Postnatal care

Question 1

When is the postnatal period?

Answer 1

End of labour –> usually 6-8 weeks after birth

Question 2

2 health workers who provide postnatal care:

Answer 2

Midwife

Maternity support worker

Question 3

Midwife =

Answer 3

Screening/identification of those at risk
Signposting, liason and referrals
Health promotion
Information

Question 4

Maternity support worker =

Answer 4

Assists midwife
Undertakes and records vital signs
Key role in breast feeding support
Idenitfy deviations from the norm

Question 5

How is the schedule of postnatal visits different from antenatal?

Answer 5

Schedule varies depending on medical condition, breast feeding etc

Question 6

When is the blood spot test?

Answer 6

5 days

Question 7

When does discharge to health visitor usually occur?

Answer 7

10 days

Question 8

Hormones in the postnatal period:

Answer 8

Oestrogen and progesterone levels fall
Oxytocin and prolactin increases
Amenorrhoea (due to inhibition of FSH and LH)

Question 9

Possible sites of infection:

Answer 9

Episiotomy, tear, mastitis, C-section, cannula site, perineum, meningitis (epidural), uterus/genital tract

Question 10

The post natal period can mask non-pregnancy related problems like…

Answer 10

Appendicitis
UTI
Meningitis

Question 11

Some important post-natal complications:

Answer 11

Postpartum hemorrhage
Thromoembolisms
Pre-eclampsia/eclampsia
Infection

Question 12

PPH is defined as =

Answer 12

> 500 mls of blood loss

Question 13

Primary post-partum heamorrhage

Answer 13

Occurs immediately after birth

Question 14

Secondary post-partum heamorrhage

Answer 14

Occurs 24hrs + after birth

Question 15

Signs of PPH =

Answer 15

faintness, dizziness, palpitations, tachycardia

Question 16

Signs of infection =

Answer 16

Fever, shivering, abdo pain

Question 17

Signs of pre-eclampsia, eclampsia =

Answer 17

Headaches
Visual disturbance
Nausea, vomiting
Seizures

Question 18

Signs of thromoboembolism =

Answer 18

Unilateral calf pain
Redness or swelling of calves
SOB
chest pain

Question 19

Leading causes of direct deaths =

Answer 19

Thrombosis and thromboembolism

Question 20

3 common symptoms at postnatal contact =

Answer 20

Headache
Fatigue
Backache

Question 21

What should be considered when dealing with headaches

Answer 21

pre-eclampsia

epidural spinal headache

Question 22

What should be considered when dealing with fatigue

Answer 22

general wellbeing, diet, exercise, activites
psychological issues
Hb and PPH

Question 23

Observations to make at post-natal =

Answer 23

General physical
Mental health
Nutrition
Breasts
Lochia
Involution of uterus
Wound 
Contraception/resumption of sexual activity
Elimination (passing urine)
Legs/chest

Question 24

Lochia =

Answer 24

diminished amount of blood loss should diminish within the first few days

Question 25

Why should you assess the low limbs?

Answer 25

DVT

Question 26

When should you discuss the resumption of sexual intercourse?

Answer 26

2-6 weeks after birth

Question 27

What may occur when resuming sexual intercourse?

Answer 27

Dyspareunia

Question 28

The blues occurs in what % of pregnancy

Answer 28

50-80%

Question 29

What causes the baby blues?

Answer 29

Hormones drop in the first hours

Question 30

Baby blues usually pass when?

Answer 30

Within a couple days, spontaneous recovery. Needs empathetic listening

Question 31

Post-natal depression occurs in what % of pregnancies?

Answer 31

10-15%

Question 32

Extreme rare psychological condition occuring after pregnancy, usually within first 2 weeks =

Answer 32

Puerperal psychosis

Question 33

Symptoms of puerperal psychosis =

Answer 33

``` Mania Depression Confusion Hallucinations Delusions ```

Question 34

What increases risk of puerperal psychosis?

Answer 34

Family history Bipolar disoder High reoccurance

Question 35

Score to assess newborn:

Answer 35

APGAR

Question 36

APGAR stands for:

Answer 36

``` Activity Pulse Grimace (reflex irritability) Appearance Respiration ```

Question 37

Normal APGAR score =

Answer 37

8-10

Question 38

APGAR score for resus

Answer 38

7

Question 39

APGAR score to transfer to unit

Answer 39

<5

Question 40

Newborn exam should occur within

Answer 40

72 hours

Question 41

Newborn exam looks at:

Answer 41

eyes heart hips testicles

Question 42

what should be done before discharge, within first 4 weeks?

Answer 42

Hearing test (cochlear, midbrain)

Question 43

Screening is done at:

Answer 43

5 days

Question 44

2nd physical exam is done at:

Answer 44

6-8 weeks

Question 45

Blood spot looks for:

Answer 45

``` Sickle cell Cystic fibrosis Hypothyroidism PKU GA1 Homocysisuria Maple-syrup urine disease Isovaleric acidaemia MCADD ```