usually after course of antibiotics
associated with oralthrush and candidal nappy rash in infant

29
Q

how does candida infection of the nipple present

A

bilateral sore nipples
nipple tenderness and itching
cracked, flaky or shiny areola
symptoms in baby : white patches in mouth/tongue or candidal nappy rash

30
Q

how is candidal infection of nipple managed

A

topical miconazole after breastfeeding
for baby : miconazole gel or nystatin

31
Q

what is postpartum thyroiditis and the pathophysiology behind it

A

Thyrotoxicosis, hypothyroidism or both within 12 mnths of delivery

32
Q

what are the 3 possible stages of postpartum thyroiditis

A
  1. Thyrotoxicosis (usually within first 3 mths)
  2. Hypothyroid (3-6mnths later)
  3. Thyroid function gradually returns to normal
33
Q

what is sheehan’s syndrome and what does it affect

A

rare complication of PPH
drop in circulating volume causes avascular necrosis of pituitary gland
low BP and reduced perfusion of pituitary gland = ischaemia of cells in pituitary and cell death
ONLY ANTERIOR PITUITARY

34
Q

why does Sheehan’s syndrome only affect the anterior pituitary

A

the anterior pituitary gets blood from the hypothalamo-hypophyseal portal system = susceptible to rapid drops in BP
the posterior pituitary gets blood supply from various arteries

35
Q

what hormones does sheehan’s syndrome effect and what are the sympoms as a result

A

Prolactin -> reduced lactation
Amenorrhoea -> lack of FSH and LH
Adrenal insufficiency and adrenal crisis ->lack of cortisol due to low ACTH
Hypothyroidism -> low thyroid hormones due to lack of TSH
Growth hormone also affected

36
Q

how is sheehan’s syndrome managed

A

replacement of missing hormones
Oestrogen and progesterone
hydrocortisone
levothyroxine
growth hormone

37
Q

How is the thyrotoxicosis phase of postpartum thyroiditis managed

A

Propranolol

38
Q

How is hypothyroidism in postpartum thyroiditis managed ?

A

Levothyroxine

3a (45 decks)

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