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Repro > Lecture 18 Post Partum > Flashcards

Lecture 18 Post Partum Flashcards

1
Q

Post partum

A

Period from the delivery of the placenta to 6 weeks post natal
Reverting back to pre pregnancy state

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2
Q

Midwife responsibilities

A 
Provide contraception 
Advice on breast feeding 
Check episiotomy healing 
Health check and development progress 
Advice on immunisation
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3
Q

Complicated delivery

A

Post natal examination at 6 weeks by GP of obstetrician

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4
Q

Post natal examination

A

Women’s mental and physical health
Check feeding behaviours of the baby
Cervical smear of needed

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5
Q

Low oestrogen levels

A

Lower genital tract inspection

  • reduction in the size of the vulva, vagina and cervix
  • poor lubrication of the vagina
  • transformation zone of the cervix withdraws into the endocervix
  • internal obs is closed
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6
Q

Physiological changes

A

Bleeding - initially heavy glow (Lochia rubra)
Changes from red -brown to red - pink - heavy white (Lochia alba)
Variable bleeding time - 1 in 10 still bleed after 6 weeks
Passage of clot on Day 3 or 4

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7
Q

Endometrium and lactation

A

If no lactation new endometrium by 3 weeks and 1st period in 6 weeks

If lactation, ovarian activity is suppressed and menses is delayed for 6 months

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8
Q

Skeletal muscle and skeleton changes

A

Ligament and muscle laxity resolves

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9
Q

Cardiovascular function

A

Increased PR interval and increased CO reverses by 6 weeks

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10
Q

Haematology changes

A

Hb

  • diuresis causes reduced blood plasma
  • increased Hb

Ferritin, transferritin and iron

  • decreased
  • return to normal by 5 - 8 weeks

Platelets and WCC
- high levels during delivery

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11
Q

Endocrinology changes

A

LFT

  • normal in pregnancy
  • increase after delivery

Cholesterol and triglycerides
- fall slowly over many months

Prolactin
- remain high in lactating women

Thyroxine
- returns to normal in 6 weeks

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12
Q

Puerperium

A

Hours after birth

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13
Q

Maintenance of lactation hormones and effects

A

Hormones involved:
Oestrogen - inhibits HPL during pregnancy
Progesterone - inhibits HPL during pregnancy
Prolactin
Growth hormone
Adrenal steroids

Effects:

  • hypertrophy in alveolar lobular structures
  • formation of new alveolae by budding from milk ducts
  • proliferation of milk collecting ducts
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14
Q

When is prolactin released

A

When baby suckles

Decreases dopamine therefore less inhibition on prolactin

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15
Q

Accumulation of milk inside alveoli

A

Distension and atrophy of the glandular epithelium therefore must empty secreting glands

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16
Q

Galactokinetic hormones

A

Promote contraction of the myoepithelial cells

17
Q

Galactopoietic hormones

A

Maintain milk production

18
Q

Mammogenic hormones

A

Promote proliferation of alveolar and duct cells

19
Q

Oxytocin and Let down reflex

A

Oxytocin causes contraction of the myoepithelium cells causing the alveolae to contract and expel milk into the milk collecting ducts to the nipple

20
Q

Milk collecting ducts

A

Have longitudinal muscle cells which when stimulated causes dilation to improve flow of milk

21
Q

Colostrum

A

Initially secreted when milk volume is low

Contains high fat and immunoglobulins

22
Q

Components of breast milk

A 
Lower salt content 
Lower protein content 
More lactose 
More energy 
More digestible by baby
23
Q

How does breast milk protect against infection

A 
Lactoferrin 
Populates neonatal gut with non pathogenic flora 
Bacteriocidal enzymes 
Immunoglobulin 
Lymphocytes T cells and granulocytes
24
Q

Lactoferrin

A

Binds to iron preventing the proliferation of E. coli

25
Q

Immunoglobulin formation

A

Formed by mother’s Payer’s patches in the gut

26
Q

Maternal indication for formula feeding

A

Severe maternal illness
Maternal HIV
Mothers on medication that are contraindicated for breast feeding

27
Q

Breast problems

A 
Nipple sensitivity 
Engorgement 
Mastitis 
Breast abscesses 
Breast lumps
28
Q

Problems of the peurperium

A 
Postpartum haemorrhage 
Retained placenta 
Uterine inversion - inversion 
Perineal trauma 
Maternal collapse 
Cardiac arrest 
Thromembolic disease
29
Q

Primary and secondary post partum haemorrhage

A

Primary - from birth of baby to 24 hours after

Secondary - haemorrhage 24 hours to 6 weeks after birth

30
Q

Perinatal mental health

A

Postnatal blues
Postpartum depression
Puerpural psychosis
PTSD

31
Q

Postpartum family planning

A

Prevents unintentional pregnancy

Prevents closely spaced pregnancies after child birth

Repro (20 decks)

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