Postnatal care Flashcards
How long does the postnatal period last?
6 weeks after the baby is born
When does a midwife visit a mother and her baby after birth?
In the first 9-10 days after birth after that they are referred to a health visitor
What is a health visitor responsible for?
Looks after all pre-school children but also looks after the mother.
Observes for evidence of:
- Infection
- Abnormal bleeding
- Wound breakdown (perineal or C-Section)
- Endometritis / Breast (mastitis)
- Talk about events around birth (especially if emergency C-Section)
- Assess woman’s Mental health
- Infection
What things are often discussed at a 6 week postnatal review with a GP?
- Postnatal contraception - want to delay future pregnancies etc
- Mental health / general well being
- How they are coping with their newborn / life as a new parent etc
- Problems they may have encountered i.e infant feeding or bonding or social issues like partner, other children and financial issues
Complications of breast feeding
- Mastitis - infection - present with red, hot/tender breasts or systemic signs of infection
- Breast abscesses
- Blocked milk ducts
- Difficulty feeding / baby latching - require support
- Skin irritation ‘cracked nipples’
What are some of the key postnatal conditions affecting women? i.e these occur during the postnatal period (5)
- Post partum haemorrhage
- Venous thromboembolism or PE
- Sepsis
- Post-natal depression
- Hypertensive disorders i.e Pre-eclampsia / eclampsia
Thromboembolic disease and pregnancy/postpartum period: discuss
- Pregnancy and the postpartum period is a hypercoagulable state
- Pregnant women are 6-10 times more likely to develop DVT or PE
- High quality risk assessment is key
- Some women require thromboprophylaxis both antenatally and postnatally
- Women who have a c-section are routinely given thromboprophylaxis to prevent blood clots
What are some red flag symptoms/signs that suggest a woman has some sort of thromboembolic disease during pregnancy or postpartum?
- Unilateral leg swelling and/or pain
- SOB or chest pain
- Unexplained tachycardia - sometimes the only sign of a PE
Always have a high index of suspicion for VTE in pregnant or postnatal women
True or false: Immobilisation following spinal anaesthetic / caesarean section will not further increase risk of thromboembolic disease
false
It will increase risk
Which key investigations should be done if VTE or PE is suspected?
- ECG
- Doppler USS - assesses blood flow
- CXR +/- VQ scan or CTPA (CT pulmonary angiogram)
Which medication is used to treat thromboembolic disease during…
- Pregnancy?
- When Breast feeding?
During pregnancy - treat with low molecular weight heparin as warfarin is teratogenic
Breast feeding - warfarin can be used - it can be found in small amounts in breast milk but not enough to affect the newborn
If you suspect postpartum/puerperal sepsis in a woman what should your immediate management be?
Prompt IV antibiotic administration - ‘golden hour’ ideally want medication within 1 hour of suspected sepsis diagnosis.
Then do the following:
- Antipyretic measures
- IV fluids
- Referral to hospital if you are concerned a pregnant or postnatal woman is septic
What does a full septic screen involve in pregnant women?
- Blood cultures
- Low vaginal swab
- MSSU
- Wound swab
Look
MMBRACE report 2015 - Almost a quarter of women who died between 6 weeks and 1 year after pregnancy died from mental-health related causes
1 in 7 of those women died from suicide
In 2019 suicide was the 2nd largest cause of direct maternal deaths during or within the 6 weeks after birth
What are the baby blues?
- Affects most women due to hormonal changes around the time of birth
- It is thought to be a normal part of the postpartum period
- Does not affect functioning and requires no specific treatment
- May present with low mood or being excessively tearful
