Post-partum Care Flashcards

1
Q

What do we call the first 6 wks following delivery?

A

The Peurperium

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2
Q

Who sees the mother during the Peurperium?

A

Midwife for the 1st 9-10 days
Then Health Visitor

Go to GP for 6wk postnatal check

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3
Q

What do the midwife and health visitor do when seeing the new mum?

A

Observe for signs of abnormal bleeding and infection (wound, breast or endometritis)

Debrief the events of the birth especially if there was an emergency CS

Also discussing family planning

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4
Q

What are the common and fairly normal problems in the Peurperium?

A
  • Feeding problems
  • Bonding issues
  • Social problems e.g. the partner, other children or financial
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5
Q

What are the major dangers to the mother in the Post-partum period?

A
Post-Partum Haemorrhage
VTE
Sepsis
Post-natal Hypertensive disorders
Psychiatric Disorders
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6
Q

What are the types of PPH?

A

Primary - >500ml within 24hrs

Secondary = >500ml after 24 hrs to the 6wk boundary

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7
Q

What causes primary PPH?

A

Tone - e.g. Atonic Uterus
Trauma - e.g. tears or ruptures
Tissue - Retained
Thrombin - e.g. can’t clot

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8
Q

What causes secondary PPH?

A

Retained Tissue
Endometritis
Tears/trauma

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9
Q

How do we reduce risk of a VTE?

A

A proper risk assessment and if necessary Thromboprophylaxis

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10
Q

How might a VTE present in the Peurperium

A
  • Unilateral Leg Swelling and/or pain
  • SOB or Chest pain
  • Unexplained Tachycardia
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11
Q

How can we test for a VTE?

A

ECG
Doppler US
CXR +/- VQ scan

D-dimer isn’t useful in pregnant or post-partum women because they’re already hypercoagulable

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12
Q

How do we treat a VTE in pregnancy?

A

LMWH

Warfarin can be used when breastfeeding but not during pregnancy

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13
Q

Sepsis is the leading cause of direct maternal death in the UK, how do we test for it if suspicious?

A

Blood Culture
MSSU
Wound Swab
Lower Vaginal Swab (LVS)

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14
Q

How do we manage a suspected case of post-partum sepsis?

A
  • Promopt IV abx
  • Antipyretics
  • IV fluids
  • Refer to hospital
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15
Q

What are the major psych disorders in post-partum women?

A
  • Baby blues
  • Postnatal Depression
  • Peurperal Psychosis
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16
Q

What is the baby blues?

A

Hormonal changes cause the blues in many mothers 1-3 days PN.
Doesn’t affect function and doesn’t require treatment

17
Q

What is postnatal depression?

A

Classic depressive symptoms that do affect function and bonding
Look for a history or family history of affective disorder

It does require specific treatment unlike baby blues

18
Q

How do we handle Peurperal Psychosis?

A

Much more serious, women can be a danger to themselves and babies.

So inpatient psych care is required

Look for a history/FH of affective disorder, bipolar or pyschosis

19
Q

what is Lochia

A

o Vaginal discharge
o Normal for up to 3-4 weeks post-partum
o Should be like a period or less

20
Q

Post-natal hypertensive disorders

A
  • Most eclamptic seizures occur in the postnatal period

* Pre-eclampsia can develop postnatally or may worsen several days following delivery