10. Post-partum Period Flashcards
What is the definition of the postpartum period?
Period from delivery of placenta to 6 weeks post natal
Period when the changes that occurred as a result of pregnancy revert to the pre-pregnancy state
What is asked and examined in the postnatal examination?
Urinary, bowel and sexual function, incontinence
BP, urinalysis, general breast, abdominal and pelvic/perineal as required
What are the changes to the lower genital tract post partum?
Secondary to low oestrogen levels
Reduction in size of vulva, vagina and cervix
Poor lubrication of vagina
Transformation zone of the cervix withdraws into the endocervix
Internal os is closed
What are the physiological changes post partum?
Bleeding - initial heavy flow
Changes from red-brown/red-pink-heavy white
Duration of bleeding is variable
Passage of clots not normal except for one on D3/4
Endometrium regulates
What negative feelings may be present in post partum?
Dissatisfaction, disappointment or distress over delivery
Anxiety about baby
Rejection or ambivalence about baby
Jealousy about baby being centre of attention
Fears of harming the baby
Physical discomfort and anxiety about physical damage during birth
What happens in preparation for lactation?
Progesterone, oestrogen, prolactin, growth hormone and adrenal steroids change
Hypertrophy in pre-existing alveolar-lobular structures
Formation of new alveolae by budding from milk ducts, proliferation of milk collecting ducts
Prolactin released by action of suckling
When are prolactin levels highest?
In early puerperium and reduce slowly, only returning to normal after weaning
What is milk secretion dependent on?
Adequate emptying of secreting glands
Describe the delivery of breast milk
Oxytocin released in response to a variety of sensory inputs (suckling)
Oxytocin causes contraction of myoepithelial cells situated around the alveolae to cast them to contract and expel the milk
What is breast milk called initially?
Colostrum - high fat content, high in immunoglobulins
How much milk is produced a day?
800ml
What is breast milk composed of?
Water Protein Carbohydrates/lactose Various fats Antibodies Vitamins and minerals Human milk oligosaccharides Hormones Bacteria
What is the role of lactoferrin in breast milk?
Binds iron, preventing the proliferation of E.coli
What are the medical indications when formula feeding is used?
Severe maternal illness
Maternal HIV
Mothers on medications that are contraindicated when breastfeeding
What are some breast problems in post partum?
Nipple sensitivity and pain Engorgement Mastitis Breast abscess Breast lumps - benign or malignant
