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3a > WH: puerperium + Postnatal > Flashcards

WH: puerperium + Postnatal Flashcards

1
Q

What is puerperium ? how long ?

A

the period of about six weeks after childbirth during which the mother’s reproductive organs return to their original non-pregnant condition

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2
Q

What happens in the days after delivery ? what care provided ? (5)

A
  • Analgesia
  • Help with breast or bottle feeding
  • VTE risk assessment
  • Anti-D for rhesus -ve patients (if baby positive)
  • Routine baby check
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3
Q

What topics are discussed at the 6 week post natal check ? what does this coincide with ? (5)

A

usually same time as NIPE (6 week)
- General wellbeing
- Mood + depression
- Bleeding + menstruation
- Contraception
- Breast feeding

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4
Q

What is lochia ? describe

A

mix of blood, endo tissue + mucus
- normal in puerperium

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5
Q

what menstrual device should be avoided for lochia

A

tampons due to infection risk

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6
Q

How can Brest feeding affecting menstruation ?

A

can cause lactational amenorrhoea

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7
Q

how long after giving birth will bottle feeding women have menstural periods ?

A

from 3 weeks onwards

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8
Q

when does fertility return after childbirth ? (days)

A

21 days (don’t need contraception before then but then do)

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9
Q

how effective is lactational amenorrhoea ? what is required for it to be effective ?

A

98% effective
- If fully breastfeeding + fully amenorrhoea

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10
Q

which hormonal contractions are safe during breast feeding ? which should be avoided and for how long ?

A
  • Safe: POP + progesterone implant are safe during breast feeding
  • COCP should be avoided (for 6 weeks)
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11
Q

When is the copper coil + mirena safe after birth ?

A

<48 hrs
or
more than 4 weeks after birth
(not in between)

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12
Q

What is post party endometritis ? usually caused by ?

A

it is inflammation of the endometrium (lining of the uterus)
- Usually caused by infection

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13
Q

why is there in increased risk of endometritis in the PPP ?

A

due to the infection risk in labour + delivery

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14
Q

After what kind of delivery is endometritis most common ? what is done to try to prevent this ?

A

CS
- prophylactic Abx given during CS

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15
Q

endometritis presentation ? (4) when ?

A

shortly after birth till several weeks post partum
- foul smelling discharge of lochia
- Lower abdo/pelvic pain
- Fever
- Signs of sepsis

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16
Q

endometritis investigations ? what other differential is important to exclude ?

A
  • Vaginal swabs
  • Urine culture + sensitivities
  • US: to exclude retained products of conception
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17
Q

post partum endometritis management ?

A

oral Abx: broad spectrum

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18
Q

What is retained products of conception ? what 2 types of tissue ?

A

it is when pregnancy related tissue (placental or fetal membranes) remains in the uterusdur

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19
Q

which events could lead to retained products of conception ? (3)

A
  • Delivery
  • Miscarriage
  • TOP
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20
Q

significant RF for retained products of conception ?

A

placenta accreta

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21
Q

retained products of conception presentation ?

A
  • Vaginal bleeding
  • Abnormal vaginal discharge
  • Lower abdo/pelvic pain
  • Fever (if infection)
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22
Q

how is retained products of conception diagnosed ?

A

US

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23
Q

Retained products of conception management ?

A
  • Surgical removal: evacuation of retained products of conception (ERPC) under GA
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24
Q

Complications of retained products of conception management (surgical) ? (2)

A

evacuation of retained products of conception (ERPC)
- endometritis
- Ashermanns syndrom e

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25
Q

what is ashermanns syndrome ?

A

adhesion form with uterus => stick structures together that should be stuck => infertility

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26
Q

Why is anaemia common is the PPP ?

A

common due to the acute blood loss during labour + delivery

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27
Q

When would you do an FBC for suspected anaemia in the postpartum period ?

A
  • PPH
  • CS
  • Antenatal anaemia
  • If symptomatic
28
Q

post partum anaemia management ?

A

Depends on level of deficiceny
- Ferrous sulphate, iron transfusion, blood transfusion

29
Q

SE of ferrous sulphate ?

A
  • N&V
  • Constipation
  • Dark poo
30
Q

what are the 3 mood disorders present in the postnatal period ?

A
  • baby blues
  • Postnatal depression
  • Puerpral psychosis
31
Q

What is baby blues ? when ? how common ?

A

low mood in the first week after birth
- majority of women (>50%)
- especially 1st time mothers

32
Q

what is baby blues presentation ? (5) symptoms severity and how long do they last ?

A
  • Mood swings
  • Low mood
  • anxiety
  • Irritabily
  • Tearfullness
    (symptoms usually mild and resolve within 2 weeks)
33
Q

what causes baby blues ?

A
  • Hormonal changes
  • Recovery from birth
  • Fatigue + sleep deprivation
  • Establishing feeding
34
Q

What is postnatal depression ? how common ? When ?

A

depressive episode within first 12 months post partum
- 1/10 women with peak at 3 months after birth

35
Q

classic triad of postnatal depression presentation ? how long do symptoms last ?

A
  • Low mood
  • Anhedonia
  • Low energy (Lethargy)
    (symptoms last at least 2 weeks)
36
Q

What antidepressant is appropriate in breast feeding women (2) type ?

A
  • sertraline
  • paroxetine
    (SSRI)
37
Q

How is post natal depression treated ? (4)

A

(similar to regular depression)
- additional help
- SSRI (if moderate)
- CBT
- Edinburgh postnatal depression scale

38
Q

what screening tool can be used for post partum depression ? what number indicated depression ?

A

Edinburgh post batal depression scale
>10 => post natal depression

39
Q

how common is puerperal psychosis ? how soon after birth ?

A

rare but severe
- 1/1000
- a few weeks after birth

40
Q

how does puerperal psychosis present ? (6)

A
  • Delusions
  • Hallucinations
  • Depression
  • Mania
  • Confusion
  • Though disorder
41
Q

How is puerperal psychosis managed ? (5)

A

urgent assessment + input from specialist NH services
- Spot early to avoid harm to mum or baby
- Mother + baby unit: they can remain together and continue to bond
- CBT
- ECT
- Meds (antidepressant, antipsychotics, mood stabilisers)

42
Q

puerperal psychosis RF ?

A
  • Previous MH condition (BP, schizophrenia, OCD, eating disorder)
  • If had prev PP psychosis (=> 50% chance again with next)
  • Can occur if no prev psychiatric disorder
43
Q

What preparation can be done during pregnancy if mother has preexisitng MH condition ?

A
  • consider SSRI use
  • Maintain good social network
44
Q

how can antenatal SSRI use effect the neonate ?

A

neonatal abstinence syndrome
- Irritability
- Poor feeding

45
Q

What is lactational mastitis ?

A

It is inflammation of beast tissue
- Common complication of breast feeding (+/- infection)

46
Q

What 2 things could cause lactational mastitis ?

A
  • Obstruction
  • Infection
47
Q

how would obstruction cause mastitis ? and how can this be prevented ?

A

obstruction in the ducts + the accumulation of milk => mastitis
- Regularly expressing milk can preven this form occurring

48
Q

how does infection cause mastitis ? which causative organism ?

A
  • bacteria (s.aures) enters nipple => back track to ducts => infection + inflammation
49
Q

lactational mastitis presentation ? (5)

A

unilateral
- treat pain/tenderness
- Localaised errythema
- Local warmth + infammation
- Nipple discharge
- Fever

50
Q

Lactational mastitis management ?

A
  • If due to duct blockage: conservative, continue breathing feeding, express milk, breast massage
  • Infection: sample of milk sent to lab for culture + sensitivity, Abx (flucloxaillin)
51
Q

what happens if mastitis is not adequately treated ? management of this ?

A

can develop breast abscess => required incision + drainage

52
Q

complication of mastitis after Abx treatment ?

A

after Abx course => candidal infection of nipple => recurrent mastitis

53
Q

how does candidial infection of nipple present ?

A

mum: bilateral sore nipples, nipple tenderness + itching, cracked/flakey areolar
Baby: with parches in mouth + tongue, or condidial nappy rash

54
Q

candidiasis infection management ?

A

treatment required for both mother + baby
- topical micronazole (to breast and affected area on baby)

55
Q

What is Sheehans syndrome ? complication of what ?

A

it is a rare complication of PPH
- drop in circulating blood vol => avascular necrosis of pituitary => ischaemia of cells in pituitary => cell death

56
Q

why does Sheehans only affect AP ? explain

A

blood supply
- AP gets blood form low pressure system (vulnerable to rapid drops in BP)
- PP has different food blood supply form various arteries

57
Q

what homones does AP secrete ? (6)

A
  • TSH
  • ACTH
  • FSH
  • LH
  • GH
  • Prolactin
58
Q

what hormones does posterior pituitary produce ? how is this affected in sheehan’s

A
  • Oxytocin
  • ADH
    its not affected by Sheehan’s
59
Q

Sheehas presentation ? say what causes each one ?

A

sign + symptoms of decreased AP hormones
- reduced lactation (due to low prolactin)
- Amenorrhoea (due to low FSH + LH)
- Adrenal insufficiency (low ACTh => low cortisol)
- Hypothyroidism (due to low TSH)

60
Q

Sheehans management ?

A

long term replacement of the missing hormones
- Oestrogen + progesterone, Hydrocortisone, levothyroxine, GH

61
Q

What is post partum thyroiditis ?

A

condition where there are changes to thyroid function within 12 months of delivery affecting women wihtough Hx of thyroid disease
- over time third function returns to normal and Px will be asympotmattic

62
Q

stages to post partum thyoiditis ?

A

usually
- thyrotoxicosis (first 3 months)
- hypothyroidism (3-6 months after birth)
- function begins to return to normal

63
Q

thyrotoxicosis Sx ? (6)

A

hyperthyroidism
- anxiety/irritabilty
- sweating + heat intolorance
- tachycardia
- weight loss
- fatigue
- frequent loose stools

64
Q

hypothyroidism Sx ? (7)

A
  • weight gain
  • fatigue
  • dry skin
  • hard loss
  • low mood
  • heavy periods
  • constipation
65
Q

what would be seen on TFT for thyrotoxicosis and hypothyroidism ?

A

thyrotoxicosis: high T3, high T4, low TSH
hypothyroidism: low T3, low T4, high TSH

66
Q

post partum thyroiditis Mx ? (3)

A
  • thyrotoxicosis: symptomatic control (propanolol)
  • hypo: levothyroxine
    annual monitoring (TFT)

3a (43 decks)

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