Postnatal Care

Question 1

When is the postnatal period?

Answer 1

First 6 weeks after the baby is born

->can also be referred to as puerperium

Question 2

How often does a community midwife visit the postpartum mother?

Answer 2

A couple of times in first 9-10 days

Question 3

What happens in the postpartum midwife visits?

Answer 3

Observe for signs of abnormal bleeding
Observe for signs of infection
Mental health
Debrief events around birth- especially if emergency CS
Wound care- e.g. perineal stitches, CS wounds

Question 4

When do patients require a postnatal GP visit?

Answer 4

6wks postpartum

Question 5

What is discussed in the 6wk postnatal GP visit?

Answer 5

Contraception
Mental health/ general wellbeing

Question 6

What are some of the common postnatal problems?

Answer 6

Problems with infant feeding
Problems with bonding
Social issues- partner, other children, financial issues

Question 7

After the midwife visits, babies and mothers are referred to which team?

Answer 7

Health visitor- they see all prescholl age children

->Auntie Gill

Question 8

How quickly after giving birth can a woman fall pregnant again?

Answer 8

21 days after giving birth

Question 9

Women should be advised regarding the benefits of breastfeeding for both mother and baby but supported whatever their feeding choice.

What are some of the potential complications of breastfeeding?

Answer 9

Mastitis
Blocked milk ducts
Difficulty feeding/baby latching
Skin irritation - ‘cracked nipples’

->breast abscesses can occur further down the line

Question 10

List a few of the key postnatal complications you have to be aware of.

Answer 10

Postpartum haemorrhage
Venous thromboembolism
Sepsis
Psychiatric disorders of the puerperium
Pre-eclampsia

Question 11

Primary postpartum haemorrhage?

Answer 11

Blood loss >500ml within 24hrs of delivery

Question 12

Secondary postpartum haemorrhage?

Answer 12

Blood loss >500ml from 24hrs-6wks

Question 13

What the four T’s which can cause PPH?

Answer 13

Tone
Trauma
Thrombin
Tissue

->these usually cause primary PPH, secondary may be due to retained tissue, endometritis or tears (trauma)

Question 14

Why may tissue be a cause of PPH?

Answer 14

Retained tissue, retained placenta, retained membrane can all cause excessive bleeding

Question 15

What kind of trauma may be a cause of PPH?

Answer 15

Perineal tears

Question 16

What is the most common cause of a secondary PPH?

Answer 16

Retained tissue

Question 17

Lochia?

Answer 17

Normal bleeding after giving birth, normal to have this bleeding 3-4wks postnatal

->advise should be like a period or less. Anything heavier than a period with large clots is abnormal

Question 18

Pregnancy and the immediate postpartum period is a hypercoagulable state.
How much more likely are pregnant women to develop a thromboembolism like DVT or PE?

Answer 18

6-10 x more likely

Question 19

Pregnant women or women in the postpartum period may not present with typical signs of DVT/PE.

When should you suspicious?

Answer 19

Women with unilateral leg swelling and/or pain
SOB
Chest pain

->sometimes the only sign of a PE is unexplained tachycardia

Question 20

What increases thromboembolic risk in after delivery?

Answer 20

Immobilisation following spinal anaesthetic/ C-section

Question 21

How would you investigate thromboembolic disease?

Answer 21

ECG
Leg dopplers
CXR +/- VQ scan
Treat with low molecular weight heparin

->note that warfarin is teratogenic but can be used when breastfeeding

Question 22

In any women you suspect sepsis in, what do you need to immediately administer?

Answer 22

IV antibiotics

Question 23

If you suspect puerperal sepsis, you need to carry out a full septic screen.
What does this involve?

Answer 23

Blood cultures
LVS
MSSU
Wound swab

Question 24

What is one of the key microorganisms which can cause puerperal sepsis?

Answer 24

Group A streptococcus

Question 25

Mental health problems postnatally are very common.
However, they can continue in the form of postnatal depression, psychosis.

Discuss postnatal depression.

Answer 25

Can continue on from ‘baby blues’ or start later
Has classical symptoms of depression
Affects functioning and bonding

Question 26

Who is at increased risk of postnatal depression?

Answer 26

Patients with FH of affective disorder

Question 27

Puerperal psychosis?

Answer 27

Rare but serious psychotic illness of postnatal period
Women can be a danger to themselves and baby

Question 28

Management of puerperal psychosis?

Answer 28

Inpatient psychiatric care

Question 29

Who is at increased risk of developing puerperal psychosis?

Answer 29

Personal or FH of affective disorder, bipolar disorder or psychosis

Question 30

When do most eclamptic seizures occur in the pregnancy?

Answer 30

Postnatal period

->pre-eclampsia can develop post-natally or can worsen several days after delivery