Postnatal care Flashcards
how long after birth are women not considered fertile
21 days
give 4 methods of contraception following birth
-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
what is lactational amenorrhea
absence of periods related to breastfeeding
can be used as contraception for 6mnths after birth - women must be fully breastfeeding and amenorrhoeic
what is postpartum endometritis and when is it more common
infection of the endometrium following labour and delivery
more common in c sections, prophylactic abx are usually given
shortly after birth
foul smelling discharge or lochia
bleeding getting heavier and not improving with time
lower abdo/pelvic pain
fever
sepsis
endometritis
how is endometriosis diagnosed?
vaginal swabs (including chlamydia and gonorrhoea as these are RF)
urine culture and sensitivities
what abx are used in endometriosis both in community and in hospital
-mild case -> community oral abx -> co-amoxiclav
-septic -> inpatient -> sepsis 6 -> clindamycin and gentamicin
how does retained products of conception present and how is it diagnosed
vaginal bleeding getting heavier
abnormal vaginal discharge
low abdo or pelvic pain
fever (if infected)
USS = diagnosis
how is retained products of conception (ERPC) managed
evacuation of retained products of contraception under general anaesthetic = dilation and curettage
give 2 SE of dilation and curettage in (ERPC)
endometritis
asherman’s = adhesions form within uterus
what is defined as postpartum anaemia
Hb : <100g/l
when is a FBC done the day after delivery
PPH >500ml
c section
antenatal anaemia
symptoms of anaemia
how is postpartum anaemia with Hb of <100g/l managed
Oral ferrous sulphate 200mg 3x daily for 3 mnths
how is postpartum anaemia with Hb of <90g/l managed
consider iron infusion in addition to oral iron
How is postpartum anaemia with Hb of <70g/l managed
blood transfusion in addition to oral iron
what is a CI to an iron infusion
active infection !
give 2 risks of iron infusions
allergic and anaphylactic reactions
define the spectrum of postpartum mental health illness
baby blues -> within a week
postnatal depression -> peaks around 3 mnths after birth
puerperal psychosis -> few weeks after birth
give 5 symptoms of baby blues
mood swings
low mood
anxiety
irritability
teearfulness
what is the classic triad of postnatal depression and when is it diagnosed
low mood
anhedonia
low energy
needs to last at least 2 weeks for diagnosis
give a screening tool used for postnatal depression
Edinburgh postnatal depression scale
what are the treatment options for peurperal psychosis managed
admission to mother and baby unit
CBT
medications (antidepressants, antipsychotics and mood stabilisers
what is a risk of SSRIs in pregancy
neonatal abstinence syndrome : irritability and poor feeding shortly after birth
what is mastitis and 3 causes
inflammation of breast tissue
causes : breastfeeding, duct obstruction, infection
what bacteria most commonly caises mastitis
staph aureus
how does matitis present
unilateral breast pain and tenderness
erythema in a focal area of breast tissue
local warmth and inflammation
nipple discharge
fever (if infected)
how is mastitis manged if duct obstruction is the cause ?
conservative : continued breatfeeding, expressing milk and breast massage
what is the 1st line Abx for mastitis if infection is suspected
flucloxacillin (erythromycin if penicillin allergic)
what is candida of the nipple and when does it often occur
candidal infection of the nipple -> can lead to recurrent mastitis
usually after course of antibiotics
associated with oralthrush and candidal nappy rash in infant
how does candida infection of the nipple present
bilateral sore nipples
nipple tenderness and itching
cracked, flaky or shiny areola
symptoms in baby : white patches in mouth/tongue or candidal nappy rash
how is candidal infection of nipple managed
topical miconazole after breastfeeding
for baby : miconazole gel or nystatin
what is postpartum thyroiditis
- Thyrotoxicosis, hypothyroidism or both within 12 mnths of delivery
- Requires annual monitoring
what are the 3 possible stages of postpartum thyroiditis
- Thyrotoxicosis (usually within first 3 mths)
- Hypothyroid (3-6mnths later)
- Thyroid function gradually returns to normal
what is sheehan’s syndrome and what does it affect
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
why does Sheehan’s syndrome only affect the anterior pituitary
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
what hormones does sheehan’s syndrome effect and what are the sympoms as a result
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
how is sheehan’s syndrome managed
replacement of missing hormones
Oestrogen and progesterone
hydrocortisone
levothyroxine
growth hormone
How is the thyrotoxicosis phase of postpartum thyroiditis managed
Propranolol
How is hypothyroidism in postpartum thyroiditis managed ?
Levothyroxine
when is a routine postnatal appointment offered by GPs?
6wks
