2. WOUND CARE

3. Question 1 What is an easily available method for drying episiotomy wounds?

4. TO HEAL WELL, A WOUND NEEDS: 1.Drying 2.Avoidance of friction, heat & infection 3.Reduction of mechanical tension C/S scars & episiotomies can therefore be difficult to manage!

5. 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!

6. ESPECIALLY EPISIOTOMIES … Excessive discomfort is often due to irritant contact dermatitis If topical E 2 is ineffective, do not continue >1 month

7. PUERPERAL SEPSIS

8. Question 2 What are the three most common causes of secondary PPH?

9. 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. 2 nd trimester)

10. MANAGEMENT Ultrasound to exclude RPOC/abscess Assess blood loss / Hb Antibiotics Early referral to hospital PRN

11. PELVIC FLOOR

12. IDENTIFYING HIGH-RISK WOMEN Operative delivery + episiotomy Obese Constipated Chronic cough Pre-existing bladder dysfunction ?? Family history of prolapse

13. REALISTIC IS THERE A REALISTIC PROGRAMME ? Minimise risk-factors Pelvic floor muscles are linked neurologically to “corset” muscles SO: long walks will help PFM strength

14. BREAST FEEDING

15. Question 3 How far apart do breast-feeds have to become before the mini- pill is less effective?

16. 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 !!

17. CONTRACEPTION

18. Question 4 Which currently-available female contraception method has the lowest pregnancy rate?

19. DEAD ?? IS LAP.STERI 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!

20. 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.

21. SEXUAL PROBLEMS

22. Question 5 What is the most common cause of post-partum superficial dyspareunia?

23. “I’M NOT INTERESTED” Antenatal education of male. The exhaustion factor. Female selfishness!

24. NOT DYSPAREUNIA: NOT ALL IN HER HEAD If the perineum hurts, consider a dermatological cause. Use dermatitis R x first, not E 2. No quickies, lots of lube (not KY). Avoid condoms if possible. Revision of epis. hardly ever needed.