Postpartum

Question 1

The puerperium

• definition
• Physiological changes: lochia + uterine involution, lactation, menstruation
• Contraception
• pyrexia dd

Answer 1

• def: up to 6 weeks
  changes: lochia: bleeding common from 1 week up until 6
  menstruation: starts around 8 weeks unless b feeding.
• cont: No need for cont for 21 days then need pop/implant, or coil within 48 hours or >1 month, cocp contraind if <6 weeks if breast feeding (reduces milk volume)
• pyrexia dd: vte, endometritis most common - admit for iv clindamycin + gentamicin, uti, chest infection, wound infection, mastitis

Question 2

Breast feeding:

• Constituents
• Advantages
• Difficulties
• contraind
• want to stop mx

Answer 2

Breast feeding:

• Constituents
• Advantages: bonding, dec depression, can’t overfeed, free, reduces infections
• Difficulties: pain, milk bleb (blocked duct), candidiasis, mastitis, engorgement, normal to loose 10% weight in baby in first week, still needs vit c/d/iron
• Contraind: galactosaemia, viral infection (hiv), abx (penicillins, trimeth, cephalosp), high dose steroids, levothy, na valp/carbamez, salbut, theophyllines, lithium, tcas, clozapine, b blockers, hydralazine, warfarin, heparin, digoxin
• Want to stop: stop suckling/expressing, supportive bra, cabergoline

Question 3

Mental health:

• Definition of maternal death
• Risk factors
• Baby blues: timing, mx
• Depression: timing, symptoms, mx, screening tool
• Puerperal psychosis: timing, symptoms, mx
• Pre-existing mental health: discussions at preconceptual counselling

Answer 3

Mental health:

• Definition of maternal death
• Risk factors
• Baby blues: timing, mx
• Depression: timing, symptoms, mx, screening tool: from 1 month to a year. Score >13/30 on Edinburgh scale. Paroxetine, sertraline
• Puerperal psychosis: timing, symptoms, mx - baby mum unit for chlorpromazine, lithium, cbt when recovering
• Pre-existing mental health: discussions at preconceptual counselling

Question 4

Endometritis:
- risk factors
- causes
- symptoms
- ix
- mx

Answer 4

Endometritis:
- risk factors : prom, retained products, diab, gbs
- causes: group b strep
- symptoms: foul discharge, bleed, fever, abdo pain
- ix: swabs, urine mc+s, uss
- mx: sepsis 6, clindamycin + gentamicin