15. The Pueperium and Breast Feeding Flashcards
What is the pueperium?
What is involution of the uterus?
Describe the process of involution.
6-8w after birth: maternal physical and anatomical changes (esp. to reproductive, urinary and cadiovascular systems), and psychological adjustment to parenthood and its roles and responsibilites.
Uterus returns to pre-pregnant state, fundus can’t be palpated from 10 days as it’s reduced and below pubic symphysis. Usually lasts 6w.
Myometrium thickness returns to normal via ischaemia (uterus and walls contract, apply pressure to placental site and reduce blood supply to uterus), autolysis (self-ingestion of myometrial cells by proteolytic enzymes, removal of redundant actin and myosin muscle fibres and cytoplasm) and phagocytosis (engulf and remove waste products of autolysis). Decidua (uterus lining) shed as locia, regeneration of endometrium (basal layer remains intact).
What is lochia? Describe how the colours change with the time after birth.
What haematological changes does the woman go through after birth?
What cardiovascular changes does the woman go through after birth?
Vaginal loss during pueperium, varies in duration, amount and colour, consists of red cells, leucocyte, shreds of decidua and organisms. Lochia types: rubra (red, up to 3d), serosa (pink, up to 10d), alba (yellow-white, deminishes over 3-6w).
Transitory increase in coagulation maximising clot formation on 1st day. Hb conc increases on 1st day postpartum. Withdrawal of oestrogen = gradual reduction in plasma volume, returning to normal in 1w.
Reduction in plasma volume = reduction in BV to non-pregnant state in 10d. Reduction in CO, HR and stroke volume in pre-labour value 24-72h and non-prengnant 6-8w. Decrease in progesterone = removal of excess tissue fluid = normal vascular tone.
What respiratory changes does the woman go through after birth?
What renal changes does the woman go through after birth?
What GI changes does the woman go through after birth?
Reduction in compression of lungs due to reduction in uterine size leading to full inflation of lungs (no more SoB), less O2 demand as reduction in cardiac work and circulatory volume (no more hyperventilation), all return to non-pregnant 6-12w.
Dilation of renal tract resolves. Displaced bladder and stretched urethra return to prepregnant. Increased diuresis occurs 2 -5th day for excretion of broken down products following pregnancy.
GI motility, food absorption, LOS pressure all increase back to normal levels. Gastric emptying slower during labour so gastric volume increased.
What neuromuscular and integumentary changes does the woman go through after birth?
What inhibits milk synthesis during pregnancy?
Increased sensitivity of CNS and PNS, return to normal 36h. Relaxin responsible for generalised ligamentous relaxation (so uterus can be accommodated) and softening of collagenous tissues causing lordosis during pregnancy, return to normal up to 5m. Melanocyte-stimulating hormone responsible for hyperpigmentation of certain parts of body e.g. face, neck, abdo midline.
High levels of oestrogen and progesterone. Once placenta delivered = reduction in production of oestrogen, progesterone and prolactin.
What is the breast composed of?
Describe the 3 different changes in breast and lactation.
15-25 lobes, 20-40 lobules, alveoli, milk ducts, lactiferious sinuses, glandular and CT, myoepthelial cells, blood, lymph, nerve, fat.
1) Mamogenesis: mammary duct-gland growth and development, from 6w. Oestrogen = growth of lactiferious ducts and tubules and increase in breast size. Progesterone, prolactin and hPL = proliferation and enlargement of alveoli, fat deposition, developement of lobes/lobules. 12w nipple and aerola more pigmented. 16w colostrum formed (hPL, prolactin). 24w 20 alveoli formed.
2) Lactogenesis: 3 stages: 1) initiation of milk secretion in alveoli during pregnancy. 2) production of colostrum and milk following progesterone fall and high prolactin. 3) 10d, maintenance of etablished lactation and removal of milk by baby
3) Galactokinesis: removal of milk from gland. Oxytocin secreted in posterior pituitary gland, impulses from nipple -> brain and also triggered by sight, sound and touch of baby. Transported brain -> milk ducts to make milk flow, ejects milk into baby’s mouth. Sometimes spontaneous.
Where is prolactin secreted, and what does it do?
What are some advantages to the baby of breastfeeding?
What are some advantages to the mum of breastfeeding?
Secreted in anterior pituitary gland, impulses from nipple -> brain during feeding, transported in blood from brain -> milk producing cells, stay high for 90mins to make milk for next feed. Level higher at night.
WHO: exclusive BF for 1st 6m. Protection from infections/diseases. Lower risk of SIDS. Right nutritional balance in v. easily digested form. Less constipation. Less obesity and allergies. Free. Always available. Right temperature.
Lowers risk of breast and ovarian cancer, use up to 500cal/day, saves money, maternal bond, acheivement, body back to normal quicker.
What are some disadvantages of breast feeding?
What is the correct position to breast feed?
What problems can arise with positioning and attachment?
Can’t measure amount baby’s getting, difficult/tiring/stressful?, hard to leave baby for long, father can’t feed baby, can be hard to wean baby.
Baby held close to breast on its side with body in straight line, nose to nipple with whole body supported. Head free, able to to tilt it back so can get milk easily.
Sore nipples (friction - incorrect positioning/attachement), engorgement (build up of milk in ducts, breasts hard and lumpy, due to insufficient emptying, can be hard for baby to latch on), mastitis (milk stasis and infection - if milk not removed it tracks back, continue to feed, affected side first, if no improvement then antibiotics).
Label A-G of the breast.
A) areolar glands
B) fat tissue
C) alveoli
D) lactiferous ducts
E) lobule (contains alveoli)
F) lactiferous sinuses
G) areola
