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11.7 Postpartum Care

Table of Contents

11.7.1 Mastitis

It is an infection/inflammation of the tissue of one or both of the mammary glands inside the breasts. Mastitis usually affects women who are producing milk and breast–feeding.

Diagnostic Criteria

May develop rapidly, breast becomes red and swollen, tenderness, warmth and burning sensation

Non Pharmacologic treatment

  • Drinking plenty of liquids and resting
  • Feed the baby more frequently. If an individual cannot feed the baby more frequently, expressing the milk more often can be helpful. During a feed, start with the affected breast. This ensures that it is drained more regularly and after a feed, gently express any leftover milk

Pharmacological treatment

A: Ibuprofen 500mg 8 hourly for 5 days

OR

A: Paracetamol 500–1000mg 8 hourly for 5 days

11.7.2 Abnormal Uterine Bleeding in Pre-Menopausal Women

Abnormal uterine bleeding (AUB) is a common condition affecting womenof reproductive age that has significant social and economic impact. Pre-menopausal abnormal uterine bleeding can be ovulatory, anovulatory, or anatomic

Diagnostic Criteria

Ovulatory might be associated with

  • Premenstrual symptoms
  • Dysmenorrhea

Anovulatory

  • Irregular bleeding, often heavy
  • endometrial hyperplasia

Anatomic

  • Fibroids, polyps, or adenomyosis
  • Often heavy bleeding, pain
  • Uterus might be enlarged

Investigations

  • A complete blood count (CBC)
  • Pregnancy test
  • Cervical and vaginal swab
  • Ultrasound
  • Testing for coagulation disorders should be considered only in women who have a history of heavy menstrual bleeding beginning at menarche or who have a personal or family history of abnormal bleeding
  • Other investigations might be done on the basis of clinical suspicions

Pharmacological Treatment

The treatment will depend of the causative factor.

B: Mefenamic acid (250 mg)

OR

A: Ibuprofen (200–400 mg)1–2 tablets before or at beginning of menses, then 1 tablet every 6–8 hours for 5days

C: Tranexamic acid (500 mg–1000 mg every 6–8 hours as required

Combined oral contraceptives: Useful for anovulatory bleeding, might have benefit for ovulatory bleeding11

A: Medroxyprogesterone acetate (5–10 mg/d for 10–14 days initially and repeated for 10 days each month thereafter

Note:
AUB in the adolescent most commonly represents ovulatory dysfunction related to immaturity of the hypothalamic-pituitary-ovarian axis
Selection of a medical therapy for AUB in adolescents should consider the need for contraception. Long acting reversible contraception may be considered first line therapy for both sexually active adolescents and, with individualized counseling, non-sexually active adolescents

Surgical management

AUB not responding to medical treatment may be due to intracavitary lesions such as submucosal fibroids. AUB secondary to submucosal fibroids may be managed by hysteroscopy myomectomy.

11.7.3 Dysmenorrhea

It is a painful menstruation preventing normal activities and requires medication. There are 2 types of dysmenorrhea:

Primary (no organic cause). Typically, in primary dysmenorrhea pain occurs on the first day of menses, usually about the time the flow begins, but it may not be present until the second day. Nausea and vomiting, diarrhea and headache may occur.

Secondary (pathological cause) e.g. PID and uterine polyposis and membranous (castoff endometrial cavity shed as a single entity (rare).

Pharmacological Treatment

A: Ibuprofen 200–600 mg (PO) 8 hourly (maximum 2.4 g/day)

OR

A: Acetylsalicylic acid 300–600 mg (PO) 4 hourly

OR

A: Diclofenac 50–100mg (PO) 8–12 hourly

OR

C: Mefenamic acid 500mg (PO) 8 hourly

AND

A: Hyoscine butyl bromide 20mg 8 hourly for 5 days

Women with regular complaints can easily detect length of use during their periods (2–3 days usually sufficient). Treat the underlying condition if known.

Note: For primary dysmenorrhea patients may be advised to start taking ibuprofen one or two days before menses and continue for three to four days during menses to minimize painful menstruation

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