Postnatal Care Flashcards
When is fertility returned after giving birth?
21 days
What are the contraception options after childbirth?
lactation amenorrhoea (>98% for six months if fully breastfeeding and amenorrhoeic)
progesterone-only pill and implant
COCP (avoided in breast-feeding and before six weeks post-partum)
copper coil or IUS (within 48hrs of birth or more than four weeks)
What is the presentation of endometritis?
foul-smelling discharge or lochia
bleeding that gets heavier or does not improve with time
lower abdominal or pelvic pain
fever
sepsis
What is the presentation of retained products of conception?
vaginal bleeding that gets heavier or does not improve with time
abnormal vaginal discharge
lower abdominal or pelvic pain
fever
What is the standard management of postpartum retained products of conception?
surgical removal - evacuation of retained products of conception
What is Asherman’s syndrome?
adhesions form within the uterus
What can cause Asherman’s syndrome?
endometrial curettage
What is a complication of Asherman’s syndrome?
infertility
What is postpartum anaemia?
haemoglobin <100g/l in the postpartum period
What are the symptoms of the baby blues?
mood swings
low mood
anxiety
irritability
tearfulness
When do the baby blues occur?
first week after birth
When is the peak incidence of postnatal depression?
three months post partum
What is the screening tool for postnatal depression?
Edinburgh postnatal depression scale
What Edinburgh postnatal depression score indicates a depressive illness?
> 13
When is the typical onset of puerperal psychosis?
2-3 weeks after delivery
What is postpartum thyroiditis?
changes in thyroid function within 12 months of delivery affecting women without a history of thyroid disease
What is the typical pattern of postpartum thyroiditis?
first three months = thyrotoxicosis
3-6 months = hypothyroid
6+ months = thyroid function gradually returns to normal
What is Sheehan’s syndrome?
rare complication of PPH where the drop in circulating blood volume leads to avascular necrosis of the anterior pituitary gland
What is the blood supply to the anterior pituitary?
hypothalamo-hypophyseal portal system
What is the presentation of Sheehan’s syndrome?
reduced lactation (lack of prolactin)
amenorrhoea (lack of LH and FSH)
adrenal insufficiency and adrenal crisis caused by low cortisol (lack of ACTH)
hypothyroidism with low thyroid hormones (lack of TSH)
What is the management of Sheehan’s syndrome?
oestrogen and progesterone (HRT)
hydrocortisone (adrenal insufficiency)
levothyroxine (hypothyroidism)
growth hormone
What are the features of Raynaud’s disease of the nipple?
intermittent pain - present during and immediately after feeding
blanching of the nipple followed by cyanosis and/or erythema
nipple pain resolves when nipples return to normal colour
What are the management options for Raynaud’s disease of the nipple?
minimise cold exposure
use heat packs following a breast feed
avoid caffeine and stop smoking
if symptoms persist, consider specialist referral for a trial of oral nifedipine (off-license)
What drugs should be avoided when breastfeeding?
antibiotics = ciprofloxacin, tetracycline, chloramphenicol, sulphonadmides
psychiatric drugs = lithium, benzodiazepines, clozapine
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone
What is the management of postpartum thyroiditis?
thyrotoxic phase = propranolol for symptom control
hypothyroid phase = thyroxine
What antibodies are found in 90% of patients with postpartum thyroiditis?
thyroid peroxidase antibodies
Is it safe for mother’s with hepatitis B to breast feed?
yes
What Ig is found in breast milk?
IgA
What is puerperal pyrexia?
temperature >38 in the first 14 days following delivery
What are the causes of puerperal pyrexia?
endometritis (most common)
UTI
wound infections
mastitis
VTE
What is the management of puerperal pyrexia caused by endometritis?
referred to hospital for IV clindamycin and gentamicin until afebrile for >24 hrs
