Postnatal Care

Question 1

When is fertility returned after giving birth?

Answer 1

21 days

Question 2

What are the contraception options after childbirth?

Answer 2

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)

Question 3

What is the presentation of endometritis?

Answer 3

foul-smelling discharge or lochia
bleeding that gets heavier or does not improve with time
lower abdominal or pelvic pain
fever
sepsis

Question 4

What is the presentation of retained products of conception?

Answer 4

vaginal bleeding that gets heavier or does not improve with time
abnormal vaginal discharge
lower abdominal or pelvic pain
fever

Question 5

What is the standard management of postpartum retained products of conception?

Answer 5

surgical removal - evacuation of retained products of conception

Question 6

What is Asherman’s syndrome?

Answer 6

adhesions form within the uterus

Question 7

What can cause Asherman’s syndrome?

Answer 7

endometrial curettage

Question 8

What is a complication of Asherman’s syndrome?

Answer 8

infertility

Question 9

What is postpartum anaemia?

Answer 9

haemoglobin <100g/l in the postpartum period

Question 10

What are the symptoms of the baby blues?

Answer 10

mood swings
low mood
anxiety
irritability
tearfulness

Question 11

When do the baby blues occur?

Answer 11

first week after birth

Question 12

When is the peak incidence of postnatal depression?

Answer 12

three months post partum

Question 13

What is the screening tool for postnatal depression?

Answer 13

Edinburgh postnatal depression scale

Question 14

What Edinburgh postnatal depression score indicates a depressive illness?

Answer 14

> 13

Question 15

When is the typical onset of puerperal psychosis?

Answer 15

2-3 weeks after delivery

Question 16

What is postpartum thyroiditis?

Answer 16

changes in thyroid function within 12 months of delivery affecting women without a history of thyroid disease

Question 17

What is the typical pattern of postpartum thyroiditis?

Answer 17

first three months = thyrotoxicosis
3-6 months = hypothyroid
6+ months = thyroid function gradually returns to normal

Question 18

What is Sheehan’s syndrome?

Answer 18

rare complication of PPH where the drop in circulating blood volume leads to avascular necrosis of the anterior pituitary gland

Question 19

What is the blood supply to the anterior pituitary?

Answer 19

hypothalamo-hypophyseal portal system

Question 20

What is the presentation of Sheehan’s syndrome?

Answer 20

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)

Question 21

What is the management of Sheehan’s syndrome?

Answer 21

oestrogen and progesterone (HRT)
hydrocortisone (adrenal insufficiency)
levothyroxine (hypothyroidism)
growth hormone

Question 22

What are the features of Raynaud’s disease of the nipple?

Answer 22

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

Question 23

What are the management options for Raynaud’s disease of the nipple?

Answer 23

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)

Question 24

What drugs should be avoided when breastfeeding?

Answer 24

antibiotics = ciprofloxacin, tetracycline, chloramphenicol, sulphonadmides
psychiatric drugs = lithium, benzodiazepines, clozapine
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone

Question 25

What is the management of postpartum thyroiditis?

Answer 25

thyrotoxic phase = propranolol for symptom control
hypothyroid phase = thyroxine

Question 26

What antibodies are found in 90% of patients with postpartum thyroiditis?

Answer 26

thyroid peroxidase antibodies

Question 27

Is it safe for mother’s with hepatitis B to breast feed?

Answer 27

yes

Question 28

What Ig is found in breast milk?

Answer 28

IgA

Question 29

What is puerperal pyrexia?

Answer 29

temperature >38 in the first 14 days following delivery

Question 30

What are the causes of puerperal pyrexia?

Answer 30

endometritis (most common)
UTI
wound infections
mastitis
VTE

Question 31

What is the management of puerperal pyrexia caused by endometritis?

Answer 31

referred to hospital for IV clindamycin and gentamicin until afebrile for >24 hrs