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

Postnatal Care, Lactation and Maternal Problems Flashcards

1
Q

What is lochia?

A

Blood and decidua. Normal discharge from uterus after childbirth

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2
Q

What are the genital tract changes after birth?

A
  • Uterus returns to pelvis ~2 wks
  • Afterbirth pains
  • Lochia (200-500mL; ~1month)
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3
Q

What are the haem/CV changes after birth?

A
  • Diuresis
  • Resoution of oedema
  • Return to normal blood volume
  • Hypercoaguable state (need VTE prophylaxis)
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4
Q

What is the composition of human milk?

A
  • 4%fat (TGs, phospholipids)
  • Carbs: lactos, oligosaccharides
  • Proteins: casein, lactoferrin, IgA
  • Minerals: Na, K, Cl, Mg, Ca
  • Enzymes, GFs, trace elements
  • Leukocytes, epithelial cells
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5
Q

What are the benefits to the baby of breastfeeding?

A
  • Nutritional - digestion
  • Obesity, HT
  • SIDS
  • Dec atopy incidence
  • Dec infection, hospitalisations, mortality from infections (diarrhoea and respiratory)
  • IQ
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6
Q

What are the benefits of breastfeeding to the mother?

A
  • Faster return to pre weight
  • oxytocin encourages involution of the uterus, less blood loss
  • some protection against breast, ovarian Ca; CVD
  • contraceptive effect
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7
Q

Breastfeeding CIx?

A

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

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8
Q

What are the keys to successful breastfeeding?

A
  • Antenatal education
  • Early feeding / skin contact
  • Encourage demand feeding
  • Avoid supplemental feeds and dummies
  • Encourage rooming in
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9
Q

What triggers initiation of lactation?

A
  • Preg: oestrogen, progesterone, prolactin, HPL

- Delivery: fall progesterone, allows prolactin

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10
Q

What is colostrum?

A

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

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11
Q

How to minimise sore / cracked nipples?

A
  • Correct positioning: nipple forms distal third of teat with baby’s jaw and lower tongue against areola and breast tissue
  • Lanolin
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12
Q

Mx engorgement?

A
  • “supply and demand”
  • Express to soften breast to ensure correct attachment
  • Firm bra, cold packs
  • analgesia
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13
Q

Mx candida infection?

A

Treat mother and baby after feed.

  • M: miconazole / fluconazole
  • B: nystatin, miconazole
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14
Q

What are the general indicators of low milk supply?

A
  • 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
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15
Q

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

A

-weight gain

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16
Q

How to increase milk supply?

A
  • 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
Q

What is mastitis?

A

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

18
Q

Mx mastitis?

A
  • Keep feeding
  • Flucloxacillin
  • Analgesia, fluids
  • Consider breast abscess if fails to respond and drain surgically
19
Q

LOS post birth?

A

2 night vaginal; 4 c section

20
Q

Daily review early post natal?

A
  • 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
Q

What is puerperal pyrexia / maternal sepsis?

A

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

22
Q

What are the sources of maternal sepsis?

A 
A. Ob specific: uterine / adnexal, wound infection
B. Breast infection
C. UTI
D. Thrombophlebitis
E. Haematoma
F. Anaesthetic infection
23
Q

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

A
  • RPOC
  • Infection
  • Idiopathic subinvolution
  • Coagulopathy
  • Trauma

CFx:

  • fever, tachy
  • tender bulky uterus
  • offensive vaginal loss
24
Q

What is the causes of endometritis (micro aetiology)?

A

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

25
Q

Mx endometritis?

A

may need blood +/- fluid resuscitation

  • Outpatient Mx: oral Augmentin
  • Inpatient Mx: Amp/ Gent/ Flagyl IV
  • +/- careful curettage after delay for antibiotics
26
Q

Mood disorders postpartum?

A
  • Post partum blues 80%
  • PP depression
  • PP psychosis
27
Q

Efficacy of lactational contraception?

A

97% effective contraceptive if

– baby

28
Q

What are the options for hormonal contraception?

A

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
Q

IUD insertion post partum time frame?

A

Either within 48/24 OR after 4/52

30
Q

RFx puerperual pyrexia / sepsis?

A
  • Prolonged rupture of membranes
  • Frequent use of urinary catheters
  • Prolonged labour
  • Assisted birth
  • Vaginal lacerations
  • Post partum haemorrhage
  • C section
31
Q

What are the major pathogens causing puerperal pyrexia

A

– 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
Q

Ix in secondary post partum haemorrhage?

A
  • FBE
  • Coags
  • Blood group
  • Vaginal swabs / cultures
33
Q

mx secondary post partum haemorrhage?

A
  • 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
Q

Preventative strategies to minimise secondary post partum haemorrhage?

A
  • Active Mx of third stage
  • Careful inspection of placenta
  • AB during labour or immediate post partum if woman at risk of endometritis
35
Q

Screening tool for mental health problems post natally

A

Edinburgh postnatal depression scale

36
Q

Degrees of perineal laceration?

A
  • 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
Q

What is included in episiotomy?

A
  • Perineal skin and s/c tissue
  • Post vaginal wall
  • bulbocavernosus muscle
  • superficial transverse perineal muscle
  • pubococcygeus muscle
38
Q

What is a vulval haematoma?

A
  • 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

Women's Health (39 decks)

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