Postnatal care Flashcards
When is the postnatal period?
End of labour –> usually 6-8 weeks after birth
2 health workers who provide postnatal care:
Midwife
Maternity support worker
Midwife =
Screening/identification of those at risk
Signposting, liason and referrals
Health promotion
Information
Maternity support worker =
Assists midwife
Undertakes and records vital signs
Key role in breast feeding support
Idenitfy deviations from the norm
How is the schedule of postnatal visits different from antenatal?
Schedule varies depending on medical condition, breast feeding etc
When is the blood spot test?
5 days
When does discharge to health visitor usually occur?
10 days
Hormones in the postnatal period:
Oestrogen and progesterone levels fall
Oxytocin and prolactin increases
Amenorrhoea (due to inhibition of FSH and LH)
Possible sites of infection:
Episiotomy, tear, mastitis, C-section, cannula site, perineum, meningitis (epidural), uterus/genital tract
The post natal period can mask non-pregnancy related problems like…
Appendicitis
UTI
Meningitis
Some important post-natal complications:
Postpartum hemorrhage
Thromoembolisms
Pre-eclampsia/eclampsia
Infection
PPH is defined as =
> 500 mls of blood loss
Primary post-partum heamorrhage
Occurs immediately after birth
Secondary post-partum heamorrhage
Occurs 24hrs + after birth
Signs of PPH =
faintness, dizziness, palpitations, tachycardia
Signs of infection =
Fever, shivering, abdo pain
Signs of pre-eclampsia, eclampsia =
Headaches
Visual disturbance
Nausea, vomiting
Seizures
Signs of thromoboembolism =
Unilateral calf pain
Redness or swelling of calves
SOB
chest pain
Leading causes of direct deaths =
Thrombosis and thromboembolism
3 common symptoms at postnatal contact =
Headache
Fatigue
Backache
What should be considered when dealing with headaches
pre-eclampsia
epidural spinal headache
What should be considered when dealing with fatigue
general wellbeing, diet, exercise, activites
psychological issues
Hb and PPH
Observations to make at post-natal =
General physical Mental health Nutrition Breasts Lochia Involution of uterus Wound Contraception/resumption of sexual activity Elimination (passing urine) Legs/chest
Lochia =
diminished amount of blood loss should diminish within the first few days
Why should you assess the low limbs?
DVT
When should you discuss the resumption of sexual intercourse?
2-6 weeks after birth
What may occur when resuming sexual intercourse?
Dyspareunia
The blues occurs in what % of pregnancy
50-80%
What causes the baby blues?
Hormones drop in the first hours
Baby blues usually pass when?
Within a couple days, spontaneous recovery. Needs empathetic listening
Post-natal depression occurs in what % of pregnancies?
10-15%
Extreme rare psychological condition occuring after pregnancy, usually within first 2 weeks =
Puerperal psychosis
Symptoms of puerperal psychosis =
Mania Depression Confusion Hallucinations Delusions
What increases risk of puerperal psychosis?
Family history
Bipolar disoder
High reoccurance
Score to assess newborn:
APGAR
APGAR stands for:
Activity Pulse Grimace (reflex irritability) Appearance Respiration
Normal APGAR score =
8-10
APGAR score for resus
7
APGAR score to transfer to unit
<5
Newborn exam should occur within
72 hours
Newborn exam looks at:
eyes
heart
hips
testicles
what should be done before discharge, within first 4 weeks?
Hearing test (cochlear, midbrain)
Screening is done at:
5 days
2nd physical exam is done at:
6-8 weeks
Blood spot looks for:
Sickle cell Cystic fibrosis Hypothyroidism PKU GA1 Homocysisuria Maple-syrup urine disease Isovaleric acidaemia MCADD
