Postnatal Care Flashcards

1
Q

When is the postnatal period?

A

First 6 weeks after the baby is born

->can also be referred to as puerperium

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2
Q

How often does a community midwife visit the postpartum mother?

A

A couple of times in first 9-10 days

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3
Q

What happens in the postpartum midwife visits?

A

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

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4
Q

When do patients require a postnatal GP visit?

A

6wks postpartum

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5
Q

What is discussed in the 6wk postnatal GP visit?

A

Contraception
Mental health/ general wellbeing

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6
Q

What are some of the common postnatal problems?

A

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

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7
Q

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

A

Health visitor- they see all prescholl age children

->Auntie Gill

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8
Q

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

A

21 days after giving birth

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9
Q

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?

A

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

->breast abscesses can occur further down the line

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10
Q

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

A

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

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11
Q

Primary postpartum haemorrhage?

A

Blood loss >500ml within 24hrs of delivery

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12
Q

Secondary postpartum haemorrhage?

A

Blood loss >500ml from 24hrs-6wks

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13
Q

What the four T’s which can cause PPH?

A

Tone
Trauma
Thrombin
Tissue

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

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14
Q

Why may tissue be a cause of PPH?

A

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

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15
Q

What kind of trauma may be a cause of PPH?

A

Perineal tears

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16
Q

What is the most common cause of a secondary PPH?

A

Retained tissue

17
Q

Lochia?

A

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

18
Q

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?

A

6-10 x more likely

19
Q

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

When should you suspicious?

A

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

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

20
Q

What increases thromboembolic risk in after delivery?

A

Immobilisation following spinal anaesthetic/ C-section

21
Q

How would you investigate thromboembolic disease?

A

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

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

22
Q

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

A

IV antibiotics

23
Q

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

A

Blood cultures
LVS
MSSU
Wound swab

24
Q

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

A

Group A streptococcus

25
Q

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

Discuss postnatal depression.

A

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

26
Q

Who is at increased risk of postnatal depression?

A

Patients with FH of affective disorder

27
Q

Puerperal psychosis?

A

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

28
Q

Management of puerperal psychosis?

A

Inpatient psychiatric care

29
Q

Who is at increased risk of developing puerperal psychosis?

A

Personal or FH of affective disorder, bipolar disorder or psychosis

30
Q

When do most eclamptic seizures occur in the pregnancy?

A

Postnatal period

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

31
Q
A