Postnatal Care, Lactation and Maternal Problems Flashcards Preview

Women's Health > Postnatal Care, Lactation and Maternal Problems > Flashcards

Flashcards in Postnatal Care, Lactation and Maternal Problems Deck (38):
1

What is lochia?

Blood and decidua. Normal discharge from uterus after childbirth

2

What are the genital tract changes after birth?

-Uterus returns to pelvis ~2 wks
-Afterbirth pains
-Lochia (200-500mL; ~1month)

3

What are the haem/CV changes after birth?

-Diuresis
-Resoution of oedema
-Return to normal blood volume
-Hypercoaguable state (need VTE prophylaxis)

4

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

5

What are the benefits to the baby of breastfeeding?

-Nutritional - digestion
-Obesity, HT
-SIDS
- Dec atopy incidence
-Dec infection, hospitalisations, mortality from infections (diarrhoea and respiratory)
-IQ

6

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
-contraceptive effect

7

Breastfeeding CIx?

-Viruses: HIV
-Drugs (some): 1% will cross to infant.
>antineoplastics
>ergotamine
>methotrexate
>cyclosporine
>radiopharmaceuticals

8

What are the keys to successful breastfeeding?

-Antenatal education
-Early feeding / skin contact
-Encourage demand feeding
-Avoid supplemental feeds and dummies
-Encourage rooming in

9

What triggers initiation of lactation?

-Preg: oestrogen, progesterone, prolactin, HPL
-Delivery: fall progesterone, allows prolactin

10

What is colostrum?

During early breastfeeding. Thick, small volume (0.5-1mL) yellow; lipid and immunoglobulin rich

11

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
-Lanolin

12

Mx engorgement?

-"supply and demand"
-Express to soften breast to ensure correct attachment
-Firm bra, cold packs
-analgesia

13

Mx candida infection?

Treat mother and baby after feed.
-M: miconazole / fluconazole
-B: nystatin, miconazole

14

What are the general indicators of low milk supply?

-breasts feel softer
-baby feeds more often
-baby takes less time to feed
-baby unsettled
-baby settles better on formula
-growth slows after 3 months

15

what are the physical changes in baby indicating low milk supply?

-weight gain

16

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

17

What is mastitis?

Breast infection due to blocked duct. Indurated, painful red area with systemic symptoms. May require admission.

18

Mx mastitis?

-Keep feeding
-Flucloxacillin
-Analgesia, fluids
-Consider breast abscess if fails to respond and drain surgically

19

LOS post birth?

2 night vaginal; 4 c section

20

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

21

What is puerperal pyrexia / maternal sepsis?

Maternal temp >38 within 2 weeks birth (not first 24h)

22

What are the sources of maternal sepsis?

A. Ob specific: uterine / adnexal, wound infection
B. Breast infection
C. UTI
D. Thrombophlebitis
E. Haematoma
F. Anaesthetic infection

23

What are the causes and features of secondary post partum haemorrhage / endometritis?

-RPOC
-Infection
-Idiopathic subinvolution
-Coagulopathy
-Trauma

CFx:
-fever, tachy
-tender bulky uterus
-offensive vaginal loss

24

What is the causes of endometritis (micro aetiology)?

Polymicrobial
-aerobes (strep GAS, GBS, enterococcus, E.coli, S. aureus, Klebsiella, Gardnerella)
-anaerobes (peptostreptococcus, bacteroides, clostridium)
mycoplasma (ureaplasma, mycoplasma)

25

Mx endometritis?

may need blood +/- fluid resuscitation
-Outpatient Mx: oral Augmentin
-Inpatient Mx: Amp/ Gent/ Flagyl IV
-+/- careful curettage after delay for antibiotics

26

Mood disorders postpartum?

-Post partum blues 80%
-PP depression
-PP psychosis

27

Efficacy of lactational contraception?

97% effective contraceptive if
– baby

28

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 )

29

IUD insertion post partum time frame?

Either within 48/24 OR after 4/52

30

RFx puerperual pyrexia / sepsis?

-Prolonged rupture of membranes
-Frequent use of urinary catheters
-Prolonged labour
-Assisted birth
-Vaginal lacerations
-Post partum haemorrhage
-C section

31

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

32

Ix in secondary post partum haemorrhage?

-FBE
-Coags
-Blood group
-Vaginal swabs / cultures

33

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)
-Embolisation
-Hysterectomy

34

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

35

Screening tool for mental health problems post natally

Edinburgh postnatal depression scale

36

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

37

What is included in episiotomy?

-Perineal skin and s/c tissue
-Post vaginal wall
-bulbocavernosus muscle
-superficial transverse perineal muscle
-pubococcygeus muscle

38

What is a vulval haematoma?

-A/w nulliparity, episiotomy, operative delivery
-excruciating pain, appearance of tense, fluctuating swelling covered by discoloured skin
-bleed can be considerable and lead to hypovolemia, shock and severe anaemia