Postpartum Care Flashcards

Question

Immediate PP care: Rhogam delivery

Answer 1

**Rh negative mothers should be given rhogam if the baby is Rh positive** Rohgam should be given to... - unsensitized mothers at 28 weeks - if baby is confirm Rh + = give mom rhogam within 72 hours - given with any risk of bleed, trauma, bleeding, etc. during pregnancy to decrease mom's ability to produce antibodies to Rh factor *this protects future babies because it stops mom from creating ab. which woud attack future baby if Rh+* *this is not needed in moms who are Rh+* *decreases risk of developing IPP in baby*

Answer 2

Estrogen - levels fall PP and will remain suppressed **only in the presence of breastfeeding: lactation** - in non-BF mothers: ovariain function can return in as little as 4-6 weeks PP - 70% have return of menses within 7 weeks Prolactin - suppresses ovulation within the first 3 weeks of PP - the suckling from baby triggers increases in prolactin: making milk - thus, if there is no breastfeeding, no trigger of the prolactin, thus no suppression of estrogen Breastmilk - after devliery, the breasts begin to secrete **colostrum** - this contains high levels of vitamins, minerals, AAs, & proteins with less sugar fat (hence they get lots of good, but initial BW can decrease) - immunoglobulin, macrophages and other immune protects contained within this coslsrum: help baby mount an immune system

Answer 3

**breast is good, but fed is better!!** - encourage BF, but if not fesable do not push!!! Timeframe - recommendation is to **breastfeed exculsively for 6 months**, continue until up to 2 years or beyond depending on motehr preference - at 6 months: solids are encouraged Always consider barriers to BF - education level, langugage, inforamtion, experiecnes Benefits for Mom - helps with subinvoluation of the uterus - contracenption if using LAM (lactacional amenorrhea method) - cheaper, promotes bonding Benefits for Baby - promotes GI function and growth of GI tract - lower incidence of acute illnesses - positive for decreasing obestiy, DM, cancer and potential cognitive benefits **assisst lactation consultants!!: get them invovled early**

Answer 4

LAM: lactional amenorrhea method - in the presence od prolactin; there is an inhibtion of estrogen and therefore a hault in the regualr menstarul cycle - can be considered extremely effective (98%) ONLY IF.... the following conditiosn MUST be met - amenorrhea sustatined while LAM used - fully or nearly fully breastfeeding: no intervals longer that 4-6 hours without breastfeeding - < 6 months PP POP (progesterone only pill) can be perscribed as a backup method always councel on other methods and the future, barriers and inconsistency to breastfeeding

Answer 5

**many women find the haredest part of PP time period is around the two week mark** currently, post-partum follow up visits are scheuleded 4-6 weeks out: after they've experienced the hard part..... - suggest doing telehealth or visit at 2 weeks to check in (within the first 3 weeks of PP) : assess acute issues and most important concerns NOW - then real PP visit at 4-6 weeks :more comprehensive PP visit to cover all else **no later than 12 weeks!! according to ACOG** - **c-section: often come in for an incision check around 1-2 weeks**

Answer 6

**discussion about the PP period should be talked about during the 35-36 week period** Topics Included materials to have at home contraception & family planning - discuss obstaining from sex until 6 weeks - contraception: BF, etc. **use the USMEC** to determine which contraception is best support system at home - **IPV**: highest in first 2 months PP, espeically with increased kids - **baby blues v depression** breast v bottle bladder and bowel preparations

Answer 7

POP: can be used for BF moms - no effect on breast milk - differnet instructions: take at same time daily IUDS - can be inserted up to 10 minutes after delviery (of placenta) - **except in case of PP sepsis** obv dont isnert soemthing in infection Diaphgrams and caps - need to be refitted and refitted againa fter PP weight loss Perminent methods - vasectomy or tubual ligation Nexplanon (implant) and depo (injection) can be used after delivery - bleeding, depression risk, weight gain and BMD risk with depo injections = watch this in PP moms - opt for nexplanon **combined Oral contraceptions are a cat. 4 AVOID in PPmoms for first 21 days!!!** due to DVT/VTE risk - watch in BF: can be cat. 2 fpr those without DVT factors at 20 days (watch milk supply) - in non BF: ok (cat 2) for non DVT risk pt. at 21 days PP

Answer 8

Baby Blues - seen in up to 85% of patients - defined as; transient symptoms that occur within the first few days after delivery, usually disappating by PP day 10 - come and go feelings of sad ; but they DO PASS Depression - highest occurance of depression is PP - **suicide and overdose** associated with disorders are the elading cause of maternal mortality in the US Risk Factors for PP Depression - personal or family hsitory of depression/anxiety - depression or anxiety DURING pregnancy - stressful life events - poor social support - martial issues - lower SES - neuroticism: negative affect

Answer 9

PP Depression **edinburgh Depression Scale** good to SCREEN for depression - **shouldve already been done prior to d/c from hospital & then give AGAIN in the inpt PP visit** Treatment - can include pharm and behavioral therapy - **SSRI: often first line** benefits > risk - specifically **sertraline** and **escitalopram**

Answer 10

PP Psychosis - rare but a OB and psych. emergecny - assocaited wtih high risk of sucide and infanticide Risk Factors - **women with bipolar disorder had marked increased in PP psychosis compared to normal** - history of PP psychosis at increased risk Symptoms - **usually start suddenly:within 2week PP within hours to days** - hallucinations: seeing, hearing, feeling, smelling things not there - delusions: beliefs or thoughr processes that arent liekly to be true - manic: irritable, euphoric, quick thinking/speaking - depressed/low modd - mix of manic and depressed moods with cycling - loss of inibition: inappropriate responses - fearful, suspisious feelings - restlessness - abnormal behavior compared to baseline

Answer 11

**ACOG recommends everyone getting prenatal and postnatal care be screened for bipoalr, anxiety and depression** using screening tools **ACOG recomeends screening for bipolar before intiating medication for anxiety or depression** if not already done

Answer 12

incision, suture sites care, bladder, bowel and vagina care lochia and perneal issues return to sex and libido return - return to sex 6 weeks earliest - libido return around week 12: estrogen return : varies widely Social Support - IPV screen! - issues with baby Breast and bottle feeing - discuss at week 2 PP visit Sleep Return to work **6 weeks: driving, ligting, exercise and dietary needs can be incorporated back**

Answer 13

Women who has experince fetal demise: **always schedule follow up within 2 weeks** post delivery demise - inform parents together perinatal loss - assist in the greiving process - encourage them to see and touch baby at birth or later on (even if anomalies) - memetnos like footprints and hair or photos can be given Assisting Mom in the PP Period - follow up at 2 weeks PP - watch for **abnormal greif: defined as inability to work through the loss within 3-4 months withfeelings of self esteem loss** ## Footnote for babies who are born with severe anomalies, emphazie the babys healthy/normal features & always talk about the postive treatments out there for assisting

Answer 14

PE should include..... Vital signs, weight and BMI assess mood assess breast feeding and problems with breasts assess abd. pain & check c section pelvic exam and physical to assess - episitomy/lacerations - vagina - cervix - uterus - bleeding/lochia - *pap only if due* - retacl if needed Plan to include - Tx. - Dx. : iamginge, etc. - education - F/U:dispo : when to come back, when to go to ER **following postnatal visit: usualy GYN eamples can routinely begin 3 months later: set up appt ofr 3 months from that visit**

Postpartum Care Flashcards

(38 cards)