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Obs and gynae > Postnatal care > Flashcards

Postnatal care Flashcards

1
Q

What is part of rountine postnatal care on the ward?

A 
analgesia 
breast or bottle fed advice 
VTE risk assessment 
monitoring PPH
monitoring sepsis 
monitoring blood pressure 
monitoring recovery after c section or perineal tear 
FBC after bleeding 
anti D 
routine baby check
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2
Q

What are the aspects of follow up with the midwife?

A 
general wellbeing 
mood and depression 
bleeding and menstruation 
urinary incontinence and pelvic floor exercises 
scar healing after episiotomy  or c section 
contraception 
bleeding 
vaccines
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3
Q

Describe menstruation after delivery

A

endometrium initially breaks down
blood, endometrial tissue and mucus= lochia
should settle within 6 weeks
tampons should be avoided due to the risk of infection

breastfeeding leads to the release of oxytocin, causing uterus to contract and slightly heavier bleeding (normal)

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4
Q

What is the absence of periods called due to breastfeeding?

A

lactational amenorrhoea

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5
Q

when do women not breastfeeding restart periods?

A

3 weeks onwards

unpredictable

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6
Q

What contraception is used after delivery?

A

fertility doesn’t return until 21 days
lactational amenorrhoea-98% effective for up to 6 months after birth (must be fully breastfeeding and amenorrhoeic)
progesterone only pill and implant safe in breastfeeding and started at any time
COCP-avoided in breastfeeding, UKMEC 4 6 weeks postpartum UKMEC 2 >6 weeks
copper coil and IUS inserted before 48 hours or more than four weeks after birth

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7
Q

When can the COCP be started?

A

non breastfeeding: anytime with 7 days barrier protection

breastfeeding: not started before 6 weeks afterbirth

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8
Q

What is endometritis?

A

inflammation of the endometrium, usually caused by infection
more common after c section
prophylactic antibiotics may be given
gram negative, positive, anaerobic bacteria
STIs
need to rule out retained products of conception

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9
Q

What is the presentation of endometritis?

A 
foul smelling discharge 
bleeding that gets heavier 
lower abdominal pain 
sepsis 
fever
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10
Q

Treatment for endometritis

A

broad spectrum co-amoxiclav

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11
Q

When does retained products of conception occur?

A

after delivery
miscarriage
termination of pregnancy
placenta acrcreta (significant risk factor)

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12
Q

What are the complications of retained products of conception?

A

Endometritis

Ashermans syndrome

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13
Q

Presentation of retained products of conception

A

vaginal bleeding that doesn’t improve
abnormal vaginal discharge
lower abdominal pain
fever

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14
Q

what is ashermans syndrome?

A

adhesions form in the uterus
endometrial curettage can damage the basal layer of endometrium
heals abnormally creating scar tissue connecting areas of the uterus not normally connected
endocervix can seal shut

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15
Q

what does ashermans syndrome lead to?

A

Amenorrhoea and infertility

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16
Q

what is the definition of postpartum amenorrhoea?

A

<100g/l

common after acute blood loss

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17
Q

what is the treatment for postpartum anaemia?

A

<100g/l start oral iron 3 times a day for 3 months
<90g/l iron infusion plus oral iron
<70g/l blood transfusion in addition to oral iron

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18
Q

when is iron infusion considered?

A

poor adherence to oral treatment
cannot tolerate oral iron
failure to respond to oral iron
cannot absorb oral iron (IBD)

19
Q

when is oral iron contraindicated?

A

active infection

pathogens feed off the iron leading to proliferation

20
Q

when does the baby blues happen and what are the symptoms?

A

occur in the first week
affect more than 50%, particularly first time mothers
mood swings, low mood, anxiety, irritability, tearfulness

no treatment required and recovers in 2 weeks

21
Q

when does postnatal depression occur and what are the symptoms?

A

occur around 3 months
1 in 10 women
low mood, anhedonia, low energy

22
Q

how is moderate cases of depression treated?

A

SSRI and CBT

23
Q

what screening tool is used for depression?

A

Edinburgh postnatal depression scale
>10 suggests postnatal depression
assess how mother has felt over the last week

24
Q

when does puerperal psychosis occur?

A

onset 2-3 weeks after delivery

25
Q

why are the symptoms of puerperal psychosis?

A

delusions, hallucinations, depression, mania, confusion, thought disorder

26
Q

treatment for puerperal psychosis?

A

admission to mother baby unit
CBT
antidepressants, antipsychotics, mood stabilisers
ECT

27
Q

what is the risk of SSRIs in pregnancy?

A

can lead to neonatal abstinence syndrome
presents with irritability and poor feeding
neonates require monitoring and supportive management

28
Q

what is lactational mastitis?

A

inflammation of breast tissue
common complication of breastfeeding
occur with or without associated infection
bacteria can enter through cracked nipples causing inflammation and infection (staph aureus)

29
Q

why is mastitis caused?

A

can be caused by obstruction in ducts and accumulation of milk

30
Q

what is the management of mastitis?

A 
continue breastfeeding (even when suspected infection, it encourages flow)
express milk 
breast massage
heat packs, warm showers 
analgesia
31
Q

presentation of mastitis?

A 
breast pain, tenderness 
erythema of local area 
local warmth and inflammation 
nipple discharge 
fever
32
Q

What antibiotics are used when conservative management doesn’t work and suspected infection?

A

flucloxacillin

erythromycin (penicillin allergic)

33
Q

complication of mastitis?

A

breast abscess

incision and drainage

34
Q

describe candida of the breast?

A

occurs after a course of antibiotics
may lead to recurrent mastitis, as it causes cracked nipples and entrance for infection
associated with oral thrush and candidal nappy rash in infant

35
Q

treatment of candida of the breast?

A 
topical miconazole (after each breastfeed)
treatment for baby-oral miconazle gel or nystatin (anti fungal)
36
Q

Why does postpartum thyroiditis occur?

A

cause is unknown
pregnancy is an immunosuppressant to prevent rejection of the foetus
after delivery there is a rebound affect and increased immune system activity and expression antibodies
affect the thyroid e.g. thyroid perioxdase antibodies
causes inflammation of the thyroid gland leading to over or under activity

37
Q

what is the typical pattern?

A
  1. thyrotoxicosis (first 3 months)
  2. hypothyroidism (3-6 months)
  3. thyroid function returns to normal
38
Q

management of thyroiditis?

A

thyrotoxicosis-symptom control propanolol
hypothyroidism-levothyroxine

women will need annual monitoring of TFTs even after condition has resolved due to risk of developing long term hypothyroidism

39
Q

What is sheenan’s syndrome

A

rare complication of postpartum haemorrhage
drop in circulating blood volume leads to avascular necrosis of the pituitary gland
reduced perfusion leads to ischaemia of the cells of the pituitary leading to cell death

40
Q

What part of the pituitary is affected in sheenans syndrome?

A

anterior pituitary

41
Q

what hormones are affected in sheenan’s syndrome?

A 
TSH
ACTH
FSH 
LH 
GH
prolactin
42
Q

presentation of sheenans

A

reduced lactation
amenorrhoea
adrenal insufficiency
hypothyroidism

43
Q

management of sheenans

A 
replacement of missing hormones 
oestrogen and progesterone 
hydrocortisone 
levothyroxine 
growth hormone
44
Q

what hormones are produced by the posterior pituitary?

A

ADH

oxytocin

Obs and gynae (10 decks)

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