Postnatal care Flashcards
Postnatal period is first _ weeks after they are born
6
what health professionals does the mother see in post natal care?
Midwife at home for first 9-10 days thereafter referred to heal visitor
6 week postnatal check at GP
what are some common postnatal problems?
problem with infant feeding, problems with bonding, social issues (partner, other children and financial issues)
what needs to be thought about in regards to breast feeding?
Advise women about benefits of breast feeding but supported whatever their feeding choices
Prescribing in breast feeding
what are the complications of breast feeding
mastitis (inflamed breast), blocked milk ducts, difficulty feeding/baby latching, skin irritation “cracked nipples”
whata re some key postnatal conditions?
- Post partum haemorrhage
- Venous thromboembolism
- Sepsis
- Psychiatric disorders of the puerperium
- Don’t forget pre-eclampsia
what is primary postpartum haemorrhage and its cause?
- Primary = blood loss >500ml within 24 hours of delivery
- Primary normally due to the 4 Ts – tone (womb does not contract well enough after delivery so bleed form the uterus), trauma, tissue (retained tissues e.g. placenta, membranes), thrombin
what is secondary postpartum haemorrhage and its cause?
- Secondary = blood loss >500ml from 24 hours post partum to 6 weeks
- Secondary due to retained tissue, endometritis (infection), tears/trauma
what is lochia?
- Lochia normal for 3-4 weeks postnatal “should be like a period or less”
- lochia is the vaginal discharge after giving birth, containing blood, mucus, and uterine tissue. Lochia discharge typically continues for four to six weeks after childbirth, a time known as the postpartum period or puerperium
Pregnancy and the immediate post partum period is a _____________ state
hypercoagulable
Pregnant women 6-10 times more likely to develop thromboembolism (DVT or PE)
what management and treatment is required?
- High quality risk assessment and appropriate thromboprophylaxis is required to reduce the risk
- 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
- Immobilisation following spinal anaesthetic/caesarean section will further increase risk
- D-dimer unreliable in pregnancy
how do you investigate thromboembolic disease?
ECG, leg dopplers, CXR, treat with low molecular weight heparin, warfarin in teratogenic but can be used when breast feeding
Purperal Sepsis - how does it persent and what should you do?
- May present atypically
- In any women you suspect sepsis – prompt IV antibiotic administration “golden hour” (try to give antibiotic within one hour of a women presenting with sepsis)
- Perform 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 women is septic
Mental health:
- Almost 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 die from suicide
what are 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
how does postnatal depression present?
- Classic depression symptoms
- Affects functioning, bonding and often requires treatment
- Increased risk in women with person or family history or affective disorder
