Postnatal care

Question 1

4 Ts

4 major cuases of Postpartum haemorrhage (PPH)

Answer 1

Tone: Uterine atony, where the uterus fails to contract effectively after delivery, is the most common cause.

Trauma: Physical injury such as lacerations, hematomas, uterine rupture, or inversion during delivery.

Tissue: Retained placental tissue or clots remaining in the uterus, including conditions like placenta accreta.

Thrombin: Coagulation disorders or abnormalities in the blood’s clotting ability.

Question 2

The most common cause of PPH

Answer 2

Uterine atony - fails to contract after delivery

Question 3

The most common surgical intervention for PPH

Answer 3

Intrauterine balloon tamponade

Question 4

what is the most common cause of secondary PPH

Answer 4

Endometritis

Question 5

immediate postpartum haemorrhage (within 24h of delivery) Mx

Answer 5

Uterine massage

Question 6

Postpartum contraception duration

Answer 6

First 21 days after delivery

Question 7

what type of contraception is safe to start at anytime post childbirth

Answer 7

POP only

Question 8

major primary post-partum haemorrhage criteria

Answer 8

Blood loss >1000 ml within 24 hours of delivery

Question 9

Minor primary post-partum haemorrhage criteria

Answer 9

Blood loss 500 ml, within 24 hours of delivery

Question 10

Define Postpartum haemorrhage

Answer 10

the loss of >500ml of blood within the first 24 hours of delivery

Question 11

Lactational Amenorrhoea Method (LAM) criteria

Answer 11

• The baby is less than 6 months old
• The mother is fully or nearly fully (85%) breastfeeding (no formula, water, solid)
• Amenorrhoea

Question 12

when should IUS/IUD be inserted after delivery

Answer 12

within 48 hours or after 28 days of delivery

Question 13

Risk to IUS/IUD inserting after 48 hours and before 28 days of delivery

Answer 13

Uterine perforation

Question 14

when can COCP be used as a contraception for non-breastfeeding mothers

Answer 14

6 weeks with no other contraindications

Question 15

when can COCP be used as a contraception for breastfeeding mothers

Answer 15

after 6 months with no contraindications

Question 16

routine postpartum follow-up maternal components

Answer 16

Mother: General health and wellbeing assessment: Ask about overall health, concerns, and daily life impact.

Emotional and psychological wellbeing: Screen for postnatal mental health problems, mood, fatigue, emotional attachment, and provide information on how to seek help.

Physical health assessment, including:

Symptoms and signs of infection

Pain (including perineal pain)

Vaginal discharge and bleeding

Bladder and bowel function

Nipple and breast discomfort or inflammation

Signs of thromboembolism

Signs of anaemia

Signs of pre-eclampsia

Discussion topics:

Postnatal period expectations

Pelvic floor exercises and when to seek help

Nutrition, diet, physical activity, smoking, alcohol, and drug use

Contraception and sexual intercourse

Safeguarding concerns including domestic abuse and child maltreatment risk

Review of birth experience and mode of delivery, support available, and any difficulties encountered.

Question 17

routine postpartum follow-up baby components

Answer 17

Parental concerns: Ask about baby’s general wellbeing, feeding, and development.

Physical examination:

Complete newborn examination within 72 hours and again at 6–8 weeks, including assessment of appearance, breathing, behaviour, head and facial features, eyes, neck, limbs, heart, and lungs.

Monitoring for warning signs such as failure to pass meconium within 24 hours.