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Womens Rotation > Breast Feeding & Lactation > Flashcards

Breast Feeding & Lactation Flashcards

1
Q

What are the benefits of breast feeding to the mother?

A
  • There is faster return to the prepregnancy states
  • oxytocin encourages involution of the uterus, decreased blood loss, decrease in breast cancer, ovarian cancer, CVD<
  • Can have a contraceptive effect
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2
Q

What are contraindications to breast feeding?

A
  • anti-neoplastic agents
  • ergotamine
  • methotrexate
  • cyclosporine
  • radio-pharmaceuticals
  • If HIV positive
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3
Q

How much should babies be fed?

A

Encourage demand feeding

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4
Q

What is the mechanism behind the indication of lactation?

A
  • following delivery, the progesterone levels fall, and prolactin levels increase, prolactin and oxytocin is increased by feeding. Regular emptying and breast nipple stimulation required.
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5
Q

What is colostrum?

A

Thick small volume 05 - 5 ml, yellow, lipid and immunoglobilun rich

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6
Q

What are some problems associated with breast feeding? name 4 problems for the mother

A 
Nipple problems
Engorgement
Low supply
Blocked ducts, mastitis , abscess 
Cracked Grazed Nipples
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7
Q

What is the treatment of candida infection in the mother and in the bub?

A
  • Mother: miconazole/ fluconazole

- Baby: Nystatin/ miconazole

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8
Q

What are some questions to ask on history, if you suspect poor supply?

A
  • Does your breast feel softer
  • Does your baby feel for a shorter time but more often
  • Baby feeds better on formula
  • Growth is slowed after 3 months
  • Is the baby unsettled?
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9
Q

What are baby indicators of poor supply?

A

Weight gain which < 500 g per month
Baby becomes less than birth weight at 2 weeks
Small concentrated urine
Infrequent, high, dry, hard stools - green colour
Dry skin and mucus membranes, with poor muscle tone

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10
Q

What are some techniques to increase supply?

A

Improve the positioning and attachment
Increase the number of feeds, increase duration
Offer both breasts at each feed
Express following feeds
Supplemental feeding line (increases the breast stimulation)
Metoclopramide/ Domperidone

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11
Q

What are some clinical features of mastitis?

A

Fever
Indurated, painful area, erythematous
This may require admission but feeding should be continued

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12
Q

How is mastitis treated?

A

Treated with antibiotics - flucloxacillin
If it fails to address the issue, consider a breast abscess
In the vent of an abscess prompt surgical drainage is required.

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13
Q

What is the LOS post caesarian section?

A

4 nights

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14
Q

what is the hospital length of stay post primiparous vaginal delivery?

A

2 nights

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15
Q

What are the questions involved in an obstetrics review post natal?

A
  • General wellbeing
  • Vitals
  • Uterus involution: Palpation, lochia (observation/ report)
  • Wound appearance: Perineum, abdominal
  • Ask about any pain
  • How is urinary and bowel function
  • Breast nipple symptoms and signs (supply)
  • contraception
  • Social worker, physiotherapy, dietician, pastoral care
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16
Q

What factors regarding psychosocial adjustment must be counselled?

A
  • sleep deprivation
  • Libido/ physical changes
  • Cultural practices
  • family income reduction/ role canges
  • Attachment to baby and confidence in parenting
  • Readjustment back to work
17
Q

What is puerperal sepsis

A

maternal temperature > 38 degrees within 2 weeks of birth. The sources include UTI, endometrirtis, infected wounds, mastitis

Less common

  • UTI
  • URTI
  • Surgical
  • IV site
  • Epidural site
18
Q

What are indications of secondary post partum haemorrhage

A

Excess vaginal bleeding more than 24 hours post the delivery of the baby. Causes can be retained placenta/ contents of conception. They have fever, they are tachycardic, they have tender bulky uterus and offensive vginal los

19
Q

What are some critical investigations for secondary post partum haemorrhage?

A

High vaginal swab, Ultrasound and blood culture

20
Q

What is endometritis?

A

It is the inflammation of the endometrium or inner lining of the uterus

21
Q

What are the polymicrobial causes of endometritis? What are anaerobes which cause it and aerobes?

A

aerobes: GAS, GBS, enterococcus, Ecoli, SAureus, klebsiella or Gardnerella

Anaerobes: peptostreptococcus, bacteroides, clostridum

Mycoplasma: ureplasma mycoplasma

22
Q

What is the treatment for endometritis?

A

Fluid resuscitation
Outpatient: oral augmentin
Inpatient Mx: Ampicillin/ Gent/ Flagyl IV
+/- careful curettage after delay of antibiotics

23
Q

What is post partum mood disorder?

A

Post partum blues which affects 80% of women, occurs third or fourth day after the delivery. It involves mood swings, tearfulness, insomnia, loss of concentration. you can get post partum depression and post partum psychosis.

24
Q

What are the post partum contraception options?

A

If not breast feeding have normal range of contraception

  • You get poor libido and vaginal dryness
  • Ovulation: Occurs at 8 weeks in absence of prengnacy

choices
- Lactation amenorrhea (nocturnal prolactin prevents ovulation) - this is 97 % effective . If baby is less than 6 months, no formula or solid supplementary feeds, amenorrhea, 99% effective by adding the minipill

  • Progestagen method
  • Barrier methods
  • irreversible
25
Q

Inform a patient about the minipill, what would you say?

A
  • Minipill is a form of contraception safe to use in breast feeding
  • 30 microgram of levonogestrel
  • It should be commenced on day 21, increased spotting in puerperium if earlier)

-

26
Q

What are other Hormonal contraception available?

A
  • Depo-Provera ( 150 mg of medroxyprogesterone)

- Implanon: 68 mg etonogesterel

27
Q

What is surgical contraception?

A

Tubual ligation - must be appropriately counselled

28
Q

Why is the combined oral contraceptive pill contraindicated in breast feeding?

A
  • reduces the quality and quantity of milk, contraceptive steroids cross in breast milk
  • If not breast feeding, ovulation may return within 25 days ( mean 45 days) therefore adivise commencement of OCP at 21 days

Womens Rotation (19 decks)

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