Flashcards
Postnatal care and guidelines
Cards in this deck (20)
- 1What is the puerperium?postnatal period from end of labour until maternal organs have returned to their pre pregnant state. usually lasts between 6-8 weeks.
- 2What changes occur to the genital tractInvolution of the genital tract to its prepregnant tone, size and position. ovaries and fallopian tubes become pelvic organs again.
- 3what changes occur to the uterus?uterus returns to pre pregnant size, 15x11x7.5 to 7.5x5x2.5
undergoes involution
1. ischaemia - contraction of uterine muscle causes blood flow to uterus to reduce due to constriction
2. Autolysis - redundant uterine muscle fibre in the myometrium is broken down by proteolytic enzymes
3. phagocytosis - myometrial cells decrease in size as they are broken down and removal of excess fibrous tissue occurs - 4how does the health professional assess involution?palpation of uterus to determine if it is firm and well contracted is not required for every postnatal visit unless abnormal lochia is present. (NICE 2015) assess involution through both factors
- 5what happens after involution of the uterus?regeneration of the endometrium. decidua is cast off, and endometrium lining regenerates from day 10, can take 2-3 weeks. placental site takes longer 6weeks.
- 6what are after pains caused by?contraction of the uterus as a result of increase in oxytocin release, particularly when breastfeeding. can cause afterpains, worse with subsequent pregnancies due to reduced tone and increased size of uterus.
- 7what changes occur to the vagina and cervix?internal cervical os closes in second week, external becomes multips os
vagina regains elasticity a few days later
wound healing is dependant on severity
a fall in oestrogen causes a lack of lubrication in the vagina - 8What occurs with the lochia?resolves on average between 24 to 36 days
3 stages of lochia
lochia rubra - red from loss of blood cells and shreds of decidua
lochia serosa - blood cells, serum, leukocytes
lochia alba - leukocytes, serum and cervical mucus
observation of lochia important - signs of infection? retained placenta? offensive odour or clots - 9When does ovulation return?non lactating woman - between 40 - 50 days
lactation woman - 30 - 40 weeks
should not be used as form of contraception, advised it is possible to get pregnant within the first two weeks, to arrange contraception with GP if sexually active after birth
discuss dyspareunia concerns - 10What changes occur to the cardiovascular system?Blood volume returns to prepregnant state, blood loss in labour and increased micturition for diuresis
blood in hypercoagulable state postpartum , will return to normal over several weeks
hb levels return to normal after a month
wbcs after a week
concerned and looking for tachycardia, palpitations, anaemia from pph, chest pain and VTE? - 11resp system changes?full ventilation possible as uterus no longer obstructing abdominal breathing
resp rates return to normal after 1 week - 12Renal changes?urethral or bladder trauma can increase likelihood of urinary tract infection
kidney takes 6 months to return to pre pregnant size
increased micturition
wanting woman to PU by 6 hrs
OB by 3 days - 13gastrointestinal changes?OB by 3 days
slow gastric motility can cause constipation postnatally, laxatives, diet, hydration
haemorrhoids should resolve
3/4th degree tear - faecal incontinence?? - 14musculoskeletal changesdiastasis rectii ? refer for physiotherapy
- 15pelvic floorconcerned regarding incontinence? prolapse? inability to PU or OB
pelvic floor exercises - 16breast changes?increase in oxytocin and prolactin causes increase milk production and lactogenesis. prolactin inhibiting protein accumulates and prevents milk supply, discuss and look for.
looking for sore cracked nipples, engorgement, mastitis, thrush - 17mental health?routinely asking regarding mood, wellbeing
mental health history??
referral?
support groups?
baby blues or PND? GP?
domestic violence enquiry at every opportuinity - 18PN care considerations before discharge?MMR vaccine?
Cervical smear due?
infant feeding established?
support at home?
TTOs?
Anti D within 72 hours?
Health visitor aware and arranging visit?
6-8 week appt with GP, birth registration
documentation
debrief offered? NICE 2015 - 19What are some key publications regarding postnatal care in midwifery?The Lancet midwifery series 2014 - key publication framework for quality maternal and newborn care. highlights the need for policy direction for woman centered care.
RCM pressure points: postnatal care plan (2014)
- lack of continuity of carer, highlights lack of postnatal care planning as advised in NICE guidelines, 2/3rds midwives said the most important factor influencing number of PN visits was pressure on service not the woman
pressures to discharge from hospital
64 percent did not discuss pn care plan
- NICE postnatal guidelines 2015
- documented individualised care plan should be developed, ideally in antenatal period
- offered opportuinity to discuss birth
health and wellbeing discussed - 20signs and symptoms of potentially life threatening conditions postnatally?PPH - sudden profuse blood loss. faintness dizziness and palpitations.
Infection - shivering, pyrexia, abdominal pain or offensive lochia
pre eclampsia/eclampsia - headache, blurred vision, nausea vomitting
Thromboembolism - calf pain, redness or swelling, chest pain, shortness of breath
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- AMP Flashcards on Postnatal care and guidelines, created by Phoebe Crossing on 10/03/2019.
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- Phoebe Crossing
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