Postnatal care Flashcards
The postnatal period is also known as
timescale?
puerperium
first 6 weeks after a baby is born
what will the community midwife be looking for? (3-4)
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 will be discussed at the postnatal check at GP?
Contraception
Mental health / general wellbeing
common problems after postnatal period? (3)
Problems with infant feeding
Problems with bonding
Social issues (partner, other children and financial issues)
complications of breast feeding (5)
- mastitis - infection of the breast - red hot tender, systemic sign of infection
- breast abscess
- blocked milk ducts
difficulty feeding/ baby latching - Skin irritation “cracked nipples”
Key postnatal conditions? (5)
- Post partum haemorrhage
- Venous thromboembolism
- Sepsis
- Psychiatric disorders of the puerperium
- Don’t forget pre-eclampsia
Post partum haemorrhage - primary - what is it defined as?
= blood loss of >500ml within 24 hrs of delivery
What are the 4 T’s of PPH?
treatment?
Tone, Trauma, Tissue, Thrombin
womb does not contract properly causing significant treatment
- uterotonic medication or physical measures- tone
trauma - tears can be vascular and bleed
tissue - retained membranes
Thrombin - abnormal clotting process following the brith
Secondary PPH - blood loss?
blood loss > 500ml from 24 hrs post partum to 6 weeks
Retained tissue, Endometritis (infection), Tears / trauma
Most common reasons of secondary PPH
Endometritis (infection),
retained tissue - placental or membranous
- perineal haematomas
normal bleeding after pregnancy is called
Lochia normal for 3-4 weeks postnatal “should be like a period or less” - anyting with large clots or not normal need to be seen
Thromboembolic disease- pregnancy is what state?
Pregnancy and the immediate post partum period is a hypercoagulable state!
pregnant women are more likely to ?
develop thromboembolism (DVT or PE)f 6-10 times
What is required for pregnant women to prevent Thromboembolic disease?
High quality risk assessment and appropriate thromboprophylaxis is required to reduce this risk
What should you always be aware of in pregnant women regarding thromboembolic disease?
- what is suspicious
Suspicious = women with unilateral leg swelling and/or pain and women complaining of SOB or chest pain
May present atypically in pregnancy / postnatally
Always have a high index of suspicion for VTE in pregnant or postnatal women
Sometimes the only sign of PE will be?
unexplained tachycardia
What will further increase the risk of Thromboembolic disease?
Immobilisation following spinal anaesthetic / caesarean section
How to investigate women for thromboembolic disease? (3)
ECG
Leg Dopplers
CXR +/- VQ scan or CTPA (NB: radiation exposure during pregnancy /breast feeding)
How to treat suspected PE or DVT? depending on the history
Treat with low molecular weight heparin
WARFARIN IS TERATOGENIC, but can be used when Breast feeding
What is Puerperal sepsis?
leading cause of maternal death
- may not present early
Puerperal sepsis - when to suspect sepsis?
Prompt IV antibiotic administration - GOLDEN HOUR - try to administer within 1 hour for women with suspected sepsis
What is part of the full sepsis screen
– blood cultures, LVS, MSSU, wound swabs
Antipyretic measures for sepsis
IV fluids and referral to hospital if you are concerned a pregnant or postnatal woman is septic
main organism cause of sepsis
Streptococcus A
- FH, family Strap throat infections
a quarter of women who died within 6 weeks were found to have died from
mental-health related causes
1 in 7 from suicide
Suicide is the?
second largest cause of direct maternal deaths during or within the 42 days after birth (2019 MBBRACE report)
What is baby blues?
usually due to hormonal changes in the first few days of birth - tearful or low
- 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
describe some of the features of Postnatal Depression
- what does it affect?
- Can continue on from baby blues or start sometime later
- Has classical ‘depressive’ symptoms
- Affects functioning, bonding and often requires treatment
- Increased risk in women with personal or family history of affective disorder
- may struggle to bond with their baby
Puerperal psychosis - describe what this is and what you need to look out for?
- 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, bipolar disorder or psychosis
Postnatal hypertensive disorders - when do most eclamptic seizures occur?
Most eclamptic seizures occur in the postnatal period
when may pre-eclampsia occur?
postnatally or may worsen several days after delivery
With Postnatal hypertensive disorders when can women be discahrged?
antihypertensives – need follow up in the community
