Postnatal History

Question 1

When is this performed ?

Answer 1

Performed at 6 week postnatal check

Question 2

What is the mnemonic for the postnatal history ?

Answer 2

DIPS’C: Delivery and post delivery, infant, psychological problems, social problems (support) and Hx; sexual Hx and Contraception

Question 3

How you complete the rest of the postnatal history ?

Answer 3

IICE, PMH, DH, FH, SH and ICE

Question 5

What is the delivery part made up of ? (4)

Answer 5

Type of delivery, complications during labour, gestation/term and Birthweight

Question 6

What is the mnemonic for post delivery ?

Answer 6

WLPI

Question 7

What is the post-delivery part made up of ? (4)

Answer 7

WLPI: wound healing/pain, Lochia: PV Bleeding and discharge which should cease by 6 weeks; 3. Periods started 4. Incontinence: any accidents: cough/sneezing + bowel: BU

Question 8

What is the Infant part made up of ? (2)

Answer 8

1. Problems/issues or worries about baby ?; 2. Type of feeding: if breast feeding: any issues: any breast soreness + signs of infections (fever, swollen, red, discharge other than milk); milk production problems: engorgement

Question 9

With regards to psychological problems, what 2 important things must you screen for ? (2)

Answer 9

Psychiatric conditions: postnatal depression, psychosis and anxiety; and SLEEP

Question 10

What are the 3 psychiatric conditions your screening for ?

Answer 10

postnatal depression, psychosis and anxiety ;

Question 11

What scale is used to assess the postnatal depression ?

Answer 11

Edinburgh PND scale ( out of done ) done 6-8 weeks postpartum

Question 12

What is the social problems (social support) and Hx part made up of ? (3)

Answer 12

1. Social support: well supported at home and generally(family, friends, neighbours), 2. Occupation: do they work ? If so are they, still working or on maternity leave 3. Social history
2. Social history: smoking, alcohol, drugs

Question 13

What is the sexual history made up of ? (1)

Answer 13

Have they started having sex with their partner ? If not, reassure that it’s safe for them to do so

Question 14

With regards to contraception after pregnancy, what is first line ?

Answer 14

LAM:!Lactational amennorhea method

Question 15

The LAM is a 98% effective form of contraception if the following are achieved; what needs to be achieved ?

Answer 15

1. Full breast-feeding: 6 hourly during the day; 4 hourly during the night and 2. Ammenhoreic (having started their periods) for 6 months

Question 16

How long is the LAM effective for ?

Answer 16

6 months

Question 17

If the requirements for LAM not achieved, what is used ?

Answer 17

Other forms of contraception.

Question 18

Describe the use of the POP after pregnancy 😭

Answer 18

Can be started anytime after pregnancy but if started after 21 days additional contraception is required for 2 days

Question 19

Describe emergency contraception and when it is not need postpartum? 😭

Answer 19

Progesterone method: levonorgestrel IUS: not needed until 21 days postpartum

Question 20

The COCP is usually contraindicated in breast feeding. After how many weeks can it be used ?

Answer 20

It can be used after 6 weeks postpartum

Question 21

Why is the COCP not used during breast feeding before 6 weeks ? 😭

Answer 21

Suppresses lactation

Question 22

The DEPO is not recommended in what until 6 weeks ?

Answer 22

The DEPO is not recommended in breastfeeding until 6 weeks

Question 23

The DEPO can be used 5 weeks postpartum given 12 weekly if what ? 😭

Answer 23

If bottlefed

Question 24

What is the initial management for postnatal check ? (2) 😭

Answer 24

Examinations: abdominal and vaginal examinations 😭

Question 25

On abdominal examination during the postnatal check if the uterus can be felted what is this indicative of ?

Answer 25

If the uterus can be felted; this is indicative of retained products of placenta

Question 26

On abdominal examination during the postnatal check, if the abdomen is tender what is this indicative of ?

Answer 26

if the abdomen is tender, this is indicative of endometritis

Question 27

When is a vaginal examination often performed in a postnatal check ?
(2) 😭

Answer 27

If tears: from labour/episiotomy stitches and abnormal bleeding/discharge/pain

Question 28

What does the management following postnatal check ? (3) 😭

Answer 28

1. Contraception, 2. Incontinence: pelvic floor exercises and 3. If indicated; Address psychological/social problems

Question 29

What day postpartum can a female become pregnant when having unprotected sex ?

Answer 29

21 days postpartum