Postnatal Care

Question 1

What is the postnatal period?

Answer 1

• Also called the “puerperium”

* The first 6 weeks after baby is born

Question 2

What visit does a new mother receive?

Answer 2

• See midwife at home for first 9-10 days

* Thereafter referred to health visitor

Question 3

What is it important to look out for in the postnatal mother?

Answer 3

• 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

Question 4

When is the postnatal GP check-up?

Answer 4

•6 weeks postnatal

Question 5

What is discussed at the GP check-up?

Answer 5

• Contraception

* Mental health/general wellbeing

Question 6

What are common postnatal problems?

Answer 6

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

Question 7

What is a potential issue with breastfeeding?

Answer 7

Prescribing in breast feeding

Question 8

What should the health team say to the mother about breastfeeding?

Answer 8

Women should be advised regarding benefits of breast feeding but supported whatever their feeding choices

Question 9

What are the complications of breastfeeding?

Answer 9

• Mastitis
• Blocked milk ducts
• Difficulty feeding/baby latching
• Skin irritation “cracked nipples”

Question 10

What are the “key postnatal conditions?

Answer 10

• Post partum haemorrhage
• Venous thromboembolism
• Sepsis
• Psychiatric disorders of the puerperium
• Pre-eclampsia

Question 11

What is a primary PPH?

Answer 11

Blood loss of >500ml within 24 hrs of delivery

Question 12

What are the likely causes of a primary PPH?

Answer 12

Tone, Trauma, Tissue, Thrombin (4 Ts)

Question 13

What is a secondary PPH?

Answer 13

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

Question 14

What are the likely causes of a secondary PPH?

Answer 14

• Retained tissue
• Endometritis (infection)
• Tears/trauma

Question 15

What is lochia and is it normal?

Answer 15

Lochia normal for 3-4 weeks postnatal “should be like a period or less”

Question 16

Why is thromboembolic disease more common in pregnancy?

Answer 16

Pregnancy and the immediate post partum period is a hypercoagulable state

Question 17

How much does pregnancy increase risk of thromboembolism?

Answer 17

Pregnant women 6-10 times more likely to develop thromboembolism (DVT or PE)

Question 18

How is the risk of thromboembolic disease reduced?

Answer 18

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

Question 19

What might arouse suspicion of thromboembolic disease?

Answer 19

• Unilateral leg swelling and/or pain

* Women complaining of SOB or chest pain

Question 20

What might be the only sign of a PE?

Answer 20

Unexplained tachycardia

Question 21

How might a thromboembolic disease present in pregnancy/postnatally?

Answer 21

Atypically

Question 22

What might increase risk of thromboembolic disease postnatally?

Answer 22

Immobilisation following spinal anaesthetic / caesarean section will further increase risk

Question 23

How is thromboembolic disease investigated in pregnancy?

Answer 23

• 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)

Question 24

How is thromboembolic disease treated in pregnancy/postnatally?

Answer 24

• Treat with low molecular weight HEPARIN

* WARFARIN IS TERATOGENIC, but can be used when Breast feeding

Question 25

How might puerperal sepsis present?

Answer 25

Atypically

Question 26

What do you do if you suspect sepsis?

Answer 26

• Prompt IV antibiotic administration
• 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 woman is septic

Question 27

MMBARCE 2015 - What proportion of women who died between six weeks and one year after pregnancy died from mental-health related causes?

Answer 27

MMBRACE report 2015 - Almost a quarter

1/7 suicide

Question 28

What are the “baby blues”?

Answer 28

• 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 29

What is postnatal depression?

Answer 29

• 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

Question 30

What is puerperal psychosis?

Answer 30

• 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 31

When do most eclamptic seizures occur?

Answer 31

In the postnatal period

Question 32

How can delivery affect pre-eclampsia?

Answer 32

• Pre-eclampsia can develop postnatally or may worsen several days following delivery
• Women may be discharged on antihypertensives – need follow up in the community