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WH: puerperium + Postnatal Flashcards

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1
Q

What is puerperium ? how long ?

A

the period of about six weeks after childbirth during which the mother’s reproductive organs return to their original non-pregnant condition

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2
Q

What happens in the days after delivery ? what care provided ? (5)

A
  • Analgesia
  • Help with breast or bottle feeding
  • VTE risk assessment
  • Anti-D for rhesus -ve patients (if baby positive)
  • Routine baby check
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3
Q

What topics are discussed at the 6 week post natal check ? what does this coincide with ? (5)

A

usually same time as NIPE (6 week)
- General wellbeing
- Mood + depression
- Bleeding + menstruation
- Contraception
- Breast feeding

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4
Q

What is lochia ? describe

A

mix of blood, endo tissue + mucus
- normal in puerperium

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5
Q

what menstrual device should be avoided for lochia

A

tampons due to infection risk

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6
Q

How can Brest feeding affecting menstruation ?

A

can cause lactational amenorrhoea

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7
Q

how long after giving birth will bottle feeding women have menstural periods ?

A

from 3 weeks onwards

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8
Q

when does fertility return after childbirth ? (days)

A

21 days (don’t need contraception before then but then do)

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9
Q

how effective is lactational amenorrhoea ? what is required for it to be effective ?

A

98% effective
- If fully breastfeeding + fully amenorrhoea

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10
Q

which hormonal contractions are safe during breast feeding ? which should be avoided and for how long ?

A
  • Safe: POP + progesterone implant are safe during breast feeding
  • COCP should be avoided (for 6 weeks)
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11
Q

When is the copper coil + mirena safe after birth ?

A

<48 hrs
or
more than 4 weeks after birth
(not in between)

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12
Q

What is post party endometritis ? usually caused by ?

A

it is inflammation of the endometrium (lining of the uterus)
- Usually caused by infection

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13
Q

why is there in increased risk of endometritis in the PPP ?

A

due to the infection risk in labour + delivery

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14
Q

After what kind of delivery is endometritis most common ? what is done to try to prevent this ?

A

CS
- prophylactic Abx given during CS

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15
Q

endometritis presentation ? (4) when ?

A

shortly after birth till several weeks post partum
- foul smelling discharge of lochia
- Lower abdo/pelvic pain
- Fever
- Signs of sepsis

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16
Q

endometritis investigations ? what other differential is important to exclude ?

A
  • Vaginal swabs
  • Urine culture + sensitivities
  • US: to exclude retained products of conception
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17
Q

post partum endometritis management ?

A

oral Abx: broad spectrum

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18
Q

What is retained products of conception ? what 2 types of tissue ?

A

it is when pregnancy related tissue (placental or fetal membranes) remains in the uterusdur

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19
Q

which events could lead to retained products of conception ? (3)

A
  • Delivery
  • Miscarriage
  • TOP
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20
Q

significant RF for retained products of conception ?

A

placenta accreta

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21
Q

retained products of conception presentation ?

A
  • Vaginal bleeding
  • Abnormal vaginal discharge
  • Lower abdo/pelvic pain
  • Fever (if infection)
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22
Q

how is retained products of conception diagnosed ?

A

US

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23
Q

Retained products of conception management ?

A
  • Surgical removal: evacuation of retained products of conception (ERPC) under GA
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24
Q

Complications of retained products of conception management (surgical) ? (2)

A

evacuation of retained products of conception (ERPC)
- endometritis
- Ashermanns syndrom e

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25
what is ashermanns syndrome ?
adhesion form with uterus => stick structures together that should be stuck => infertility
26
Why is anaemia common is the PPP ?
common due to the acute blood loss during labour + delivery
27
When would you do an FBC for suspected anaemia in the postpartum period ?
- PPH - CS - Antenatal anaemia - If symptomatic
28
post partum anaemia management ?
Depends on level of deficiceny - Ferrous sulphate, iron transfusion, blood transfusion
29
SE of ferrous sulphate ?
- N&V - Constipation - Dark poo
30
what are the 3 mood disorders present in the postnatal period ?
- baby blues - Postnatal depression - Puerpral psychosis
31
What is baby blues ? when ? how common ?
low mood in the first week after birth - majority of women (>50%) - especially 1st time mothers
32
what is baby blues presentation ? (5) symptoms severity and how long do they last ?
- Mood swings - Low mood - anxiety - Irritabily - Tearfullness (symptoms usually mild and resolve within 2 weeks)
33
what causes baby blues ?
- Hormonal changes - Recovery from birth - Fatigue + sleep deprivation - Establishing feeding
34
What is postnatal depression ? how common ? When ?
depressive episode within first 12 months post partum - 1/10 women with peak at 3 months after birth
35
classic triad of postnatal depression presentation ? how long do symptoms last ?
- Low mood - Anhedonia - Low energy (Lethargy) (symptoms last at least 2 weeks)
36
What antidepressant is appropriate in breast feeding women (2) type ?
- sertraline - paroxetine (SSRI)
37
How is post natal depression treated ? (4)
(similar to regular depression) - additional help - SSRI (if moderate) - CBT - Edinburgh postnatal depression scale
38
what screening tool can be used for post partum depression ? what number indicated depression ?
Edinburgh post batal depression scale >10 => post natal depression
39
how common is puerperal psychosis ? how soon after birth ?
rare but severe - 1/1000 - a few weeks after birth
40
how does puerperal psychosis present ? (6)
- Delusions - Hallucinations - Depression - Mania - Confusion - Though disorder
41
How is puerperal psychosis managed ? (5)
urgent assessment + input from specialist NH services - Spot early to avoid harm to mum or baby - Mother + baby unit: they can remain together and continue to bond - CBT - ECT - Meds (antidepressant, antipsychotics, mood stabilisers)
42
puerperal psychosis RF ?
- Previous MH condition (BP, schizophrenia, OCD, eating disorder) - If had prev PP psychosis (=> 50% chance again with next) - Can occur if no prev psychiatric disorder
43
What preparation can be done during pregnancy if mother has preexisitng MH condition ?
- consider SSRI use - Maintain good social network
44
how can antenatal SSRI use effect the neonate ?
neonatal abstinence syndrome - Irritability - Poor feeding
45
What is lactational mastitis ?
It is inflammation of beast tissue - Common complication of breast feeding (+/- infection)
46
What 2 things could cause lactational mastitis ?
- Obstruction - Infection
47
how would obstruction cause mastitis ? and how can this be prevented ?
obstruction in the ducts + the accumulation of milk => mastitis - Regularly expressing milk can preven this form occurring
48
how does infection cause mastitis ? which causative organism ?
- bacteria (s.aures) enters nipple => back track to ducts => infection + inflammation
49
lactational mastitis presentation ? (5)
unilateral - treat pain/tenderness - Localaised errythema - Local warmth + infammation - Nipple discharge - Fever
50
Lactational mastitis management ?
- If due to duct blockage: conservative, continue breathing feeding, express milk, breast massage - Infection: sample of milk sent to lab for culture + sensitivity, Abx (flucloxaillin)
51
what happens if mastitis is not adequately treated ? management of this ?
can develop breast abscess => required incision + drainage
52
complication of mastitis after Abx treatment ?
after Abx course => candidal infection of nipple => recurrent mastitis
53
how does candidial infection of nipple present ?
mum: bilateral sore nipples, nipple tenderness + itching, cracked/flakey areolar Baby: with parches in mouth + tongue, or condidial nappy rash
54
candidiasis infection management ?
treatment required for both mother + baby - topical micronazole (to breast and affected area on baby)
55
What is Sheehans syndrome ? complication of what ?
it is a rare complication of PPH - drop in circulating blood vol => avascular necrosis of pituitary => ischaemia of cells in pituitary => cell death
56
why does Sheehans only affect AP ? explain
blood supply - AP gets blood form low pressure system (vulnerable to rapid drops in BP) - PP has different food blood supply form various arteries
57
what homones does AP secrete ? (6)
- TSH - ACTH - FSH - LH - GH - Prolactin
58
what hormones does posterior pituitary produce ? how is this affected in sheehan's
- Oxytocin - ADH its not affected by Sheehan's
59
Sheehas presentation ? say what causes each one ?
sign + symptoms of decreased AP hormones - reduced lactation (due to low prolactin) - Amenorrhoea (due to low FSH + LH) - Adrenal insufficiency (low ACTh => low cortisol) - Hypothyroidism (due to low TSH)
60
Sheehans management ?
long term replacement of the missing hormones - Oestrogen + progesterone, Hydrocortisone, levothyroxine, GH
61
What is post partum thyroiditis ?
condition where there are changes to thyroid function within 12 months of delivery affecting women wihtough Hx of thyroid disease - over time third function returns to normal and Px will be asympotmattic
62
stages to post partum thyoiditis ?
usually - thyrotoxicosis (first 3 months) - hypothyroidism (3-6 months after birth) - function begins to return to normal
63
thyrotoxicosis Sx ? (6)
hyperthyroidism - anxiety/irritabilty - sweating + heat intolorance - tachycardia - weight loss - fatigue - frequent loose stools
64
hypothyroidism Sx ? (7)
- weight gain - fatigue - dry skin - hard loss - low mood - heavy periods - constipation
65
what would be seen on TFT for thyrotoxicosis and hypothyroidism ?
thyrotoxicosis: high T3, high T4, low TSH hypothyroidism: low T3, low T4, high TSH
66
post partum thyroiditis Mx ? (3)
- thyrotoxicosis: symptomatic control (propanolol) - hypo: levothyroxine annual monitoring (TFT)

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