Postnatal Care Flashcards
When is the postnatal period?
First 6 weeks after the baby is born
->can also be referred to as puerperium
How often does a community midwife visit the postpartum mother?
A couple of times in first 9-10 days
What happens in the postpartum midwife visits?
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
When do patients require a postnatal GP visit?
6wks postpartum
What is discussed in the 6wk postnatal GP visit?
Contraception
Mental health/ general wellbeing
What are some of the common postnatal problems?
Problems with infant feeding
Problems with bonding
Social issues- partner, other children, financial issues
After the midwife visits, babies and mothers are referred to which team?
Health visitor- they see all prescholl age children
->Auntie Gill
How quickly after giving birth can a woman fall pregnant again?
21 days after giving birth
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?
Mastitis
Blocked milk ducts
Difficulty feeding/baby latching
Skin irritation - ‘cracked nipples’
->breast abscesses can occur further down the line
List a few of the key postnatal complications you have to be aware of.
Postpartum haemorrhage
Venous thromboembolism
Sepsis
Psychiatric disorders of the puerperium
Pre-eclampsia
Primary postpartum haemorrhage?
Blood loss >500ml within 24hrs of delivery
Secondary postpartum haemorrhage?
Blood loss >500ml from 24hrs-6wks
What the four T’s which can cause PPH?
Tone
Trauma
Thrombin
Tissue
->these usually cause primary PPH, secondary may be due to retained tissue, endometritis or tears (trauma)
Why may tissue be a cause of PPH?
Retained tissue, retained placenta, retained membrane can all cause excessive bleeding
What kind of trauma may be a cause of PPH?
Perineal tears
What is the most common cause of a secondary PPH?
Retained tissue
Lochia?
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
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?
6-10 x more likely
Pregnant women or women in the postpartum period may not present with typical signs of DVT/PE.
When should you suspicious?
Women with unilateral leg swelling and/or pain
SOB
Chest pain
->sometimes the only sign of a PE is unexplained tachycardia
What increases thromboembolic risk in after delivery?
Immobilisation following spinal anaesthetic/ C-section
How would you investigate thromboembolic disease?
ECG
Leg dopplers
CXR +/- VQ scan
Treat with low molecular weight heparin
->note that warfarin is teratogenic but can be used when breastfeeding
In any women you suspect sepsis in, what do you need to immediately administer?
IV antibiotics
If you suspect puerperal sepsis, you need to carry out a full septic screen.
What does this involve?
Blood cultures
LVS
MSSU
Wound swab
What is one of the key microorganisms which can cause puerperal sepsis?
Group A streptococcus
Mental health problems postnatally are very common.
However, they can continue in the form of postnatal depression, psychosis.
Discuss postnatal depression.
Can continue on from ‘baby blues’ or start later
Has classical symptoms of depression
Affects functioning and bonding
Who is at increased risk of postnatal depression?
Patients with FH of affective disorder
Puerperal psychosis?
Rare but serious psychotic illness of postnatal period
Women can be a danger to themselves and baby
Management of puerperal psychosis?
Inpatient psychiatric care
Who is at increased risk of developing puerperal psychosis?
Personal or FH of affective disorder, bipolar disorder or psychosis
When do most eclamptic seizures occur in the pregnancy?
Postnatal period
->pre-eclampsia can develop post-natally or can worsen several days after delivery
