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Obstetrics > Puerperium > Flashcards

Puerperium Flashcards

1
Q

Puerperium definition

A

Time from delivery until the anatomic and physiologic changes of pregnancy have resolved

Approximately 6 weeks

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2
Q

Post-natal check

A

Analgesia as required

Help establishing breast or bottle-feeding

Venous thromboembolism risk assessment

Monitoring for postpartum haemorrhage

Monitoring for sepsis

Monitoring blood pressure (after pre-eclampsia)

Monitoring recovery after a caesarean or perineal tear

Full blood count check (after bleeding, caesarean or antenatal anaemia)

Anti-D for rhesus D negative women (depending on the baby’s blood group)

Routine baby check

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3
Q

topics in routine midwife follow up

A

General wellbeing

Mood and depression

Bleeding and menstruation

Urinary incontinence and pelvic floor exercises

Scar healing after episiotomy or caesarean

Contraception

Breastfeeding

Vaccines (e.g. MMR)

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4
Q

6 week post-natal check

A

General wellbeing

Mood and depression

Bleeding and menstruation

Scar healing after episiotomy or caesarean

Contraception

Breastfeeding

Fasting blood glucose (after gestational diabetes)

Blood pressure (after hypertension or pre-eclampsia)

Urine dipstick for protein (after pre-eclampsia)

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5
Q

how long for periods to come back in breastfeeding

A

6 months

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6
Q

how long for periods to come back in bottle feeding

A

3 weeks

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7
Q

lochia

A

endometrium breaks down then returns to normal over time
avoid tampons
bleeding settles within 6 weeks

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8
Q

physiological changes after pregnancy

A

lochia
uterine involution
lactation
menstruation

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9
Q

examination after pregnancy

A

Temperature, BP, pulse, RR, Sats

Uterine size and involution

Vaginal bleeding

Lochia/ discharge

Abdominal wound (if CS)

Perineum and para-vaginal tissue

Breast

Lower limbs for DVT

Enquire about bladder function

Enquire about bowel function

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10
Q

when does fertility return after childbirth?

A

21 days

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11
Q

contraception after childbirth

A

lactational amenorrhea
POP and implant
COCP
copper coil or IUS

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12
Q

when can IUD IUS be inserted?

A

within 48 hours

>4 weeks after birth

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13
Q

breast feeding advantages to newborn

A 
easily digested nutrients
antibodies in colostrum
aboid milk allergies
good source of nutrition
cannot overfeed
low risk of hypocalcaemia
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14
Q

breast feeding advantages to mother

A

promoted bonding
improved uterine involution
reduced risk of breast cancer, contraception
safe and cheap

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15
Q

difficultues with breast feeding

A

nipple inversion
maternal fatigue
emotional stress

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16
Q

management of mastitis

A

flucloxacillin

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17
Q

candida of the nipple management

A

topical miconazole after breastfeed

miconazole gel or nystatin in baby

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18
Q

puerpal pyrexia

A

temperature >38 in 6 weeks after delivery

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19
Q

causes of puerpal pyrexia

A 
UTI
endometritis
breast
chest
DVT
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20
Q

investigations for puerpal pyrexia

A 
sepsis pathway
MSU
HVC
blood culture
sputum if indicated
USS, VQ
21
Q

secondary PPH definition

A

bleeding after 1st 24 hours

22
Q

secondary PPH causes

A

retained products or blood clots

infection

23
Q

management of secondary PPH

A

conservative
antibiotics
evacuation under GA

24
Q

risk factors for thromboembolic disease

A

Operative delivery

Past history of VTE

FH of VTE

Thrombophilia

Obesity

Maternal age >35

Immobilisation

Prolonged labour

25
Q

post-natal depression

A

low mood in postnatal period

26
Q

post-natal mental health illnesses

A

baby blues
postnatal depression
puerpal psychosis

27
Q

baby blues time line

A

starts day 3/4-14 days

28
Q

symptoms of baby blues

A

Mood swings

Low mood

Anxiety

Irritability

Tearfulness

29
Q

post-natal depression triad

A

Low mood

Anhedonia (lack of pleasure in activities)

Low energy

30
Q

post-natal depression timeline

A

2 weeks- 3 months

31
Q

management of post-natal depression

A

Mild cases may be managed with additional support, self-help and follow up with their GP

Moderate cases may be managed with antidepressant medications (e.g. SSRIs) and cognitive behavioural therapy

Severe cases may need input from specialist psychiatry services, and rarely inpatient care on the mother and baby unit

32
Q

edinburgh postnatal depression scale

A

The Edinburgh postnatal depression scale can be used to assess how the mother has felt over the past week, as a screening tool for postnatal depression.

There are ten questions, with a total score out of 30 points. A score of 10 or more suggests postnatal depression.

33
Q

patient factors causing poor detection

A

Stigma

Putting on a brave face

Being considered a bad mother

Baby might be taken away

Not knowing what is normal

Not knowing if treatment will help

34
Q

health professional factors causing poor detection

A

Not asking

Time constraints

Not recognising risk factors or red flags

Normalising or dismissing symptoms

Lack of training or confidence

Lack of access to specialist services

35
Q

Brief questions to screen for depression

A

During the past months have you been bothered by feeling down, depressed or hopeless?

During the past month have you often been bothered by having little interest or pleasure in doing things?

Is there something you feel you need help with?

36
Q

risk factors of post natal depression

A

Poor diagnosis of mental health illness

FH of severe perinatal health illness

History of childhood abuse and neglect

Domestic violence

Language barrier

Interpersonal conflict

Inadequate social support

Substance misuse

Migration status, language and cultural barriers

Unplanned or unwanted pregnancy

Pregnancy complications or traumatic birth

Fetal or neonatal loss

37
Q

red flags for postnatal depression

A 
bipolar disorder
severe depression
disclosure
recent change in mental health
chronic mental illness
38
Q

puerpal psychosis symptoms

A

Delusions

Hallucinations

Depression

Mania

Confusion

Thought disorder

39
Q

treatment of puerpal psychosis

A

Admission to the mother and baby unit

Cognitive behavioural therapy

Medications (antidepressants, antipsychotics or mood stabilisers)

Electroconvulsive therapy (ECT)

40
Q

mother and baby unit in puerpal psychosis

A

The mother and baby unit is a specialist unit for pregnant women and women that have given birth in the past 12 months. They are designed so that the mother and baby can remain together and continue to bond. Mothers are supported to continue caring for their baby while they get specialist treatment.

ECT

Anti-psychotics, mood stabilisers, anti-depressants

CBT in recovery phase

Risk of recurrence is 50% higher if next pregnancy within 2 years of recovery

41
Q

sodium valproate side effects

A

Increase risk of neural tube defect by 1-2%

Neurodevelopmental issues

Teratogenic

42
Q

carbamazepine side effects

A

cleft lip

43
Q

lithium side effects

A

Fetal hypotnia

Poor reflexes

Arrhythmias

Ebstein’s anomaly

Neonatal goitre

Use with caution

44
Q

lamotrigine side effects

A

SJS

45
Q

olanzapine side effects

A

fetal macrosomia

GDM

46
Q

SSRI side effects

A

pulmonary HTN

paroxetine: cardiac defects

47
Q

antimanic drugs side effects

A

Monitor infants for sedation

Poor feeding, behavioural defects and developmental milestones

48
Q

neonatal withdrawal syndrome

A

Poor adaptation

Jitteriness

Irritability

Poor gaze control

Poor feeding

Rarely seizures

49
Q

neonatal abstinence syndrome

A

neonatal withdrawal syndrome
paroxetine is the worst for withdrawal symptoms
withdrawal symptoms are self-limiting and generally occur within 24-48 hours (fluoxetine)

Obstetrics (10 decks)

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