Postnatal History Flashcards
When is this performed ?
Performed at 6 week postnatal check
What is the mnemonic for the postnatal history ?
DIPS’C: Delivery and post delivery, infant, psychological problems, social problems (support) and Hx; sexual Hx and Contraception
How you complete the rest of the postnatal history ?
IICE, PMH, DH, FH, SH and ICE
What is the delivery part made up of ? (4)
Type of delivery, complications during labour, gestation/term and Birthweight
What is the mnemonic for post delivery ?
WLPI
What is the post-delivery part made up of ? (4)
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
What is the Infant part made up of ? (2)
- 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
With regards to psychological problems, what 2 important things must you screen for ? (2)
Psychiatric conditions: postnatal depression, psychosis and anxiety; and SLEEP
What are the 3 psychiatric conditions your screening for ?
postnatal depression, psychosis and anxiety ;
What scale is used to assess the postnatal depression ?
Edinburgh PND scale ( out of done ) done 6-8 weeks postpartum
What is the social problems (social support) and Hx part made up of ? (3)
- 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
- Social history: smoking, alcohol, drugs
What is the sexual history made up of ? (1)
Have they started having sex with their partner ? If not, reassure that it’s safe for them to do so
With regards to contraception after pregnancy, what is first line ?
LAM:!Lactational amennorhea method
The LAM is a 98% effective form of contraception if the following are achieved; what needs to be achieved ?
- Full breast-feeding: 6 hourly during the day; 4 hourly during the night and 2. Ammenhoreic (having started their periods) for 6 months
How long is the LAM effective for ?
6 months
If the requirements for LAM not achieved, what is used ?
Other forms of contraception.
Describe the use of the POP after pregnancy 😭
Can be started anytime after pregnancy but if started after 21 days additional contraception is required for 2 days
Describe emergency contraception and when it is not need postpartum? 😭
Progesterone method: levonorgestrel IUS: not needed until 21 days postpartum
The COCP is usually contraindicated in breast feeding. After how many weeks can it be used ?
It can be used after 6 weeks postpartum
Why is the COCP not used during breast feeding before 6 weeks ? 😭
Suppresses lactation
The DEPO is not recommended in what until 6 weeks ?
The DEPO is not recommended in breastfeeding until 6 weeks
The DEPO can be used 5 weeks postpartum given 12 weekly if what ? 😭
If bottlefed
What is the initial management for postnatal check ? (2) 😭
Examinations: abdominal and vaginal examinations 😭
On abdominal examination during the postnatal check if the uterus can be felted what is this indicative of ?
If the uterus can be felted; this is indicative of retained products of placenta
On abdominal examination during the postnatal check, if the abdomen is tender what is this indicative of ?
if the abdomen is tender, this is indicative of endometritis
When is a vaginal examination often performed in a postnatal check ?
(2) 😭
If tears: from labour/episiotomy stitches and abnormal bleeding/discharge/pain
What does the management following postnatal check ? (3) 😭
- Contraception, 2. Incontinence: pelvic floor exercises and 3. If indicated; Address psychological/social problems
What day postpartum can a female become pregnant when having unprotected sex ?
21 days postpartum
