Postnatal Care & Intrapartum Care

Question 1

What is the puerperium (post-natal period) defined as?

Answer 1

First 6 weeks after the baby is born

Question 2

How is monitoring done in the early post-natal period and what should be looked out for?

Answer 2

See midwife at home for first 9-10 days, thereafter referred to health visitor (sees all preschool aged children)

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 3

When is the post natal check done at the GP?

Answer 3

6 weeks

• Contraception
• Mental health/general wellbeing

Question 4

What common problems are encountered in the post-natal period?

Answer 4

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

Question 5

What are some complications of breastfeeding?

Answer 5

• Mastitis
• Blocked milk ducts
• Difficulty feeding/baby latching
• Skin irritation ‘cracked nipples’

Question 6

What are some key post-natal conditions?

Answer 6

• PPH
• Venous thromboembolism
• Sepsis
• Psychiatric disorders of the puerperium
• Pre-eclampsia

Question 7

What is the difference between primary & secondary PPH?

Answer 7

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

Tone, Trauma, Tissue, Thrombin (4 T’s)

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

Retained tissue, Endometritis (infection), Tears / trauma

Question 8

When is lochia normal?

Answer 8

3-4 weeks postnatal-should be like a period or less

Anything heavier than a period & large clots is not normal

Question 9

Why are pregnant women more likely to develop thromboembolic disease?

Answer 9

Preg & the immediate post partum period is a hypercoagulable state

Preg women 6-10 x more likely to develop thromboembolism (DVT or PE)

Question 10

What is required to reduce the risk of thromboembolic disease?

Answer 10

High quality risk assessment and appropriate thromboprophylaxis

Some women require thromboprophylaxis both antenatally & certainly postnatally

After CS women are routinely given thromboprophylaxis to reduce the risk of blood clots

Question 11

What are symptoms of thromboembolic disease?

Answer 11

Women with UNILATERAL leg swelling &/or pain & women complaining of SOB or CHEST PAIN

Question 12

What is sometimes the only sign of a PE?

Answer 12

An unexplained tachycardia

Question 13

Always have a high index of suspicion for ..?.. in pregnant or postnatal women

Answer 13

VTE

(May present atypically)

Question 14

Immobilisation following spinal anaesthetic/CS will further increase the risk of what?

Answer 14

Thromboembolic disease

Question 15

Are D-dimers reliable in pregnancy?

Answer 15

No, D-dimers are unreliable in pregnancy

Question 16

How is thromboembolic disease investigated for?

Answer 16

• ECG
• Leg Dopplers
• CXR +/- VQ scan or CTPA (NB: radiation exposure during pregnancy /breast feeding)
• Treat with LMWH
• WARFARIN IS TERATOGENIC, but can be used when Breast feeding

Question 17

How does puerperal sepsis present and what is a key causative organism of it?

Answer 17

May present atypically

Group A strep (ask about FH & anyone ill at home particularly young children with sore throats that might have strep throat infections)

Question 18

What should be done for any woman you suspect sepsis in?

Answer 18

Prompt IV Abx administration

‘Golden hr’

Question 19

What is included in a septic screen and what should be done if concerned of sepsis?

Answer 19

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 20

Increased risk of postnatal depression in whom and what are the symptoms?

Answer 20

Increased risk in women with personal or FH of affective disorder

Has classical ‘ depressive’ symptoms & affects functioning, bonding & often requires treatment

Can continue on from baby blues or start sometime later

Question 21

What is puerperal psychosis?

Answer 21

Rare but serious psychotic illness of the postnatal period where women can be a danger to themselves & their babies

Question 22

What does puerperal psychosis require & in whom is it much more common in?

Answer 22

• Requires inpatient psychiatric care
• Much more common in women with personal or FH of affective disorder, bipolar disorder or psychosis

Question 23

Who do baby blues affect?

Answer 23

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

• Have perinatal mental health team

Question 24

Post-natal HT disorders: When do most eclamptic seizures occur?

Answer 24

In the post-natal period

Pre-eclampsia can develop postnatally or may worsen several days following delivery

(women may be discharged on Anti- HTs - need follow up in the community)

Question 25

Why is the post-natal period a unique period?

Answer 25

Body is transitioning from the pregnant state to non-pregnant state & carries specific risks during that time

Important to think about feeding, mental health, support & contraception