POST PARTUM CARE/COMPLICATIONS

PromptHistoric features of delivery and their clinical significance in postpartum period (Maternal - not paeds hx)

ResponseMode of delivery SVD vs section - SVD = increased risk RPOC
Epidural use - Increased risk CNS infection
Epesiotomy/peroneal tears - ?wound infection
IDC during labour - ? UTI
PROM - ? endometritis
IV lines during labour - ? infection

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PromptList Post partum fevers differentials

ResponseMastitis/breast abscess
Perineal wound infection
C section wound infection
endometritis/retained placenta
UTI/Pyelo
Pneumonia
CNS infection (from Epidural!)- Meningitis/encephalitis/spinal abscess
Toxic shock syndrome (group A strep)
Septic pelvic thrombosis (rare)
DVT/PE

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PromptSeptic post partum patient management

ResponseEarly broad spectrum IVABx (Tazocin + clindamycin)
Circulation support

N/S bolus 20 mL/kg
Early inotropes (Norad)
aim MAP >65

Seek and treat source of sepsis

Eg: U/S ?RPOC

Admission (?O+G, ?ICU)

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PromptMASTITIS

Response

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PromptContributing factors to lactational mastitis

ResponsePoor infant positioning
Milk stasis
Nipple drainage

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PromptNon pharmacologic treatments for lactation mastitis

ResponseFrequent breast emptying (Breast feeding does not need to be interrupted
Routine hand washing prior to breast manipulation
Referral to a lactation consultant to assist with technique

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PromptPharmacologic management mastitis

ResponseFluclox 500 QID x 5/7
NON severe penicillin allergy = Cefalexin 500 mg QID x 5/7
Severe penicillin allergy = Clindamycin 450 mg TDS x 5/7
(READ the question - good place to throw in a penicillin allergy)

Analgesia (paracetmol, ibuprofen, low dose endone)
eTG 8/24

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PromptManagement if failure of oral antibiotics for lactation mastitis

ResponseAdmit for IV antibiotics
U/S ? Breast abscess
Consider alternative diagnoses (eg: inflammatory breast cancer)

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PromptPOSTNATAL DEPRESSION

Response

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PromptRisk factors for post natal depression

ResponseHistory of depression/other mental health illness (bipolar)
Prior post partum depression
Recent stressors - pregnancy compilation, Job issues, health problems
Baby problems - health/special needs
Feeding difficulties
Relationship issues
Lack of support
Unwanted pregnancy

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PromptIndication for admission in postnatal depression

ResponsePsychosis
Thoughts of infanticide/harm
Thoughts of self harm
Any suicidality
Poor social support

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