Postnatal care Flashcards
what is the post natal period
Also called the “puerperium”
= the first 6 weeks after baby is born
what occurs in the first 9-10 days postnatally
see midwife at home for first 9-10 days, thereafter referred to health visitor
Continue to observe for signs of abnormal bleeding
Observe for evidence of infection
Wound (perineal or CS) / Endometritis / Breast
Debrief events around birth (especially if emergency CS)
Mental health
what occurs 6 weeks post natally
6 weeks post natal check at GP
contraception
mental health / general well being
what are common problems post natally
infant feeding problems
problems bonding
social issues
what should be advised in relation to breast feeding to women
Women should be advised re: benefits of breast feeding but supported whatever their feeding choices
Prescribing in breast feeding
what are some complications of breastfeeding
Mastitis
Blocked milk ducts
Difficulty feeding / baby latching
Skin irritation “cracked nipples”
what are some key post-natal conditions
Post partum haemorrhage
Venous thromboembolism
Sepsis
Psychiatric disorders of the puerperium
Don’t forget pre-eclampsia
what is primary post partum haemorrage
= blood loss of >500ml within 24 hrs of delivery
Tone, Trauma, Tissue, Thrombin (4 T’s)
what is secondary post partum haemorrage
= blood loss > 500ml from 24 hrs post partum to 6 weeks
Retained tissue, Endometritis (infection), Tears / trauma
what is lochia
Lochia normal for 3-4 weeks postnatal “should be like a period or less”
what are the four T’s of post partum haemorrage
Tone: Uterine atony
Trauma: Lacerations, hematomas, inversion, or rupture
Tissue: Retained tissue or invasive placenta
Thrombin: Coagulopathy
what are signs of thromboembolic disease in women
Suspicious = women with unilateral leg swelling and/or pain and women complaining of SOB or chest pain
Sometimes the only sign of a PE will be an unexplained tachycardia
May present atypically in pregnancy / postnatally
Always have a high index of suspicion for VTE in pregnant or postnatal women
is pregnancy a hyper-coagulative state?
Pregnancy and the immediate post partum period is a hypercoagulable state
Pregnant women 6-10 times more likely to develop thromboembolism (DVT or PE)
High quality risk assessment and appropriate thromboprophylaxis is required to reduce this risk
what increases the risk of thromboembolic disease
Immobilisation following spinal anaesthetic / caesarean section will further increase risk
D-dimer unreliable in pregnancy
what investigations should be done for women with suspected thromboembolic disease
ECG
Leg Dopplers
CXR +/- VQ scan or CTPA (NB: radiation exposure during pregnancy /breast feeding)
Treat with low molecular weight heparin
WARFARIN IS TERATOGENIC, but can be used when Breast feeding
what is the typical presentation puerperal sepsis
usually atypical
what is the treatment plan for women with puerperal sepsis
In any woman you suspect sepsis – prompt IV antibiotic administration “golden hour”
erform full septic screen – blood cultures, LVS, MSSU, wound swabs
Antipyretic measures, IV fluids and referral to hospital if you are concerned a pregnant or postnatal woman is septic
how impactful is mental health in the post-natal period
MMBRACE report 2015 - Almost a quarter of women who died between six weeks and one year after pregnancy died from mental-health related causes
1 in 7 of those women died from suicide
Suicide is the second largest cause of direct maternal deaths during or within the 42 days after birth (2019 MBBRACE report)
peri-natal mental health team
Baby blues
Affects most women due to hormonal changes around the time of birth – usually 1-3 days PN
Does not affect functioning and requires no specific treatment
what are signs of post natal depression
Can continue on from baby blues or start sometime later
Has classical ‘depressive’ symptoms
Affects functioning, bonding and often requires treatment
when is there an increased risk of post-natal depression
increased risk in women with personal or family history of affective disorder
what is puerperal psychosis
Rare but serious psychotic illness of the postnatal period
Women can be a danger to themselves and their babies
Requires inpatient psychiatric care
Much more common in women with personal or family history of affective disorder,
when do most eclamptic seizures occur
Most eclamptic seizures occur in the postnatal period
Pre-eclampsia can develop postnatally or may worsen several days following delivery
Women may be discharged on antihypertensives – need follow up in the community
