Postnatal checks

Question 1

What needs to be covered at the 6wk postnatal check

Answer 1

Mother
Pap smear (if not performed at first visit)
Check rubella status
Check hepatitis B status
Review antenatal screening tests for follow-up action
Check for adequate contraception
Check if intercourse has resumed and give advice (if appropriate)
Check bowel and urine control
Encourage abdominal and pelvic floor exercises
Check for back problems
Check weight, blood pressure and urine
Check breasts
Check abdomen (uterus should be impalpable) ?Caesarean wound
Check perineum
Check psychological health, including coping ability
Check for postpartum thyroiditis
Discuss adequate diet, rest and personal care
Perform pelvic examination
Check pelvic floor strength
Further follow-up if necessary
Give Personal Health Record folder to mother
Baby
Routine examination
Check growth and feeding
Educate mother regarding immunisation schedule

Question 2

The 10 Bs of care of mother

Answer 2

Be careful: do not use douches or tampons for 4-6wk post delivery
Be fit: encourage gradual increases in walking, Kegel exercises
Birth control: assess for use of contraceptives; breastfeeding is NOT an effective method of birth control.
Bladder: assess for urinary incontinence, maintain

Question 3

Postpartum blues

Answer 3

Occurs in 85% of new mothers
Onset 3-10 days
Normal hormonal changes and adjustment to new baby
Self limited, should resolve by 2 wk
Presents as 
mood lability,
depressed affect
increased sensitivity to criticism, 
tearfulness
fatigue
irritability
poor concentration/despondency

Question 4

Postnatal depression definition

Answer 4

major depression occurring within 6 m of childbirth

Occurs 10-20% with 50% risk of recurrence

Question 5

Risk factors of postnatal depression

Answer 5

Personal or FmHx of depression
Prenatal depression or anxiety
Stressful life situation
poor support system
Unwanted pregnancy
Colicky or sick infant

Question 6

Presentation of postnatal depression

Answer 6

baby blues lasting longer then 2 wks
if symptoms in the first 2 weeks are severe
e.g. extreme disinterest in the baby, suicial or homicidal/infanticial ideation

Question 7

Investation for postnatal depression

Answer 7

Edinburgh Postnatal Depression Scale or other

Question 8

Treatment for Postnatal depression

Answer 8

Antidepressant
Psychotherapy
Supportive care
ECT if refractory

Question 9

Prognosis of postnatal depression

Answer 9

interferes with bonding and attachment between mother and baby so it can have long-term effects.

Question 10

Define postpartum psychosis

Answer 10

onset of psychotic symptoms over 24-72 hrs within first month postpartum
can be present in the context of depression.