Postnatal care

Question 1

The postnatal period is also known as

timescale?

Answer 1

puerperium

first 6 weeks after a baby is born

Question 2

what will the community midwife be looking for? (3-4)

Answer 2

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

Question 3

What will be discussed at the postnatal check at GP?

Answer 3

Contraception

Mental health / general wellbeing

Question 4

common problems after postnatal period? (3)

Answer 4

Problems with infant feeding
Problems with bonding
Social issues (partner, other children and financial issues)

Question 5

complications of breast feeding (5)

Answer 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”

Question 6

Key postnatal conditions? (5)

Answer 6

• Post partum haemorrhage
• Venous thromboembolism
• Sepsis
• Psychiatric disorders of the puerperium
• Don’t forget pre-eclampsia

Question 7

Post partum haemorrhage - primary - what is it defined as?

Answer 7

= blood loss of >500ml within 24 hrs of delivery

Question 8

What are the 4 T’s of PPH?

treatment?

Answer 8

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

Question 9

Secondary PPH - blood loss?

Answer 9

blood loss > 500ml from 24 hrs post partum to 6 weeks

Retained tissue, Endometritis (infection), Tears / trauma

Question 10

Most common reasons of secondary PPH

Answer 10

Endometritis (infection),
retained tissue - placental or membranous
- perineal haematomas

Question 11

normal bleeding after pregnancy is called

Answer 11

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

Question 12

Thromboembolic disease- pregnancy is what state?

Answer 12

Pregnancy and the immediate post partum period is a hypercoagulable state!

Question 13

pregnant women are more likely to ?

Answer 13

develop thromboembolism (DVT or PE)f 6-10 times

Question 14

What is required for pregnant women to prevent Thromboembolic disease?

Answer 14

High quality risk assessment and appropriate thromboprophylaxis is required to reduce this risk

Question 15

What should you always be aware of in pregnant women regarding thromboembolic disease?
- what is suspicious

Answer 15

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

Question 16

Sometimes the only sign of PE will be?

Answer 16

unexplained tachycardia

Question 17

What will further increase the risk of Thromboembolic disease?

Answer 17

Immobilisation following spinal anaesthetic / caesarean section

Question 18

How to investigate women for thromboembolic disease? (3)

Answer 18

ECG
Leg Dopplers
CXR +/- VQ scan or CTPA (NB: radiation exposure during pregnancy /breast feeding)

Question 19

How to treat suspected PE or DVT? depending on the history

Answer 19

Treat with low molecular weight heparin

WARFARIN IS TERATOGENIC, but can be used when Breast feeding

Question 20

What is Puerperal sepsis?

Answer 20

leading cause of maternal death

- may not present early

Question 21

Puerperal sepsis - when to suspect sepsis?

Answer 21

Prompt IV antibiotic administration - GOLDEN HOUR - try to administer within 1 hour for women with suspected sepsis

Question 22

What is part of the full sepsis screen

Answer 22

– blood cultures, LVS, MSSU, wound swabs

Question 23

Antipyretic measures for sepsis

Answer 23

IV fluids and referral to hospital if you are concerned a pregnant or postnatal woman is septic

Question 24

main organism cause of sepsis

Answer 24

Streptococcus A

- FH, family Strap throat infections

Question 25

a quarter of women who died within 6 weeks were found to have died from

Answer 25

mental-health related causes

1 in 7 from suicide

Question 26

Suicide is the?

Answer 26

second largest cause of direct maternal deaths during or within the 42 days after birth (2019 MBBRACE report)

Question 27

What is baby blues?

Answer 27

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

Question 28

describe some of the features of Postnatal Depression

- what does it affect?

Answer 28

• 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

Question 29

Puerperal psychosis - describe what this is and what you need to look out for?

Answer 29

• 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

Question 30

Postnatal hypertensive disorders - when do most eclamptic seizures occur?

Answer 30

Most eclamptic seizures occur in the postnatal period

Question 31

when may pre-eclampsia occur?

Answer 31

postnatally or may worsen several days after delivery

Question 32

With Postnatal hypertensive disorders when can women be discahrged?

Answer 32

antihypertensives – need follow up in the community