Flashcards in Postnatal Care, Lactation and Maternal Problems Deck (38):
What is lochia?
Blood and decidua. Normal discharge from uterus after childbirth
What are the genital tract changes after birth?
-Uterus returns to pelvis ~2 wks
-Lochia (200-500mL; ~1month)
What are the haem/CV changes after birth?
-Resoution of oedema
-Return to normal blood volume
-Hypercoaguable state (need VTE prophylaxis)
What is the composition of human milk?
-4%fat (TGs, phospholipids)
-Carbs: lactos, oligosaccharides
-Proteins: casein, lactoferrin, IgA
-Minerals: Na, K, Cl, Mg, Ca
-Enzymes, GFs, trace elements
-Leukocytes, epithelial cells
What are the benefits to the baby of breastfeeding?
-Nutritional - digestion
- Dec atopy incidence
-Dec infection, hospitalisations, mortality from infections (diarrhoea and respiratory)
What are the benefits of breastfeeding to the mother?
-Faster return to pre weight
-oxytocin encourages involution of the uterus, less blood loss
-some protection against breast, ovarian Ca; CVD
-Drugs (some): 1% will cross to infant.
What are the keys to successful breastfeeding?
-Early feeding / skin contact
-Encourage demand feeding
-Avoid supplemental feeds and dummies
-Encourage rooming in
What triggers initiation of lactation?
-Preg: oestrogen, progesterone, prolactin, HPL
-Delivery: fall progesterone, allows prolactin
What is colostrum?
During early breastfeeding. Thick, small volume (0.5-1mL) yellow; lipid and immunoglobulin rich
How to minimise sore / cracked nipples?
-Correct positioning: nipple forms distal third of teat with baby's jaw and lower tongue against areola and breast tissue
-"supply and demand"
-Express to soften breast to ensure correct attachment
-Firm bra, cold packs
Mx candida infection?
Treat mother and baby after feed.
-M: miconazole / fluconazole
-B: nystatin, miconazole
What are the general indicators of low milk supply?
-breasts feel softer
-baby feeds more often
-baby takes less time to feed
-baby settles better on formula
-growth slows after 3 months
what are the physical changes in baby indicating low milk supply?
How to increase milk supply?
-positioning and attachment
-increase number of feeds
-increase duration of feeds
-offer both breasts at each feed
-express after feeds
-supplemental feeding line
-metoclpramide / domperidone
What is mastitis?
Breast infection due to blocked duct. Indurated, painful red area with systemic symptoms. May require admission.
-Consider breast abscess if fails to respond and drain surgically
LOS post birth?
2 night vaginal; 4 c section
Daily review early post natal?
-General appearance, wellbeing
-T, P, BP
-Uterus involution (palpation, lochia)
-Wound appearances (perineum, abdominal)
-Urinary and bowel function
-Breast, nipple symptoms
-Allied health as appropriate
What is puerperal pyrexia / maternal sepsis?
Maternal temp >38 within 2 weeks birth (not first 24h)
What are the sources of maternal sepsis?
A. Ob specific: uterine / adnexal, wound infection
B. Breast infection
F. Anaesthetic infection
What are the causes and features of secondary post partum haemorrhage / endometritis?
-tender bulky uterus
-offensive vaginal loss
What is the causes of endometritis (micro aetiology)?
-aerobes (strep GAS, GBS, enterococcus, E.coli, S. aureus, Klebsiella, Gardnerella)
-anaerobes (peptostreptococcus, bacteroides, clostridium)
mycoplasma (ureaplasma, mycoplasma)
may need blood +/- fluid resuscitation
-Outpatient Mx: oral Augmentin
-Inpatient Mx: Amp/ Gent/ Flagyl IV
-+/- careful curettage after delay for antibiotics
Mood disorders postpartum?
-Post partum blues 80%
Efficacy of lactational contraception?
97% effective contraceptive if
What are the options for hormonal contraception?
Progesterone-only contraception. Safe in breast feeding.
– Minipill (30 microgram levenorgestrel)
• commence D21 (earlier --> inc spotting in puerperium)
– Depo Provera (150 mg medroxyprogesterone acetate)
– Implanon (68mg etonorgestrel )
IUD insertion post partum time frame?
Either within 48/24 OR after 4/52
RFx puerperual pyrexia / sepsis?
-Prolonged rupture of membranes
-Frequent use of urinary catheters
-Post partum haemorrhage
What are the major pathogens causing puerperal pyrexia
– Group A streptococcus (Str. Pyogenes)
– Group B streptococcus
– Aerobic gram-neg bacilli (E Coli, Klebsiella pneumoniae, Proteus)
– Anaerobic gram-neg bacilli (Bacteriodes, Prevotella)
– Staphylococcus Aureus
– Methicillin-resistant S. Aureus (MRSA), clostridium
septicum, morganella morganii
Ix in secondary post partum haemorrhage?
-Vaginal swabs / cultures
mx secondary post partum haemorrhage?
-IVF and blood if required
-Correct coagulation defects
-Instigate medical mx: ABx, uterotonics
-Surgical Mx if required: suction curettage (24h ABx prior)
Preventative strategies to minimise secondary post partum haemorrhage?
-Active Mx of third stage
-Careful inspection of placenta
-AB during labour or immediate post partum if woman at risk of endometritis
Screening tool for mental health problems post natally
Edinburgh postnatal depression scale
Degrees of perineal laceration?
-First: laceration of vaginal mucosa
-Second: laceration of vaginal epithelium, perineal skin and muscle of perineal body but does not include anal sphincter
-Third: tear through whole of perineal body and involves external sphincter
-Fourth: extends into anal canal or rectal mucosa
What is included in episiotomy?
-Perineal skin and s/c tissue
-Post vaginal wall
-superficial transverse perineal muscle