Postnatal Care Flashcards
What is the postnatal period?
- Also called the “puerperium”
* The first 6 weeks after baby is born
What visit does a new mother receive?
- See midwife at home for first 9-10 days
* Thereafter referred to health visitor
What is it important to look out for in the postnatal mother?
- Continue 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
When is the postnatal GP check-up?
•6 weeks postnatal
What is discussed at the GP check-up?
- Contraception
* Mental health/general wellbeing
What are common postnatal problems?
- Problems with infant feeding
- Problems with bonding
- Social issues (partner, other children and financial issues)
What is a potential issue with breastfeeding?
Prescribing in breast feeding
What should the health team say to the mother about breastfeeding?
Women should be advised regarding benefits of breast feeding but supported whatever their feeding choices
What are the complications of breastfeeding?
- Mastitis
- Blocked milk ducts
- Difficulty feeding/baby latching
- Skin irritation “cracked nipples”
What are the “key postnatal conditions?
- Post partum haemorrhage
- Venous thromboembolism
- Sepsis
- Psychiatric disorders of the puerperium
- Pre-eclampsia
What is a primary PPH?
Blood loss of >500ml within 24 hrs of delivery
What are the likely causes of a primary PPH?
Tone, Trauma, Tissue, Thrombin (4 Ts)
What is a secondary PPH?
Blood loss > 500ml from 24 hrs post partum to 6 weeks
What are the likely causes of a secondary PPH?
- Retained tissue
- Endometritis (infection)
- Tears/trauma
What is lochia and is it normal?
Lochia normal for 3-4 weeks postnatal “should be like a period or less”
Why is thromboembolic disease more common in pregnancy?
Pregnancy and the immediate post partum period is a hypercoagulable state
How much does pregnancy increase risk of thromboembolism?
Pregnant women 6-10 times more likely to develop thromboembolism (DVT or PE)
How is the risk of thromboembolic disease reduced?
High quality risk assessment and appropriate thromboprophylaxis is required to reduce this risk
What might arouse suspicion of thromboembolic disease?
- Unilateral leg swelling and/or pain
* Women complaining of SOB or chest pain
What might be the only sign of a PE?
Unexplained tachycardia
How might a thromboembolic disease present in pregnancy/postnatally?
Atypically
What might increase risk of thromboembolic disease postnatally?
Immobilisation following spinal anaesthetic / caesarean section will further increase risk
How is thromboembolic disease investigated in pregnancy?
- D-dimer - unreliable in pregnancy
- ECG
- Leg Dopplers - US to check blood flow
- CXR +/- VQ (ventilation-perfusion) scan or CTPA (CT pulmonary angiogram)
(NB: radiation exposure during pregnancy/breast feeding)
How is thromboembolic disease treated in pregnancy/postnatally?
- Treat with low molecular weight HEPARIN
* WARFARIN IS TERATOGENIC, but can be used when Breast feeding
