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Chinese Clinical Med 1 > Lactation / postpartum > Flashcards

Lactation / postpartum Flashcards

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Chinese (Mandarin) flashcards
1
Q

What is a normal vs breech baby?

A

Normally, the foetus settles into a head- down (cephalic) position within the pelvis around the 34th-36th week of pregnancy.

o Chin is tucked down towards the chest, the occiput has an anterior presentation to the pelvic outlet and spine is aligned outwards towards the mother’s abdomen.​

o At 32 weeks, approximately 7% of foetuses are breech. The majority of these revert to a cephalic presentation (head down) spontaneously, and only 3% - 4% are breech at term.

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2
Q

What are the types of breech presentation?

A

In a breech presentation, the foetus presents ‘bottom down’.
There are three main types, depending on the position of the legs:
* A) Complete (flexed) breech – both legs are flexed at the hips and knees (foetus appears to be sitting ‘crossed-legged’).
* B) Frank (extended) breech – both legs are flexed at the hip and extended at the knee. This is the most common type of breech presentation.
* C) Footling breech – one or both legs extended at the hip, so that the foot is the presenting part.

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3
Q

What is the moxibustion protocol for breech baby?

A

Apply moxibustion to BL67
* 15 minutes x each toe
* Daily x 2 weeks (teach client to
self-administer)
* If no changes are observed,
add acupuncture points: BL65 & SI1
* Other lifestyle advice? (eg. Postural exercises, yoga)

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4
Q

What are the contradictions of moxibustion?

A
  • Placenta previa (placenta on top of cervix)
  • History of antepartum bleeding (or bleeding later in pregnancy)
  • Multiple pregnancy
  • Known abnormality of the uterus or pelvis
  • History of premature labour or premature rupture of membranes
  • Previous Caesarean section (if more recent than 2 years)
  • Oligohydramnios (too little amniotic fluid around the baby)
  • Known hydrocephalic baby with enlarged head
  • Presence of Rhesus antibodies
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5
Q

What is the differential diagnosis of breech presentation?

A

Qi stagnation > blocks movement of foetus
Qi deficiency > inadequate Qi to move the foetus

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6
Q

What is the postpartum CM diagnosis?

A

deficiency: * Labour exertion > qi deficiency
* Blood loss during labour > blood and yin deficiency

excess: * Retained lochia > blood stagnation

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7
Q

What postpartum treatments should be avoided?

A

Sweating > damages Qi
Moving downwards > damages Spleen
Promoting urination > damages body fluids

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8
Q

What is the CM diagnosis of postpartum depression?

A

Heart blood xu
Heart yin xu
Heart blood xu

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9
Q

What is breast feeding?

A
  • Breast feeding is the most beneficial method of providing the newborn baby’s essential needs for growth, development and protection from illness and disease
  • The first yellow coloured milk is called colostrum
  • Mature milk takes around 60 hours to come in which can sometimes be an uncomfortable process.
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10
Q

What are the mammary glands and their function?

A

Mammary glands
* Mammary glands are modified sweat glands within the breasts.
* Breasts are the hemispheric projections of variable size, anterior to the pectoralis major and serratus anterior muscles
* Mammary glands synthesise, secrete and eject milk and colostrum collectively known as lactation.
* Milk nourishes offspring and provides them with immune protection in the form of WBC, antibodies and antimicrobial substances.

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11
Q

What substances in TCM are vital for breast feeding?

A
  • Blood volume (yin)
  • Qi transformation (yang)
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12
Q

What is breast milk in TCM?

A
  • Breast milk is the product of the transformation of Qi and Blood. Milk cannot be generated without blood, but it cannot be transformed without qi.
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13
Q

What are some insufficient lactation patterns and pathogenesis?

A
  • Long and difficult labour and/or profuse blood loss during labour (watery milk).
  • Emotional concerns (such as worry, anger, frustration, resentment).
  • Qi and Blood Xu
  • Liver Qi stagnation
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14
Q

What is the treatment for Liver Qi Xu in breast feeding?

A
  • Qi and Blood xu: SI1, ST36, SP6, LIV8, GB41, GB21, CV4, CV17, GB20, BL23. Tong Ru Dan, Si Wu Tang.
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15
Q

What is the treatment for Liver Qi stagnation in breast feeding?

A
  • Liver Qi Stagnation: SI1, GB41, GB21, LIV3, SP4, PC6, CV17. Yong Quan San, Tong Gan Sheng Ru Tang.
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16
Q

What are some breast feeding issues to consider?

A

Breast feeding issues to consider:
* Adequate fluid intake: client may need to increase water consumption.
* Improper lactating issues
* Breast surgery: medical or cosmetic procedures may affect milk production
* Formula milk: introducing formula milk decreases breast milk.
* Oral contraceptives, smoking and some herbal remedies: this may decrease breast milk production

17
Q

What are lactation PROMS?

A
  • Breast feeding efficiency: breast feeding self-efficacy scale (BSES)
  • Latching issues: latch, audible swallowing, type of nipple, comfort, hold (LATCH) scoring system
  • Infant malnutrition: neonatal oral motor assessment scale (NOMAS)
18
Q

What is High blood pressure in pregnant women?

A
  • Three main types of high BP experienced by some pregnant women
  • Chronic hypertension
  • Pregnancy induced hypertension (PIH)
  • Pre-eclampsia
19
Q

What is considered healthy and high BP in pregnancy?

A
  • BP monitoring measures the health of the cardiovascular system
  • Top number (systolic) = pressure when heart is pumping
  • Bottom number (diastolic) = pressure in between each beat
  • Healthy BP in pregnancy 120/80
  • High BP 140+/90+
20
Q

What is chronic hypertension?

A
  • Chronic / long-standing hypertension is high BP that was present before pregnancy or HBP that is diagnosed in the first half of the pregnancy (before 20 weeks).
  • This type of hypertension continues after the birth of the baby.
21
Q

What is pregnancy induced hypertension? (PIH)

A
  • Women who develop HBP in the second half of pregnancy without any effects on their kidneys or other organs have ‘pregnancy-induced hypertension.’ This condition requires monitoring in case there is a worsening of BP or progression to pre-eclampsia
22
Q

What is pre-eclampsia?

A
  • Is a potentially dangerous medical condition with life threatening complications if left untreated. Begins 20 weeks after gestation and usually takes the form of HBP and abnormal kidney function.
  • Symptoms: HBP (160/110), proteinuria, rapid swelling of hands and feet, persistent headaches and/or dizziness and visual disturbances such as blurring, flashing lights or spots.
  • Risk factors: HBP, pre-eclampsia previously, history of HBP, diabetes, over 40+, overweight, IVF conception, expecting multiple births
23
Q

What is oedema in pregnancy?

A

Oedema pattern and pathogenesis
Oedema is expected during pregnancy, as women generally increase their ECF by 2500ml during pregnancy

24
Q

What is Kidney yang xu in pregnancy oedema?

A

Kidney Yang Xu
* Swelling of ankles and legs due to overwork (standing too long)
* Treatment: BL23, GV4, KID7, KI3, ST36, CV9 + MOXA. Zhen Wu Tang.

25
Q

What is Spleen Yang Xu in pregnancy oedema?

A

Spleen Yang Xu
* Swelling of face and whole body due to excessive consumption of greasy foods or dairy (damp forming)
* Treatment: BL20, CV12, ST36, SP3, KID7, CV9 + MOXA. Bai Zhu Tang

26
Q

What is retained placenta?

A
  • Normal placental delivery after vaginal birth requires adequate uterine contractions during the third stage of labour.
  • Retained placenta after vaginal delivery occurs when the placenta does not spontaneously separate (with 60 minutes) from the uterine wall during the third stage of labour.
27
Q

What empirical point is used for retained placenta?

A
  • GB21 is an empirical point used to expel retained placenta
28
Q

What is uterus involution?

A
  • Uterus involution takes 6-8 weeks for the uterus to shrink from approximately the size of watermelon to approximately the size of an orange.
29
Q

What is lochia?

A

LOCHIA: lochia refers to the retained products of conception.
* Post-partum vaginal discharge includes a mixture of blood, mucus and endometrial lining, which change colour as the days progress in the post-partum period.
* Days 1 – 4: dark red coloured lochia, mostly consists of blood
* Days 5 – 9: yellowy brown coloured lochia, mostly consists of blood cells and endometrial lining
* Days 10 – 14: whitish coloured lochia, mostly consists of mucus.

30
Q

What herbal properties assist with the explosion of lochia?

A
  • warm, sweet, tonify qi and blood, move blood.
  • Sheng hua tang: famous Chinese herbal formula used during the post-partum recovery period. Formulated to invigorate blood and eliminate stagnation after childbirth.
  • Sheng Hua tang is a perfect balance of warm, sweet, qi tonic, blood tonic and blood moving herbs.
31
Q

What is postpartum (puerperal) fever?

A
  • Post-partum women are quite susceptible to infection and it’s important to understand the risk factors involved in treating these women, referring them in the appropriate post-natal care if required.
  • Post-partum fever occurs in 5-7% of women, with higher rates for those undergoing C-sections.
32
Q

What are the signs of postpartum (puerperal) fever?

A
  • Signs: elevated temperature (above 38 degrees for 24+ hrs)
  • Leg pain or swelling
  • Severe stomach pain
  • Vaginal bleeding (soaks a pad within one hour)
  • Pain, redness, swelling, bleeding or pus at the incision site (post-caesarean).
  • Causes: Surgical site infection, endo, urinary tract infection and mastitis.
  • Treatment: oral antibiotics.
33
Q

What is post-natal depression pattern and pathogenesis?

A

Post-natal depression pattern and pathogenesis:
* Heart Blood Xu: severe blood loss during childbirth (leading to mild anxiety)
* Heart Yin Xu: Blood xu gives rise to yin xu and empty heat (leading to depression)
* Heart Blood stasis: pre-existing blood stasis rebels upwards in the penetrating vessel which disturbs the shen (leading to confusion, paranoia or even suicidal thoughts).

34
Q

What is the treatment of heart blood xu in postpartum depression?

A
  • Heart Blood Xu: HT5, HT7, CV4, CV14, CV15, BL15, LIV8, GB20, ST36, PC6, SP6. Fu Shen San and Gui Pi Tang
35
Q

What is the treatment of Heart yin xu in postpartum depression?

A
  • Heart Yin Xu: HT5, HT7, PC7, CV4, CV14, CV15, LIV8, SP6, GV24. Ren Shen Dang Gui Tang, Tian Wang Bu Xin Dang, An Xin Tang
36
Q

What is the treatment of Heart blood stasis in postpartum depression?

A

PC7, GB17, GB18, GV24, CV14, BL15, SP4, PC6, KID1, LIV3, SP10. Xiao Tiao Jing Tang, Sha Xiang San

37
Q
A

Chinese Clinical Med 1 (21 decks)

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