10.) Observation of women in the puerperium , uterine palpation and loch assessment Flashcards
What is the puerperium?
The period after childbirth, typically lasting about 6 weeks, during which the mother’s body returns to a non-pregnant state.
What is uterine involution?
The process by which the uterus progressively shrinks and returns to its pre-pregnancy size over 6 weeks.
Where is the uterine fundus located immediately after birth?
Around the level of the umbilicus.
How much does the fundus descend daily after birth?
Roughly 1 cm per day.
By which day postpartum is the fundus usually no longer palpable above the pubic symphysis?
By Day 10.
What does a firm uterus on palpation indicate?
Normal involution. A “boggy” or soft uterus may indicate atony, which can lead to postpartum hemorrhage.
What could a larger or higher-than-expected uterus postpartum suggest?
Retained products of conception or infection.
What is Lochia Rubra, and how long does it typically last?
Bright red discharge with small clots, resembling heavy menstrual flow, lasting from Day 1 to Day 4.
Describe Lochia Serosa.
Pink or brownish discharge as bleeding lessens, occurring from Days 4 to 10.
What is Lochia Alba, and when does it occur?
Yellow or white discharge, signifying the end of bleeding, occurring from around Day 10 up to 6 weeks.
What could foul-smelling lochia indicate?
Possible infection, such as endometritis.
Which hormones drop significantly postpartum, allowing prolactin to rise?
Estrogen and progesterone
What is the role of prolactin in the puerperium?
Promotes milk production, with levels increasing further with breastfeeding.
How does oxytocin affect the uterus postpartum?
It aids uterine contractions, helping speed up involution.
What are signs of a postpartum infection?
Fever, uterine tenderness, and foul-smelling lochia.
What might large blood clots or very heavy bleeding postpartum indicate?
Uterine atony or retained placenta, which are hemorrhage risks.
Fat which is accumulated during pregnancy is used for
Lactation
What are the components of the growth of milk secreting apparatus?
- Glandular Cells: Produce and secrete milk in response to hormones.
- Alveoli: Small sacs where milk is produced; clusters of glandular cells line each alveolus.
- Ductal System: Network of tubes that transports milk from alveoli to the nipple.
- Breast Nodules: Dense, supportive tissue within the breast that helps structure the milk-producing areas.
Explain which hormones help in lactation
- Estrogen: Stimulates growth of the ductal system, increasing breast tissue size and preparing the ducts for milk transport.
- Progesterone: Promotes development of the alveoli and glandular cells, helping to prepare the breast for milk production.
- Prolactin: Essential for milk production; after childbirth, it signals the glandular cells in the alveoli to start producing milk.
- Cortisol: Supports glandular cell growth and helps regulate milk production by working with other hormones.
- Insulin: Necessary for the development and function of glandular cells, helping supply nutrients for milk production.
- Thyroxine (Thyroid Hormone): Supports overall breast development and metabolic activity, ensuring glandular cells have the energy to produce milk.
- Human Placental Lactogen (hPL): During pregnancy, hPL promotes breast development and prepares the mammary glands for lactation.
These hormones work together, especially estrogen and progesterone during pregnancy, to develop the breast structure and prepare for milk secretion after childbirth.
Why is there no actual milk secretion during pregnancy?
Due to progesterone inhibiting the production of lactalbumin , after delivery there will be progesterone withdrawal and this is the first stimulus for milk secretion however after 3-4 days of delivery there is only colostrum(yellow discharge )which is rich in igA this is because progesterone takes 3-4 days to decrease
The first stimulation was progesterone withdrawal what’s the next stimulus for continuous secretion of breastmilk?
Infant suckling and prolactin
Prolactin is inhibited when the hypothalamus releases dopamine.
Suckling inhibits dopamine , so when suckling stops , dopamine inhibits prolactin
