Postnatal Care & Intrapartum Care Flashcards
What is the puerperium (post-natal period) defined as?
First 6 weeks after the baby is born
How is monitoring done in the early post-natal period and what should be looked out for?
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
When is the post natal check done at the GP?
6 weeks
- Contraception
- Mental health/general wellbeing
What common problems are encountered in the post-natal period?
- Problems with infant feeding
- Problems with bonding
- Social issues (partner, other children & financial issues)
What are some complications of breastfeeding?
- Mastitis
- Blocked milk ducts
- Difficulty feeding/baby latching
- Skin irritation ‘cracked nipples’
What are some key post-natal conditions?
- PPH
- Venous thromboembolism
- Sepsis
- Psychiatric disorders of the puerperium
- Pre-eclampsia
What is the difference between primary & secondary PPH?
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
When is lochia normal?
3-4 weeks postnatal-should be like a period or less
Anything heavier than a period & large clots is not normal
Why are pregnant women more likely to develop thromboembolic disease?
Preg & the immediate post partum period is a hypercoagulable state
Preg women 6-10 x more likely to develop thromboembolism (DVT or PE)
What is required to reduce the risk of thromboembolic disease?
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
What are symptoms of thromboembolic disease?
Women with UNILATERAL leg swelling &/or pain & women complaining of SOB or CHEST PAIN
What is sometimes the only sign of a PE?
An unexplained tachycardia
Always have a high index of suspicion for ..?.. in pregnant or postnatal women
VTE
(May present atypically)
Immobilisation following spinal anaesthetic/CS will further increase the risk of what?
Thromboembolic disease
Are D-dimers reliable in pregnancy?
No, D-dimers are unreliable in pregnancy
How is thromboembolic disease investigated for?
- 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
How does puerperal sepsis present and what is a key causative organism of it?
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)
What should be done for any woman you suspect sepsis in?
Prompt IV Abx administration
‘Golden hr’
What is included in a septic screen and what should be done if concerned of sepsis?
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
Increased risk of postnatal depression in whom and what are the symptoms?
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
What is puerperal psychosis?
Rare but serious psychotic illness of the postnatal period where women can be a danger to themselves & their babies
What does puerperal psychosis require & in whom is it much more common in?
- Requires inpatient psychiatric care
- Much more common in women with personal or FH of affective disorder, bipolar disorder or psychosis
Who do baby blues affect?
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
Post-natal HT disorders: When do most eclamptic seizures occur?
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)
Why is the post-natal period a unique period?
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
