Gab Kovacs1 and Paula Briggs2
(1)
Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
(2)
Sexual and Reproductive Health, Southport and Ormskirk Hospital, Southport, UK
Definition
Discussion About the Birth Experience
Clinical Assessment
History
Examination
Investigations
Treatment
Prognosis
Contraception
Definition
This is the care of the woman and baby(s) during the puerperium (6–8 weeks after delivery).
Table 32.1
Potential problems with breast feeding
|
Solution |
|
|
Nipple pain/cracking |
Attachment adjustment/ barrier cream |
|
Engorgement |
support/massage/analgesia |
|
Mastitis |
? antibiotics |
|
Inverted nipples |
Manually evert nipples if possible |
|
Ankyloglossia (tongue tie) |
Arrange for baby to be assessed |
|
Sleepy baby |
Baby should be assessed by paediatrician |
Discussion About the Birth Experience
The woman should be given a chance to ask about any events or interventions that took place.
Clinical Assessment
History
The contents of the box below highlight the points, which are important to cover when taking a history from a woman in the puerperium
|
Postpartum haemorrhage |
Profuse blood loss |
|
Infection |
Feeling hot, shivering, abdominal/ pelvic pain, offensive lochia |
|
Pre eclampsia/eclampsia (women affected pre-delivery) |
During the first few days following delivery, possible symptoms include – headaches, visual disturbances, nausea and vomiting |
|
VTE (Deep venous thrombosis/pulmonary embolism) |
Unilateral calf tenderness, pain, redness, or swelling |
|
Chest pain and/or shortness of breath |
|
|
Postnatal depression/Puerperal psychosis |
Low mood, irritability, sleep disturbance, difficulty coping |
|
Mastitis/breast abscess |
Sore, swollen, hot, tender breast and/or fever |
|
Breast feeding |
See Table 32.1 |
Examination
The contents of the box below highlight potential important examination findings to reflect information gathered in the history
|
Postpartum haemorrhage |
Palor, pulse rate (high) blood pressure (low), fundal height |
|
Infection |
Temperature, inspect perineum, lochia (offensive), palpate abdomen and pelvis |
|
Pre eclampsia/eclampsia (women affected pre-delivery) |
Blood pressure, urine output and urine analysis |
|
VTE (Deep venous thrombosis/pulmonary embolism) |
Palpate calf, assessing for pain, redness, or swelling |
|
Dullness to percussion, decreased air entry |
|
|
Postnatal depression/Puerperal psychosis |
Nil |
|
Mastitis/breast abscess |
Examine breasts |
Investigations
The contents of the box below will help outline the possible investigations which will help confirm any potential diagnosis
|
Postpartum haemorrhage |
Full blood count (FBC) |
|
Infection |
FBE, ESR, CRP, swabs for culture and sensitivity, blood culture |
|
Pre eclampsia/eclampsia (women affected pre-delivery) |
Renal and liver function tests |
|
VTE (Deep venous thrombosis/pulmonary embolism) |
Ultrasound of deep veins |
|
Ventillation/ perfusion lung scan |
|
|
Mastitis/breast abscess |
Nil |
Treatment
The contents of the box below highlights the treatment options available for the various post partum conditions
|
Postpartum haemorrhage |
Resuscitate, ? transfuse, iron |
|
Infection |
Antibiotics, Perineal care (salt baths, air drying) |
|
Pre eclampsia/eclampsia (women affected pre-delivery) |
Anti-hypertensives medication |
|
Magnesium sulphate if at risk of eclampsia |
|
|
VTE (Deep venous thrombosis/Pulmonary Embolism) |
Anticoagulation therapy |
|
Mastitis/breast abscess |
Antibiotics |
Prognosis
With appropriate treatment the majority problems resolve.
Potential problems highlighted in the table below should be identified and managed appropriately.
Contraception
Should be offered to all women in the puerperium, ideally before discharge from hospital.
In women who are not breast feeding, fertility may return as early as day 21 post delivery. Consequently the contraceptive method of her choice following a risk assessment should be commenced by day 21.
In women who are breast feeding ovulation is usually inhibited while:
· Baby is totally breast fed
· Night feeds are continued
· Daily suckling time exceeds 60 min in total
Combined hormonal contraception is contraindicated, as it reduces breast milk production, and oestrogen is secreted in the breast milk, which may affect the baby.