Postpartum Care Flashcards
Describe the course of post-natal lochia
First 3-4 days - dark red, clots
4-10 days - slows, more brown
1-2 weeks - yellowy discharge
Advice for perineal care after episiotomy/perineal tear
Rinse rather than toilet paper, or pat dry
Regular analgesia
Baths, ice packs, numbing spray
Classification of Post-partum haemorrhage (PPH)
Primary - >500mls, in the first 24hrs post delivery
(minor 500-1L, major 1L+)
Secondary - excessive bleeding 24hrs - 6 weeks postpartum
4 T’s of PPH?
Tone
Trauma
Tissue
Thrombin
Benefits of breastfeeding?
Free
Passive immunity of infant
protective against asthma, eczema, SIDS
Protective for mother against breast cancer, ovarian cancer, diabetes
Negatives of breastfeeding?
Cracked/sore nipples - often due to improper technique
Blocked ducts/engorgement - should express 8+/day, for at least 15 minutes
Mastitis - affects 20% of mothers - S. aureus infection treated with flucloxacillin + keep feeding
abscess may require incision and drainage
When does normal ovulation restart after pregnancy?
Earliest time of ovulation is day 27 post-partum
No contraception required for the first 21 days
Contraceptive options for non-breastfeeding women?
0-21 days - POP, implant, barrier
Avoid - COCP, copper IUD
21+ days - COCP/patch/ring, POP, implant
Avoid - copper IUD (unless inserted within 48hrs of delivery or 4 weeks postpartum)
Contraceptive options for breastfeeding women?
0-6 weeks - lactational amenorrhoea. POP, implant, barrier
Avoid - COCP/patch/ring, copper IUD
Management of Post-Partum Depression (PPD)
Self-help strategies + empowerment
Moderate-severe depression: - consider antidepressants and CBT
Antidepressant of choice - Sertraline - low excretion in breast milk
Schedule and content of the post-natal visit?
3-4 days at home + 6 weeks check at GPs
Mum - depression screen, discharge, blood pressure, blood sugar, VE if episiotomy/tear, contraception
baby - weight gain/loss, feeding, latching
