Postnatal care Flashcards
ROUTINE CARE
i) how long after birth does mum have GP appt?
ii) what happens with bleeding in the period shortly after birth? what is this called? what should be avoided here? why may there be more bleeding if breastfeeding?
iii) how quick may periods return of not breastfeeding? when is fertility considered to return after giving birth?
iv) how effective is breastfeeding as contraception? for how long? which two contracep are considered safe in breastfeeding? what should be avoided?
v) what contraception can be inserted at any point after birth? when can the copper/mirena coil be inserted?
i) six weeks
ii) vaginal bleeding as endometrium breaks down then returns to normal = blood and endometrial tissue called lochia
avoid tampons due to risk of infection
more bleed if bf as releases oxytocin > uterus contracts
iii) bottle feed - periods may return in 3 weeks
fertility return in 21 days
iv) breastfeeding is 98% effective but but be fully bf and ammeorhoeic for 6 months after birth
safe in bf - POP and implant and start any time after birth
avoid COCP if bf
v) insert coul within 48 hours of more than 4 weeks after birth
POST PARTUM ENDOMETRITIS
i) what is it? what causes it? which type of birth does it more commonly occ after? what is done to reduce this risk?
ii) what type of bac can cause it? (3) what other type of infections can cause it? name five ways it can present
iii) which two things are done in investigation? what imaging can be done to look for retained prods of conception?
iv) which two abx are reccomended if patient is septic? ?
v) what abx can bee given in the community for milder cases
i) inflammation of the endometrium due to infection in the postpartum period - infection introducede during/after labour and delivery
more common in CS - give prophylactic abx during
ii) can be caused by gram pos, neg, and anerobes as well as STIs eg chlam and gon
px with foul smelling dc, bleeding that gets heavierr, low abdo/pelvic pain, fever, sepsis
iii) do vaginal swab and urine culture and sensitivity
US to look for retained prods of conception
iv) septic - septic six
give IV clindamycin and gent
v) mild symptoms - tx in community with oral broad spec abx eg co amox
RETAINED PRODUCTS OF CONCEPTION
i) what is it? name three things it can occur after? what is a significant risk factor?
ii) name four presenting features
iii) which imaging is used to dx?
iv) what is the standard mx? what procedure is done? what are two key complications of the procedure?
v) what is ashermans syndrome? what can it lead to?
i) pregnancy related tissue (plac or fetal membrane) remain in the uterus aftr delivery
can also occ after mc or termination
placenta accreta is signif RF
ii) px with vaginal bleed that gets heavier or doesnt imprive, abnormal dc, lower abdo/pelvic pain, fever
iii) dx with US
iv) standard mx is surgical removal - dilatation and cutterage - dilate cervix then vac aspurate and scrape the products out
complicats are endometritis and ashermans syndrom
v) ashermans - adhesions form in the uterus due to damage from scraping > scar tissue > seal the uterus shut > infertility
POST PARTUM ANAEMIA
i) what is it defined as Hb? give four situations where FBC is done the day after delivery?
ii) what is tx for Hb under 100? under 90? under 70?
iii) name four situations where iron infusion may be considered?
iv) name two adverse reac of iron infusions? what is a contraindication?
i) Hb < 100
do FBC if PPH >500ml, CS, antenatal anaemia, symptomatic
ii) < 100 - start oral iron eg ferrous sulphate 300mg TDS for 3 months
< 90 = consider iron infusion + oral iron (ferrinject, monofer)
< 70 - blood transfusion and oral iron
iii) infusion = poor adherence to oral tx, cant tol oral iron, fail to respond to oraal, cant absorb eg IBD
iv) adverse - allergic and anaphylaxis
CI if concurrent infection
POST PARTUM THYROIDITIS
i) what is it? what thyroid levels can it involve? (2)
ii) what is the typical pattern - 3 stages? how long does it usually take for thyroid function to return to normal?
iii) name five symptoms of each type
iv) when are TFTs done after delivery? name two tx?
v) how often should women be monitored even if resolved?
i) changes in thyroud function within 12m of deliverey
can be hyper or hypothyroid or both
ii) 1) thyroxtoxicosis - first 3m
2) hypothyroid - 3-6m
3) thyroid func returns to normal usually within a year
iii) hyper - anx, sweat, tachy, WL, fatigue, loose stool
hypo - weight gainm fatigue, dry skin, coarse hair low mood, heavy periods, fluid rten
iv) do TFTs 6-8 weeks after delivery
tx hyper with propanolok
hypo with levothyrox
v) monitor annually
POSTNATAL DEPRESSION
i) what is it? when are baby blues seen? how many women does it affect? name four symptoms? how quick do they resolve?
ii) what is the classic triad of PN depression? around what time after birth does it occur? how long should symp be present for dx?
iii) how are mild/mod/severe PN depression treated? what scale can be used?
iv) what is puerperla psychosis? when does it happen after delivery? name four symptoms?
v) name four tx approaches for PP
i) low mood in postnataal perid
baby blues - first week after birth aand aff up to 50% of women - mood swings, low mood, anx, irritable, tearful
usually resolve within 2 weeks of delivery
ii) PN depress - low mood, anhedonia, low energy
occ around 3m post birth and should be present for at least 2 weeks
iii) mild. - self help and additional support, fu with GP
mod - anti dps (SSRI) and CBT
severe - psych service input or may need mum and baby unit
edinburgh postnatal depression scale - how they have felt in the last week
iv) PP is full psychotic symptoms around 2-3 weeks post delivery
delusion, hallluc, mania, confusion, thought disorder
urgent assess by psych
v) tx PP - admit to mother and baby unitt, CBT, anti deps/anti psychotic/mood stab, ECT
MASTITIS
i) when should cons mx be done? name three things
ii) when should abx be given? what is first line? what can be sent for culture and sens? when may fluconazole be given?
iii) when may candida of the nipple occur? what can it lead to? name three ways it can px?
iv) who needs tx when there is candida? what is given to each?
i) cons if blocked duct and no sign of infection - continue bf, express milk, breast massage, heat pack, warm shower
ii) abx if cons not effective, infection
give fluxclox or erythro
send breast milk for culture
fluconzaole if candida suspec
iii) candida can occ after course of abx > recurrent masitiis
sore nipples, tender, itch, cracked, flaky
baby symp - white patches in mouth or candida nappy rash
iv) need t tx mum and baby
mum - topical miconazole after every feed
baby - miconazole gel or nystatin
