Lecture 18 Post Partum Flashcards
Post partum
Period from the delivery of the placenta to 6 weeks post natal
Reverting back to pre pregnancy state
Midwife responsibilities
Provide contraception Advice on breast feeding Check episiotomy healing Health check and development progress Advice on immunisation
Complicated delivery
Post natal examination at 6 weeks by GP of obstetrician
Post natal examination
Women’s mental and physical health
Check feeding behaviours of the baby
Cervical smear of needed
Low oestrogen levels
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
Physiological changes
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
Endometrium and lactation
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
Skeletal muscle and skeleton changes
Ligament and muscle laxity resolves
Cardiovascular function
Increased PR interval and increased CO reverses by 6 weeks
Haematology changes
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
Endocrinology changes
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
Puerperium
Hours after birth
Maintenance of lactation hormones and effects
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
When is prolactin released
When baby suckles
Decreases dopamine therefore less inhibition on prolactin
Accumulation of milk inside alveoli
Distension and atrophy of the glandular epithelium therefore must empty secreting glands
Galactokinetic hormones
Promote contraction of the myoepithelial cells
Galactopoietic hormones
Maintain milk production
Mammogenic hormones
Promote proliferation of alveolar and duct cells
Oxytocin and Let down reflex
Oxytocin causes contraction of the myoepithelium cells causing the alveolae to contract and expel milk into the milk collecting ducts to the nipple
Milk collecting ducts
Have longitudinal muscle cells which when stimulated causes dilation to improve flow of milk
Colostrum
Initially secreted when milk volume is low
Contains high fat and immunoglobulins
Components of breast milk
Lower salt content Lower protein content More lactose More energy More digestible by baby
How does breast milk protect against infection
Lactoferrin Populates neonatal gut with non pathogenic flora Bacteriocidal enzymes Immunoglobulin Lymphocytes T cells and granulocytes
Lactoferrin
Binds to iron preventing the proliferation of E. coli
