Postnatal care

Question 1

how long after birth are women not considered fertile

Answer 1

21 days

Question 2

give 4 methods of contraception following birth

Answer 2

-lactational ammenorrhea for 6 mnths
-progesterone-only pill and implant are safe and started any time after birth
-COCP avoided in breastfeeding and not started before 6 wks after birth
-copper coil or intrauterine system inserted within 48hrs after birth or >4wks

Question 3

what is lactational amenorrhea

Answer 3

absence of periods related to breastfeeding
can be used as contraception for 6mnths after birth - women must be fully breastfeeding and amenorrhoeic

Question 4

what is postpartum endometritis and when is it more common

Answer 4

infection of the endometrium following labour and delivery
more common in c sections, prophylactic abx are usually given

Question 5

shortly after birth
foul smelling discharge or lochia
bleeding getting heavier and not improving with time
lower abdo/pelvic pain
fever
sepsis

Answer 5

endometritis

Question 6

how is endometriosis diagnosed?

Answer 6

vaginal swabs (including chlamydia and gonorrhoea as these are RF)
urine culture and sensitivities

Question 7

what abx are used in endometriosis both in community and in hospital

Answer 7

-mild case -> community oral abx -> co-amoxiclav
-septic -> inpatient -> sepsis 6 -> clindamycin and gentamicin

Question 8

how does retained products of conception present and how is it diagnosed

Answer 8

vaginal bleeding getting heavier
abnormal vaginal discharge
low abdo or pelvic pain
fever (if infected)

USS = diagnosis

Question 9

how is retained products of conception (ERPC) managed

Answer 9

evacuation of retained products of contraception under general anaesthetic = dilation and curettage

Question 10

give 2 SE of dilation and curettage in (ERPC)

Answer 10

endometritis
asherman’s = adhesions form within uterus

Question 11

what is defined as postpartum anaemia

Answer 11

Hb : <100g/l

Question 12

when is a FBC done the day after delivery

Answer 12

PPH >500ml
c section
antenatal anaemia
symptoms of anaemia

Question 13

how is postpartum anaemia with Hb of <100g/l managed

Answer 13

oral iron

Question 14

how is postpartum anaemia with Hb of <90g/l managed

Answer 14

consider iron infusion in addition to oral iron

Question 15

How is postpartum anaemia with Hb of <70g/l managed

Answer 15

blood transfusion in addition to oral iron

Question 16

what is a CI to an iron infusion

Answer 16

active infection !

Question 17

give 2 risks of iron infusions

Answer 17

allergic and anaphylactic reactions

Question 18

define the spectrum of postpartum mental health illness

Answer 18

baby blues -> within a week
postnatal depression -> peaks around 3 mnths after birth
puerperal psychosis -> few weeks after birth

Question 19

give 5 symptoms of baby blues

Answer 19

mood swings
low mood
anxiety
irritability
teearfulness

Question 20

what is the classic triad of postnatal depression and when is it diagnosed

Answer 20

low mood
anhedonia
low energy

needs to last at least 2 weeks for diagnosis

Question 21

give a screening tool used for postnatal depression

Answer 21

Edinburgh postnatal depression scale

Question 22

what are the treatment options for peurperal psychosis managed

Answer 22

admission to mother and baby unit
CBT
medications (antidepressants, antipsychotics and mood stabilisers

Question 23

what is a risk of SSRIs in pregancy

Answer 23

neonatal abstinence syndrome : irritability and poor feeding shortly after birth

Question 24

what is mastitis and 3 causes

Answer 24

inflammation of breast tissue
causes : breastfeeding, duct obstruction, infection

Question 25

what bacteria most commonly caises mastitis

Answer 25

staph aureus

Question 26

how does matitis present

Answer 26

unilateral breast pain and tenderness erythema in a focal area of breast tissue local warmth and inflammation nipple discharge fever (if infected)

Question 27

how is mastitis manged if duct obstruction is the cause ?

Answer 27

conservative : continued breatfeeding, expressing milk and breast massage

Question 28

what is the 1st line Abx for mastitis if infection is suspected

Answer 28

flucloxacillin (erythromycin if penicillin allergic)

Question 29

what is candida of the nipple and when does it often occur

Answer 29

candidal infection of the nipple -> can lead to recurrent mastitis usually after course of antibiotics associated with oralthrush and candidal nappy rash in infant

Question 29

how does candida infection of the nipple present

Answer 29

bilateral sore nipples nipple tenderness and itching cracked, flaky or shiny areola symptoms in baby : white patches in mouth/tongue or candidal nappy rash

Question 30

how is candidal infection of nipple managed

Answer 30

topical miconazole after breastfeeding for baby : miconazole gel or nystatin

Question 31

what is postpartum thyroiditis and the pathophysiology behind it

Answer 31

Thyrotoxicosis, hypothyroidism or both within 12 mnths of delivery

Question 32

what are the 3 possible stages of postpartum thyroiditis

Answer 32

1. Thyrotoxicosis (usually within first 3 mths) 2. Hypothyroid (3-6mnths later) 3. Thyroid function gradually returns to normal

Question 33

what is sheehan's syndrome and what does it affect

Answer 33

rare complication of PPH drop in circulating volume causes avascular necrosis of pituitary gland low BP and reduced perfusion of pituitary gland = ischaemia of cells in pituitary and cell death ONLY ANTERIOR PITUITARY

Question 34

why does Sheehan's syndrome only affect the anterior pituitary

Answer 34

the anterior pituitary gets blood from the hypothalamo-hypophyseal portal system = susceptible to rapid drops in BP the posterior pituitary gets blood supply from various arteries

Question 35

what hormones does sheehan's syndrome effect and what are the sympoms as a result

Answer 35

Prolactin -> reduced lactation Amenorrhoea -> lack of FSH and LH Adrenal insufficiency and adrenal crisis ->lack of cortisol due to low ACTH Hypothyroidism -> low thyroid hormones due to lack of TSH Growth hormone also affected

Question 36

how is sheehan's syndrome managed

Answer 36

replacement of missing hormones Oestrogen and progesterone hydrocortisone levothyroxine growth hormone

Question 37

How is the thyrotoxicosis phase of postpartum thyroiditis managed

Answer 37

Propranolol

Question 38

How is hypothyroidism in postpartum thyroiditis managed ?

Answer 38

Levothyroxine