Postnatal care

Question 1

What proportion of women infected with Chlamydia Trachomatis at time of delivery will develop a puerperal infection?

Answer 1

34%

Sequelae:
1. PPROM
2. PTL
3. Low BW
4. Ophthalmia neonatorum
5. Chlamydia pneumonitis

Question 2

What % of neonates are at risk of developing Ophthalmia neonatorum when born vaginally to mothers with current Chlamydia infection?

Answer 2

Up to 50%

A further 15% will develop Chlamydia Pneumonitis.

Question 3

NHS Blood Spot - what is screened for?

Answer 3

Taken on Day 5.

1. PKU
2. Congenital hypothyroidism
3. Sickle cell disease
4. CF
5. MCADD (medium chain acyl-co-A dehydrogenase deficiency)

Question 4

Expulsion rate of IUS inserted at Caesarean Section?

Answer 4

0-17%

Question 5

Emergency postnatal contraception.

1. When is it indicated?
2. Methods available?

Answer 5

1. Unprotected sex > 21 days PN
2. a) Cu-IUD: most effective however insertion should be delayed until 28 days PP.

b) Levonorgestrel: dose should be doubled in women with BMI > 35 or in those taking liver enzyme drugs eg. carbamazepine

c) Ulipristal Acetate: avoid BF for 7 days due to lack of safety data!

Question 6

Risk if women with Bipolar disorder developing postpartum psychosis?

Answer 6

1/4

Question 7

Postpartum Psychosis, features:

Answer 7

1. Severe mental illness with dramatic onset shortly after delivery
2. Most commonly takes the form of mania, severe depression or a mixed picture with features of both high and low mood.
3. In addition, women shoes evidence of psychosis with delusions and hallucinations common and will also demonstrate marked confusion or perplexity.

Question 8

Incidence of postpartum psychosis?

Answer 8

1-2/1000

Question 9

Risk of Postpartum psychosis in women with bipolar and a family history of postpartum psychosis?

Answer 9

1/2

Question 10

Onset of Postpartum Psychosis?

Answer 10

50% will have symptom onset from day 1-3.

Vast majority of cases will present within 2 weeks of delivery.

Question 11

Baby Blues, incidence?

Answer 11

30-80%

Transient emotional lability during the first postpartum week.

Question 12

Baby blues, features?

Answer 12

Transient emotional lability during the first PP week.

The mother typically presents with mood swings ranging from elation to sadness, insomnia, tearfulness, crying spells, irritability, anxiety and decreased concentration.

Care of the baby is NOT impaired.
Hopelessness and worthlessness are NOT prominent.
Women do NOT feel suicidal.

Question 13

Proportion of women still exclusively BF at 6 weeks PN?

Answer 13

1/3