Postpartum Care

Question 1

Colostrum - what is it, what does it contain?

Answer 1

Thick yellow fluid produced from 20 weeks High conc of IgA

Question 2

Demand feeding frequency

Answer 2

Median of 8x a day

Question 3

Lactation mechanism

Answer 3

Prolactin from anterior pituitary gland stimulates milk secretion Prolactin is antagonised by oestrogen + progesterone, which decline after birth Oxytocin from posterior pituitary gland stimulates ejection in response to nipple degrees Lactation can be inhibited by stress

Question 4

Benefits of breastfeeding for mother and baby

Answer 4

Protection from GI infection, UTIs + resp infection Lower chance of atopic illness Less chance of leukaemia For mother: reduces risk of PPH, lactational amenorrhoea = contraception for 6 months, protective against breast and ovarian cancer

Question 5

Treatment of inadequate milk supply

Answer 5

Fluids, nutrition, dopamine antagonists, thyrotropine releasing hormone, oxytocin

Question 6

Drugs that reduce milk production

Answer 6

Progestins Oestrogen Ethanol Cabergoline

Tamoxifen inhibits production

Question 7

Infective mastitis - causes, treatment

Answer 7

Usually caused by staph aureus Use amoxicillin or cephalosporin Continue breastfeeding

Question 8

Medications contraindicated in breastfeeding

Answer 8

Amiodarone Chloramphenicol Methotrexate Lithium Tetracyclines ACEi Caffeine/ alcohol Fluoxetine

Question 9

Passing on infections via breastmilk - what infections can be spread and what infections are safe to breastfeed with?

Answer 9

HIV Hep B may breastfeed if already exposed in womb Chickenpox - breastfeed okay as passes on antibodies Rubella is safe - antibodies pass on

Question 10

Common postpartum problems

Answer 10

Pain Urinary retention/ UTI Constipation Symphisis pubis discomfort Maternal obstetric paralysis - intrapartum foot drop due to lumbosacral compression

Question 11

Postpartum depression - what is it, treatment, differentiation with baby blues

Answer 11

50% experience baby blues. Resolves in 10 days Screen for depression at 4-6 weeks and 3-4 months Antidepressants eg sertraline + CBT

Question 12

Contraception after birth

Answer 12

Not needed for 21 days Lactational amenorrhoea + fully breastfeeding for 6 months Can start POP COCP avoided in lactating women COCP can begin 21 days post partum if bottle feeding

Question 13

Chickenpox at term - risk to baby, treatment

Answer 13

If baby born before maternal IgG has crossed placenta - danger Neonate to be given passive VZV immunoglobulin if delivery within 5 days of maternal infection Tx with acyclovir

Question 14

Hepatitis at term - risk to baby, treatment

Answer 14

Vertical transmission if mother infected in 3rd trimester Baby to be given passive hep B immunoglobulin at birth + active hep B immunisation

Question 15

Listeria monocytogenes - infection in mother, consequences for baby, treatment

Answer 15

Bacterial infection in food Can cause preterm labour, miscarriage or amnionitis Meconium, jaundice, conjunctivitis, meningoencephalitis Tx: amoxicillin or erythromycin

Question 16

Group B strep - risks to pregnancy, treatment

Answer 16

Associated with PPROM High mortality + neuro impairment Intrapartum abx (amoxicillin or erythromycin)

Question 17

Postpartum care of GDM

Answer 17

Stop meds after birth

Check plasma glucose before discharge

GP to check fasting glucose after 6-13 weeks

Question 18

What is maternal obstetric paralysis?

Answer 18

intrapartum foot drop due to lumbosacral trunk compression – recovery in 5 months