WOUND CARE

Question 1

What is an easily available method for drying episiotomy wounds?

TO HEAL WELL, A WOUND NEEDS:

1. Drying2. Avoidance of friction, heat & infection3. Reduction of mechanical tension

C/S scars & episiotomies can therefore be difficult to manage!

DRYING: hair dryer “on cool”

FRICTION & HEAT: no lycra no “ultra-thin”

pads

LESS TENSION: reduce lifting/straining prevent

constipation less A/N weight gain!

ESPECIALLY EPISIOTOMIES …

• Excessive discomfort is often due to irritant contact dermatitis

• If topical E2 is ineffective, do not continue >1 month

PUERPERAL SEPSIS

Question 2

What are the three most common causes of secondary PPH?

STRICTLY SPEAKING. . . this means a bacterial infection

of the placental bed, usually by a Streptococcus.

It is more likely after:• prolonged labour/operative del.• retained products of conception• chorio-amnionitis (esp. 2nd trimester)

MANAGEMENT

• Ultrasound to exclude RPOC/abscess• Assess blood loss / Hb• Antibiotics• Early referral to hospital PRN

PELVIC FLOOR

IDENTIFYING HIGH-RISK WOMEN

• Operative delivery + episiotomy• Obese• Constipated• Chronic cough• Pre-existing bladder dysfunction• ?? Family history of prolapse

IS THERE A REALISTICREALISTIC PROGRAMME ?

• Minimise risk-factors

• Pelvic floor muscles are linked neurologically to “corset” muscles

• SO: long walks will help PFM strength

BREAST FEEDING

Question 3

How far apart do breast-feeds have to become before the mini-pill is less effective?

A FEW “GYNAE” THOUGHTS

• Continuation with breast-feeding is not worth post-natal depression.

• The POP is not effective when the infant is feeding at more than 5-hour intervals !!

CONTRACEPTION

Question 4

Which currently-available female contraception method has the lowest pregnancy rate?

IS LAP.STERI DEAD ??DEAD ??

LAP. STERI.• operative risk• high cost• 10:1000 failure• 1:3 ectopic risk• permanent, but

?regret

IMPLANON/MIRENA:• neg. insertion risk• low cost• <1:1000 failure• S/effects low• re-insertion required,

but no regret!

SOME CAVEATS re MIRENA & IMPLANON

• Women with oligomenorrhoea are not suitable for Implanon.

• Both devices may give prolonged spotting in women with pre-existing prolonged periods.

• Both devices are immediately effective as contraceptives, but may take 3-6months to achieve permanent menstrual change.

SEXUAL PROBLEMS

Question 5

What is the most common cause of post-partum superficial dyspareunia?

“I’M NOT INTERESTED”

• Antenatal education of male.

• The exhaustion factor.

• Female selfishness!

DYSPAREUNIA: NOTNOT ALL IN HER HEAD

• If the perineum hurts, consider a dermatological cause.

• Use dermatitis Rx first, not E2. • No quickies, lots of lube (not KY).• Avoid condoms if possible.• Revision of epis. hardly ever needed.