Postnatal Care

Question 1

What is the postnatal period also known as?

Answer 1

Also known as puerperium, is the first 6 weeks after the baby is born

Question 2

How often are medical staff seen in standard postnatal care?

Answer 2

• See midwife at home for first 9-10 days, after referred to health visitor
  
  • Look for signs of abdominal bleeding, infection, mental health issues
• 6 week postnatal check at GP
  
  • Contraception, mental health/general wellbeing

Question 3

What are some common problems in the postnatal period?

Answer 3

• Infant feeding
• Bonding
• Social issues
  
  • Partner, other children, financial issues

Question 4

What are possible complications of breast feeding?

Answer 4

• Mastitis
• Blocked milk ducts
• Difficulty feeding/baby latching
• Skin irritation – “cracked nipples”

Question 5

What are some key postnatal conditions?

Answer 5

• Post-partum haemorrhage
• Venous thromboembolism
• Sepsis
• Psychiatric disorders of the puerperium
• Pre-eclampsia

Question 6

What are the different categories of PPH?

Answer 6

• Primary
  
  • Blood loss of >500ml within 24 hours of delivery
• Secondary
  
  • Blood loss >500ml from 24 hours post partum to 6 weeks

Question 7

What are risk factors for thromboembolic disease?

Answer 7

• Pregnancy 6-10x more likely
• Immediately post-partum period is hypercoagulable state
• Immobilisation following spinal anaesthetic/caesarean section

Question 8

What is the presentating of thromboembolic disease?

Answer 8

• Unilateral leg swelling and/or pain
• Shortness of breath
• Chest pain
• Tachycardia

Question 9

What investigations are done for thromboembolic disease?

Answer 9

• D-dimer unreliable in pregnancy
• ECG
• Leg dopplers
• Chest x-ray with or without VQ scan

Question 10

What investigation, normally used for thromboembolic disease, is not reliable during pregnancy/postnatal?

Answer 10

D-dimer

Question 11

What is the mangement of thromboembolic disease?

Answer 11

• Thromboprophylaxis and risk assessment to avoid
• Low molecular weight heparin
• Warfarin is teratogenic, but can be used when breast feeding

Question 12

What is puerpergal sepsis?

Answer 12

Infection of the genital tract occurring at any time between the onset of rupture of membranes or labour, and the 42^nd day postpartum

Question 13

What investigations are done for puerpergal sepsis?

Answer 13

• Perform full septic screen
  
  • Blood cultures, LVS, MSSU, wound swabs

Question 14

What is the management of puerpergal sepsis?

Answer 14

• Prompt IV administration – “golden hour”
• Antipyretic measures
• IV fluids

Question 15

What is the incidence of mental health issues postnatally?

Answer 15

• 25% of woman who die between 6 weeks and 1 year after pregnancy died from mental health related causes
  
  • 1/7 of those is suicide

Question 16

What team is used to manage postnatal mental health issues?

Answer 16

Peri-natal mental health team is used to manage this

Question 17

What are some postnatal mental health issues?

Answer 17

• Baby blues
• Postnatal depression
• Puerperal psychosis

Question 18

What is the aetiology of baby blues?

Answer 18

• Affects most woman due to hormonal changes around the time of birth

Question 19

What is the management of baby blues?

Answer 19

• No specific treatment as does not affect functioning

Question 20

When can postnatal depression continue from?

Answer 20

Can continue from baby blue or start sometime later

Question 21

What are risk factors for postnatal depression?

Answer 21

• Personal or family history of affective disorder

Question 22

What is the presentation of postnatal depression?

Answer 22

• Classical depressive symptoms
• Affects functioning and bonding, requiring treatment

Question 23

What is puerperal psychosis?

Answer 23

Mental disorder occurring after childbirth, characterised by deep depression, delusions of childs death and homicidal feelings towards child

Question 24

What are risk factors for puerperal psychosis?

Answer 24

• Personal or family history of affective disorder, bipolar disorder or psychosis

Question 25

Is the incidence of puerperal psychosis common or rare?

Answer 25

Rare

Question 26

What is the management of puerperal psychosis?

Answer 26

* Inpatient psychiatric care * Woman is a danger to themselves and their baby

Question 27

What is pre-eclampsia?

Answer 27

Pre-eclampsia = causes hypertension during pregnancy and after labour

Question 28

What is the management of pre-eclampsia?

Answer 28

* Discharge on antihypertensive * Follow up in community