18 Post-Partum Period

Question 1

What is the post-partum period defined as?

Answer 1

Delivery of placenta–> 6 weeks after

Body returns to pre-pregnancy state

Question 2

When is a the post-natal examination of the mother usually carried out (by the GP) and what does it involve?

Answer 2

When?

6 weeks

What?

• BP
• Breast examination
• Abdominal examination
• Pelvic and perineal examination
• Mental well-being

Question 3

What is lochia? How many women will still be experiencing lochia at 6 weeks post partum? (out of 10)

Answer 3

Bleeding post-partum

(discharge after giving birth, containing blood, mucus, and uterine tissue)

1/10 women post partum- experience lochia

Question 4

If a mother is not breast feeding, menstruation will return by 6 weeks postpartum. This may be delayed in mothers who are nursing. What psycological changes can accompany this period?

Answer 4

• Elation
• Anxiety
• Protectiveness
• Overwhelming responsibility
• Rejection of baby

Question 5

Low levels of which hormone cause the female body to revert back to pre-pregnancy state? (Changes: Lower genital tract, haematological, endocrine, CVS function, skeletal muscle, ligaments laxity)

Answer 5

Low levels of oestrogen

Question 6

Fill in the missing labels:

Answer 6

Question 7

What can happen if there is inadequate uterine contraction after delivery?

Answer 7

Postpartum haemorrhage (PPH)

=potentially fatal

=obstetric emergency - prevent major blood loss and CVS shock

Question 8

What are the 4 causes of Postpartum Haemorrhage (4T’s)

Answer 8

• Tone (atony-muscle has lost its strength)
• Tissue (retained placenta)
• Thrombin
• Trauma

Question 9

What are the 2 most likely causes of secondary haemorrhage post partum (typically presents in primary care- after mother has gone home)?

Answer 9

1. Infection (endometritis)
2. Retained products of conception

Question 10

List some of the common problems that can occur in the post partum period (think CVS, infection)

Answer 10

Question 11

Outline the metal health issues that can affect the mother in the post partum period: (4)

Answer 11

Puerperal= post partum period

Question 12

During pregnancy, the full development of the breast is facilitated by 4 hormones. What are these hormones?

Answer 12

Oestrogen

Progesterone

Prolactin

hPL (human placental lactogen)

Question 13

What are the 4 functions of hormones than affect the breasts?

Answer 13

Question 14

How does breast milk protect a baby from infection?

Answer 14

Question 15

What is puerperal mastitis? How is it caused? How is it treated?

Answer 15

Question 16

What drug type can be given to artificially supress lactation?

Answer 16

Dopamine agonists

Dopamine aka prolactin inhibiting hormone (PIH)

Question 17

Outline the mechanism of lactation (prolactin and oxytocin)

Answer 17

Colostrum= first form of milk production

Prolactin stimulates glands of produce milk

Oxytocin stimulates milk let down

Question 18

How does cessation of lactation occur?

Answer 18

• Milk accumulates in breast alveoli
• Distention and atrophy of glandular epithelium
• Local mechanical factors- supress milk secretion
  
  • ​(rather than hormonal changes)

Question 19

Where is prolactin and oxytocin produced and released from?

Answer 19

Prolactin: produced in anterior pituitary and released from there

Oxytocin: produced in hypothalamus and released from posterior pituitary