Postnatal care Flashcards
(44 cards)
What is part of rountine postnatal care on the ward?
analgesia breast or bottle fed advice VTE risk assessment monitoring PPH monitoring sepsis monitoring blood pressure monitoring recovery after c section or perineal tear FBC after bleeding anti D routine baby check
What are the aspects of follow up with the midwife?
general wellbeing mood and depression bleeding and menstruation urinary incontinence and pelvic floor exercises scar healing after episiotomy or c section contraception bleeding vaccines
Describe menstruation after delivery
endometrium initially breaks down
blood, endometrial tissue and mucus= lochia
should settle within 6 weeks
tampons should be avoided due to the risk of infection
breastfeeding leads to the release of oxytocin, causing uterus to contract and slightly heavier bleeding (normal)
What is the absence of periods called due to breastfeeding?
lactational amenorrhoea
when do women not breastfeeding restart periods?
3 weeks onwards
unpredictable
What contraception is used after delivery?
fertility doesn’t return until 21 days
lactational amenorrhoea-98% effective for up to 6 months after birth (must be fully breastfeeding and amenorrhoeic)
progesterone only pill and implant safe in breastfeeding and started at any time
COCP-avoided in breastfeeding, UKMEC 4 6 weeks postpartum UKMEC 2 >6 weeks
copper coil and IUS inserted before 48 hours or more than four weeks after birth
When can the COCP be started?
non breastfeeding: anytime with 7 days barrier protection
breastfeeding: not started before 6 weeks afterbirth
What is endometritis?
inflammation of the endometrium, usually caused by infection
more common after c section
prophylactic antibiotics may be given
gram negative, positive, anaerobic bacteria
STIs
need to rule out retained products of conception
What is the presentation of endometritis?
foul smelling discharge bleeding that gets heavier lower abdominal pain sepsis fever
Treatment for endometritis
broad spectrum co-amoxiclav
When does retained products of conception occur?
after delivery
miscarriage
termination of pregnancy
placenta acrcreta (significant risk factor)
What are the complications of retained products of conception?
Endometritis
Ashermans syndrome
Presentation of retained products of conception
vaginal bleeding that doesn’t improve
abnormal vaginal discharge
lower abdominal pain
fever
what is ashermans syndrome?
adhesions form in the uterus
endometrial curettage can damage the basal layer of endometrium
heals abnormally creating scar tissue connecting areas of the uterus not normally connected
endocervix can seal shut
what does ashermans syndrome lead to?
Amenorrhoea and infertility
what is the definition of postpartum amenorrhoea?
<100g/l
common after acute blood loss
what is the treatment for postpartum anaemia?
<100g/l start oral iron 3 times a day for 3 months
<90g/l iron infusion plus oral iron
<70g/l blood transfusion in addition to oral iron
when is iron infusion considered?
poor adherence to oral treatment
cannot tolerate oral iron
failure to respond to oral iron
cannot absorb oral iron (IBD)
when is oral iron contraindicated?
active infection
pathogens feed off the iron leading to proliferation
when does the baby blues happen and what are the symptoms?
occur in the first week
affect more than 50%, particularly first time mothers
mood swings, low mood, anxiety, irritability, tearfulness
no treatment required and recovers in 2 weeks
when does postnatal depression occur and what are the symptoms?
occur around 3 months
1 in 10 women
low mood, anhedonia, low energy
how is moderate cases of depression treated?
SSRI and CBT
what screening tool is used for depression?
Edinburgh postnatal depression scale
>10 suggests postnatal depression
assess how mother has felt over the last week
when does puerperal psychosis occur?
onset 2-3 weeks after delivery
