Postnatal Clinical Review Flashcards
What should all women have in the postpartum period?
A 6 week postnatal check
What should the 6 week postnatal check be centred on?
The patient
What should the 6 week postnatal check cover?
Physical, psychological, and social aspects of having new baby
What are the components of the 6 week postnatal check?
- History
- Examination
- Sex and contraception
- Pelvic floor exercises
What are the components of the history in the 6 week postnatal check?
- Physical
- Psychological
- Social
What needs to be included in the physical history at the 6 week postnatal check?
- How the baby was delivered
- Any particular worries about her own health
- If perineum/C-section scar is healing well
- If lochia is normal and/or if periods have resumed
- Is she breast feeding
When does lochia normally cease?
By 6 weeks postnatally
When do periods resume after having a baby?
Not until breast-feeding ceases in the majority
What needs to be included in the psychological history at the 6 week postnatal check?
- How the birth was, and if there are any issues that need to be talked through
- How her mood is, and screen for post-natal depression
- If she has any worries about her baby
What needs to be included in the social history at the 6 week postnatal check?
- Is she well supported at home
- How is she sleeping
- Encourage any household smokers to quit
- Provide opportunity to talk without partner to explore relevant issues such as domestic violence
How can you encourage any household smokers to quit?
- Explain passive smoking increases the risk of sudden infant death syndrome and childhood asthma
- Refer to smoking cessation clinic if required
What % of cases of domestic violence being in pregnancy?
30%
What should be included in the examination at the 6 week postnatal check?
- Palpable abdomen
- Check BP
- Perform vaginal exam in some circumstances
- Measure weight
What should be considered if you are able to palpate the uterus at the 6 week postnatal check?
Consider retained products of conception or endometritis (if tender)
When should you perform a vaginal exam at the 6 week postnatal check?
- Problems with vaginal tears or episiotomy
- Abnormal bleeding or vaginal discharge
- Pain on intercourse
- Urinary or faecal incontinence
What should happen with women with a BMI over 30 at the 6 week postnatal check?
They should be offered referral for advice on healthy eating and physical activity
What should the woman be asked about regarding sex and contraception at the 6 week postnatal check?
- If sex has resumed with he partner
- If contraception is required
What should be done if the woman has not resumed sex with her partner at the 6 week postnatal check?
Reassure her that now is safe to try
What contraception options are suitable at the 6 week postnatal check?
- Condoms
- Non-hormonal or progesterone-releasing IUD
- Progesterone-only pills and implant
Why are pelvic floor exercises important?
Many incontinence problems begin during the antenatal period
What proportion of women experience problems with urinary incontinence after childbirth?
1/3
What % of women experience problems with faecal incontinence after childbirth?
10%
What does the evidence show regarding the effectiveness of pelvic floor exercises?
They can be helpful in the case of stress incontinence, particularly in those at higher risk of problems, e.g. instrumental delivery, third-degree tear
What types of pelvic floor exercises should be done?
- Slow contractions
- Quick contractions
How are slow contraction pelvic floor muscle exercises performed?
Pulling up her pelvic floor muscles as though she were trying to stop herself urinating or passing wind, and holding for 10 seconds. Repeat 10 times
How often should slow contraction pelvic floor muscle exercises be done?
3 times a day
How are quick contraction pelvic floor muscle exercises performed?
Contract pelvic muscles and relax rapidly in succession 10 times
How often should quick contraction pelvic floor muscle exercises be done?
3 times a day
What advice can be given to help patients remember to do pelvic floor muscle exercises?
Associate with a regular activity to prompt remembering, e.g. with each feed, cup of tea, or meal
