Wk 9: Postnatal complications Flashcards
What are some common causes of pain and discomfort to be aware of in the post-natal period?
- Generalized aches and pains
- Perineal pain
- Wound pain – following a Caesarean section
- Uterine involution (Afterbirth) pain – more common following subsequent births.
- Headache
- Diastasis of the rectus abdominis muscle (DRAM)
- Backache
- Dyspareunia
- Haemorrhoids
- Constipation
- Nipple damage
- Breast engorgement
- Tiredness and Fatigue
- Emotional upheaval
What are some potential long-term postnatal physical complications?
- pain- wound associated
- back pain
- Diastasis of the recuts abdominis muscle
Define diastasis rectus abdominis and what is the management?
= separation of the abdominal muscles that run between the ribs and anterior of the pelvis due to being stretched in pregnancy.
- related to lumbopelvic instability and pelvic floor weakness.
Midwifery management
- education on prevention during pregnancy
- ass at all postnatal checks
- referral to physio
Define endometritis, the risk factors, symptoms and the management.
= inflammation and infection of the uterine lining
- the cervix usually keeps bacteria out however when the cervix opens e.g during birth bacteria can enter.
- serious as can lead to sepsis
Risk
- birth
- c/s
Symptoms
- fever, chills
- increased pelvis or abdominal pain
- feeling generally unwell
- increased vaginal discharge or bleeding, often with a foul odour.
Treatment
- transfer/admit to hospital for bstric review
- IV antibiotics
- surgical D&C
- biopsy of the endometrium
Define dyspareunia, its causes, risks
= any pain or soreness that occurs during sexual intercourse
Primary dyspareunia= at time of intercourse
Secondary dyspareunia= occurs after a period of pain-free intercourse.
Causes
- psychological or physical
- scar tissue
- poor anatomical reconstruction following perineal trauma
- vaginal dryness
- BF is known to cause vaginal dryness, dyspareunia and reduced libido. (due to hyper prolactinemia reducing levels of maternal estrogen and thus libido)
Risks
- breastfeeding
- assisted vaginal delivery
- perineal trauma/injury
- vaginal delivery
What is the role of the pelvic floor?
- Support pelvic organs- bladder, bowel, uterus
- Responsible for continence of bladder and bowel
- Reflex contraction with increased abdominal pressure e.g. cough, sneeze, laugh, jump
- Detrusor (muscle in the bladder wall) inhibition, allowing the bladder to fill and prevent urge incontinence
- Faecal sensation and guide
- Sexual sensation- shape and firmness of the vagina
- Fetal guide during birth.
Explain pelvic floor weakness, urinary and/or fetal incontinence as a postnatal complication. State the definition, cause, risks, complications and management.
=
- Normal for many women to experience an episode or two of bladder weakness in the days immediately post-birth, often due to temporary loss of sensation, but this usually recovers spontaneously.
Causes
- weakness due to increased pressure on the pelvic floor during pregnancy
- weakness in abdominal muscles as a result of abdominal separation during pregnancy
- perineal injury (which is an injury to the muscles of the pelvic floor).
- unassessed third or fourth degree tear
Complications
- perineal wound infection
- impact on quality of life
Management
- assessment of continence
- referral to women’s health physio
- Obstetrician/urogynaecologist
- education from physio around strengthening exercises
- surgical repair of unrecognised tear
Define a pelvis organ prolapse and explain the management
= when one or more of the organs inside the pelvis has sunk or bulged into the vagina as opposed to being held in place by the tissues including fascia dn ligaments that help join pelvic organs to the bony pelvis and hold them in place.
Can be of the;
- bladder
- uterus
- rectum
Management
- referral to GP or women health physio
- if mild, some exercises can resolve it.
What are some signs of a prolapse?
- a heavy sensation or dragging in the vagina
- something ‘coming down’ or a lump in the vagina
- a lump bulging out of the vagina, which she can see or feel when she is in the shower or having a bath
- sexual problems of pain or less sensation
- her bladder might not empty as it should, or her urine stream might be weak
- urinary tract infections might be reoccurring, or
- it might be hard for her to empty her bowel.
- may feel prolapse rub o her underwear if it fully comes out
*signs may worsen at the end o the day
When is mastitis most common?
= can occur anytime along a women’s breastfeeding journey, however it is most common within the first six (6) weeks of breast feeding.
Define mastitis
= inflammation of the breast that can occur with or without infection.
What are some common causes of mastitis?
- Poor attachment to the breast, resulting in difficulty removing breastmilk
- Nipple damage, resulting in open cuts, and bacteria entering the breast via these cuts
- A long break between breastfeeds
- Breasts that are too full and not emptied regularly
- Blocked milk ducts, trapping milk
- Stopping breastfeeding too quickly or suppressing without correct guidance
- narrowed, inflamed milk ducts
- stopping breastfeeding suddenly
- Overly tight bra
- Exhaustion
- nipple damage
- engorgement
What are some signs and symptoms of mastitis?
- A red, sore area on the breast
- shiny skin on part of nipple
- feel hot to touch
- Flu-like symptoms – feeling hot and cold with aching joints
- Pyrexia (>38.5c)
- Pain
- may be associated with damaged nipple/s. - Inflammation of the breast tissue, not relieved by breastfeeding
- Lump/s in breast tissue
- Localised redness to the breast tissue with or without lump/s
What are the major causative pathogens of mastitis?
- Staphylococcus aureus - unilateral.
- Streptococcus family (GBS) - bilateral.
What is the treatment of mastitis?
- History taken covering when the symptoms started, breast feeding history and general health of the woman
- Full bilateral breast examination
- Continue to breastfeed or express, breasts need to be efficiently emptied (and this milk is still completely safe and beneficial for baby) Note: this is not a time to cease breastfeeding
- Place a heat pack or warm cloths on the sore area before feeding or expressing to help with your milk flow. If your milk is flowing easily then warm packs are not needed.
- Start feeds on affected side when baby’s suck is strongest.
- Gently massage any breast lumps towards the nipple when feeding or expressing or when in the shower or bath.
- Place a cool pack, such as a packet of frozen peas wrapped in a cloth, on the breast after feeding or expressing for a few minutes to reduce oedema and discomfort.
- Increase rest and fluids and adequate nutrition
- If not feeling relief after these methods see GP
- If febrile see GP immediately
- May be prescribed antibiotics
- If severe may be admitted to hospital for IV antibiotics and breast drainage under ultrasound
- Mastitis can re-occur therefore discuss prevention strategies
What are some ways to prevent mastitis?
- Breastfeed frequently and on-demand (normally 8 to 12 times in 24 hours for a new baby).
- Don’t miss or put off breastfeeds.
- Wake baby for a feed if breasts become too full. If baby doesn’t want to feed the woman may need to express a small amount of milk.
- See a lactation consultant or maternal and child health nurse to make sure baby is attaching and feeding well at the breast.
- Offer both breasts at each feed. If baby only feeds from one breast make sure to offer the alternate breast at the next feed.
- Express a small amount of milk after feeds if your breasts still feel full (express only until breasts feel comfortable, and only when needed)
- Avoid giving baby formula feeds or other fluids unless advised to by a midwife, nurse or doctor. Any interruption in breastfeeding increases the risk of mastitis.
- Avoid pressure on the breasts from clothes or from your fingers when feeding.
- ensure good attachment to remove milk easily
- allow bably to feed as long or as frequently as they like
- treat sore or damaged nipples promptly
- if weaning= try gradually reducing breastfeeds over several weeks
What is a complication of mastitis?
In about 3% of cases of mastitis a breast abscess will develop
What is the management of a breast abscess?
- Aspiration with antibiotic cover is a safe first line approach where specialist breast clinics or ultrasound guidance are available
- Incision and drainage if not settling or aspiration is unavailable
- Other management strategies as for mastitis management
Define baby blues
= a mild transient period of increased emotions, that often commences on day 3 or 4, usually when the woman’s milk is about to, or has just come in.
- a normal phenomena experienced by about 50% of people.
When does baby blues typically commence and what is the typical duration?
- onset is around day 3-4 when milk comes in.
- duration is up to 2 weeks but most will reside within 1-2 days.
What is the cause os baby blues?
- thought to be directly associated with the withdrawal of the pregnancy hormones.
- Women go from having a steady stream of progesterone produced by the placenta throughout pregnancy (progesterone associated with calm and happiness) to a sudden drop in this hormone as the placenta is now gone and it is up to the ovaries and adrenal glands to recommence production of this hormone.
- in addition, lack of sleep, tiredness and fatigue.
Explain the management of baby blues
- ensure to educate families on this normal phenomena
- do not feel guilty for experiencing this.
- if these feelings last beyond 2 weeks this may be predictive of the onset of PND
- if these feelings are accompanied w/ flash backs of birth, insomnia, extreme anxiety or other abnormal behaviours this may be indicative of more serious mental health conditions including PTSD or puerperal psychosis.
Define postnatal depression
= new development of depression within the first few months-12 months post natally.
- can develop in mothers or fathers
