Postnatal Care Flashcards
What does the six week postnatal check involve?
This is at the GP practise and to check how the mother is doing, it is normally conducted at the same time as the 6 week newborn baby check.
Topics covered+
. general well-being
. mood and depression
. Bleeding and menstruation
. Scar healing after epiostomy or caesarean
. Contraception
. Breastfeeding
. Fasting blood glucose (after gestational diabetes)
. Blood pressure (after hypertension or pre clampsia)
. Urine dipstick for protein (after pre eclampsia)
What is bleeding very soon after birth called?
In the period shortly after birth, there will be vaginal bleeding as the endometrium initially breaks down, then returns to normal over time. This vaginal bleeding is a mix of blood, endometrial tissue and mucus and is called lochia. Bleeding should settle within 6 weeks (AVOID TAMPONS- infection risk).
Why is there often slightly more bleeding during episodes of breastfeeding?
Breastfeeding releases oxytocin, this causes the uterus to contract and causes more bleeding.
What is lactational amenorrhoea?
The absence of periods related to breastfeeding.
If a women is bottle feeding, when will she start having periods?
Menstrual periods will start from 3 weeks onwards, this is unpredictable and periods can be delayed or irregular at first.
When do bottle feeding women need to start taking contraception?
They become fertile 3 weeks post partum
What contraception is suitable for bottle feeding women and when do they take it?
COCP should not be taken before 4 (if bottle feeding)/6 (if breast feeding) post partum
IUD/IUS can be inserted up to 48 hours post birth or after 4 weeks (not between the period from 48-4 weeks)
POP can be started anytime after birth
What contraception is safe for breastfeeding women?
POP
How long does breastfeeding provide contraception for?
Lactational amenorrhoea is 98% effective as contraception for up to 6 months after birth. Women must be fully breast feeding and amenorrhoeic.
What is endometritis?
Inflammation of the endometrium, usually caused by infection. It can occur in the postpartum period as infection is introduced during or after labour and delivery. The process of delivery opens the uterus and allows bacteria from the vagina to travel upwards and infect the endometrium.
What is the presentation of postpartum endometritis?
Foul smelling discharge/lochia Bleeding which gets heavier or does not improve with time Lower abdo/pelvic pain Fever Sepsis
How would you diagnose the postpartum endometritis?
Vaginal swabs
Urine culture and sensitivities
Ultrasound may be considered to rule out retained products of conception.
How would you treat endometritis?
Depends on underlying cause really, but an example of a broad spec ABx that could be used is co amoxiclav.
What is meant by retained products of conception?
Refers to when pregnancy related tissue remains in the uterus after delivery. It can also occur after miscarriage or termination of the pregnancy.
What is a significant risk factor for retained products of conception?
Placenta accreta
