Postpartum Flashcards
What folllow-up should GPs provide for women who experienced gestational diabetes in the postpartum period?
Fasting blood glucose at 6-13 weeks post partum
+
Annual HBA1C
Differentials for breast pain in breast feeding women?
1) Engorgement - typically bilateral, normally in the intial few days postpartum, may lead to difficulty with the infant attaching and suckling if engorged, breasts may appear red.
Mx - hand expression to reduce engorgement
2) Mastitis - affects 1 in 10 breast feeding women.
Tx with 10-14 days PO Flucloxacillin if Systemically unwell
or Symptoms don’t resolve after 12-24 hrs of effective milk removal
or Positive cultures
or Nipple fissure
** Safe to continue breast feeding while on Fluclox - in fact should be encouraged to help the mastitis clear!**
3) Nipple candidasis - suspect if persistent nipple pain after feeding - may have cracked sore nipples but may not be many clinical signs in mum or baby
Tx - topical Miconazole 2% cream to nipples after each feed for 2 wks (+/- hydrocortisone 1% if nipples v cracked and sore) plus oral nystatin suspension for the baby
4) Raynaud’s disease of the nipple
classically pain IMMEDIATELY AFTER BF with cyanosis of the nipple then resolving of pain once the normal nipple colour returns
Mx: minimising cold exposure, using heat packs after feeds, avoiding caffeine and smoking - can consider specialist referral for off-licence nifedipine
What are the different nerves that may rarely be damaged during an instrumental delivery and how would they present?
(most should recover in 6-8 wks but some may be permanent)
Femoral nerve - weakness in KNEE EXTENSION, numbness over the thigh, loss of patellar reflex
Lumbosacral trunk - weakness in ANKLE DORSIFLEXION, numbness in the calf and foot
Obturator nerve - weakness in HIP ADDUCTION, numbness over medial thigh
Sciatic nerve - pain travelling down buttocks to calves, weakness in knee flexion & foot movements
How many days post childbirth / miscarriage / ectopic / TOP can you start contraception without the need for additional barrier methods?
< 21 days postpartum
< 5 days post miscarriage completion/evacuation / ectopic Mx / MTX administration / TOP / evacuation of GTD
How long after gestational trophoblastic disease should pregnancy be avoided?
Partial molar pregnancy - until 2x consecutive monthly HCG levels are normal
Complete molar pregnancy - until at least 6 months
If chemo (MTX) given for GTD - wait at least 1 yr
How long can expressed breast milk be stored in the fridge / freezer?
Upto 5 days in the fridge
Upto 2 weeks in freezer drawer
Upto 6 months in a domestic freezer (<-18)
Milk in the fridge retains more of its nutrients than when frozen.
Frozen milk should be thawed in the fridge, never microwaved or heated
What are the benefits of breast feeding?
Reduced incidence of chest/GI/ear infection, type I diabetes, eczema/asthma
Reduced incidence of sudden infant death syndrome
Reduced maternal incidence of breast and ovarian Ca
What 2 deficiences can be seen in prologned breast feeding?
Vitamin D
Vitamin K
What are indications for commencing abx in mastitis?
Infected nipple fissure
Nil improvement after 12-24 hrs despite effective milk removal
Positive breast milk culture
1st line treatment for mild-moderate postnatal depression if nil prior Hx of depression?
1st line = CBT
If nil improvement / refuse CBT - SSRI (sertraline first line, avoid fluoxetine as long half life)
Correct definition of maternal death?
Death of a woman while pregnant or within 42 days (6 wks) of the end of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes
(6wks - 1 yr = a late maternal death)
What is the typical presentation of postpartum thyroiditis?
Initial hyperthyroid period - treat with propranolol to manage symptoms! not carbimazole!
Then hypothyroidism
Then normalises
High risk of recurrence in future pregnancies
