Postnatal Care

Question 1

What is a circumvallate placenta?

Answer 1

Foetal membranes double up of one side of the placenta, leaving a thick membranous ring on the foetal side.

Question 2

What is a battledore insertion placenta?

Answer 2

Where the umbilical cord comes off at one edge of the placenta rather than from the centre.

Question 3

What is a velamentous insertion placenta?

Answer 3

Where the vessels of the placenta do not initially come together to form the umbilical cord. They begin separately.

Question 4

What is a succenturiate lobe placenta?

Answer 4

Where there is a smaller placental lobe which is entirely separate to the main bulk of the placenta. The two lobes are held together by vessels and membranes.

Question 5

How many arteries and veins are present within the umbilical cord?

Answer 5

There are two arteries and one vein.

Question 6

How do we dispose of the placenta?

Answer 6

We must dispose of the placenta upon the mothers request. Some mothers may like to keep the placenta to produce capsules for nutrients. Others are happy for you to dispose of it clinically. It is the mothers preference which we must adhere to.

Question 7

What must we check when looking at the placenta? There are 7 things.

Answer 7

1. Size
2. Shape
3. Smell
4. Colour
5. Vessels
6. Membranes
7. The umbilical cord (are there any knots present? What is the length of the cord?)

Question 8

What is the first stage of vaginal blood loss following birth?

Answer 8

Rubra (red blood)- occurs 2-4 days following birth. Contains red blood cells, fragments of chorion (placental parts) and amnion (parts of the amniotic sack) as well as necrotic decidua (uterus lining).

Question 9

What is the second stage of vaginal blood loss following birth?

Answer 9

Serosa (pink discharge): occurs 4-10 days following birth. Contains leukocytes (white blood cells).

Question 10

What is the third stage of vaginal blood loss following birth?

Answer 10

Alba (white discharge only): occurs 10-14 days following birth.

Question 11

What are 5 symptoms of a uterine infection?

Answer 11

1. Temperature above 38 degrees celsius
2. Abdominal pain
3. Abnormal bleeding
4. Foul smelling discharge
5. Feeling weak

Question 12

What is chorion?

Answer 12

Placental parts that break away following birth.

Question 13

What is amnion?

Answer 13

Parts of the amniotic sack that are left in utero following birth.

Question 14

What is necrotic decidua?

Answer 14

The uterus lining after birth.

Question 15

What abnormalities of the breasts must we be aware of postnatally?

Answer 15

• nipple trauma from incorrect latching during breastfeeding
• engorgement
• mastitis
• abscess

Question 16

What vital signs must we keep a close eye on postnatally?

Answer 16

• temperature (may indicate infection)
• respiratory rate (may indicate sepsis)
• pulse
• blood pressure

Question 17

What emotional factors must we consider postnatally?

Answer 17

Postnatal depression. Abnormal fatigue. Stress. Overworking. Anxiety.

Question 18

Define uterine involution?

Answer 18

The process of the uterus returning back to normal following pregnancy. It shrinks at a rate of 1cm per day as enzymes digest the excess muscle fibres that are no longer needed.

Question 19

What is the name of general vaginal blood loss following birth?

Answer 19

Lochia.

Question 20

What 5 things does the Apgar Score assess in baby following birth?

Answer 20

Heart rate, colour, respiratory rate, muscle tone, babies reflex.

Question 21

What changes occur to the babies bowel movements following birth?

Answer 21

The first poo is called meconium. It is dark in colour and tar like. As the baby begins to take on milk (either through breastfeeding or bottle feeding) the poo lightens in colour.

Question 22

What is the name given to an infection of the umbilical cord following birth. What symptoms can we look for to detect infection?

Answer 22

Omphalitus.

Symptoms include- a red ring surrounding the base of the cord, oedema of the cord (swelling), tenderness, discharge.

Question 23

What is Dry Gangrene?

Answer 23

The process which occurs as the umbilical cord begins to dry out and darken postnatally. We must watch carefully during this stage as infection is likely.

Question 24

What 7 guidelines are given to promote good cord care?

Answer 24

1. Asceptic technique during labour- prevents infection spreading.
2. 24 hour rooming period where skin to skin occurs. Mother is dominant Carer so baby is less likely to pick up infection from others.
3. Breastfeeding- breastmilk contains antibodies which can help baby to fight infection.
4. Open cord care- do not cover the cord, leave it to dry and come away from the abdomen naturally.
5. Keep cord clean using water only.
6. Observe cord for infection. It is important to keep a close eye on the umbilical cord as it is so prone to infection.
7. Where the baby is unable to breastfeed or have skin to skin contact, we can give topical antiseptic to reduce infection risk.

Question 25

How long does it take for the umbilical cord to come away from the abdomen naturally?

Answer 25

5-15 days.