Lecture 18 - Post Partum Period Flashcards
What is the definition of the post partum period?
Period from the delivery of the placenta to 6/52 post natal
Generally what happens in the post partum period?
When th exchanges that occured as a result of pregnancy revert to the pre pregnancy state
When does a GP do a post-natal exam?
6 weeks post partum
What is normally examined in the 6 week postnatal exam?
Woman’s mental + physical health
Feeding and behaviour of the baby
Urinary, bowel and sexual function, inconitnence
Dyspareunia or anxiety about intercourse
BP, urinalysis, general breast, abdominal and pelvic perineal exam as required
What are some anatomical changes that occur to the lower genital tract in the post partum period?
Reduction in size of vulva, vagina and cervix
Poor lubrication of vagina
Transformation zone of cervix withdraws into the endocervix
Internal os is closed
Why do anatomical changes occur in the postnatal period?
Oestrogen levels are low
What do you call the heavy bleeding that occurs post partum?
Lochia rubra
What is lochia alba?
Changing of red brown blood to red-pink heavy white blood
Should a post-partum lady be passing clots?
No pathological
If there’s no lactation post partum, when does new endometrium form and when will th effort period be due?
3/52
1st period by 6th week
If there’s lactation post partum, when does new endometrium form and when will th effort period be due?
Ovaria activity surpressed so menses delayed by several months
What occurs to the skeletal muscle, skeleton and cardiovascular function post partum?
In clevel of physcial activity
Pre pregnancy laxity returns in ligaments
Cardiovascular changes revert
What psychological changes can occur in the post partum period?
Protectiveness
Love
Elation
Dissatisfaction
Discomfort
Depression
Overwhelming responsibility
What happens to haemoglobin levels post partum?
Increased due to reduced plasma volume
What happens to the white cell count post partum?
Very high
What happens to platelet found post partum?
Rise
What happens to serum ferritin, transferrin and iron levels post partum?
Will increase back to normal levels
How do levels of GGT, AST and ALT change post partum?
All increase following pregnancy
How do prolactin levels change post partum?
Remain elevated in lactating women
What happens anatomically in preparation for lactation?
Hypertrophy in pre-existing alveolar-lobular structures in the breast (INC LACTIFEROUS LOBULES)
Formation of new alveloae by budding from milk ducts
What gland produces prolactin?
Anterior pituitary
What gland produces oxytocin?
Posterior pituitary
What hormones inhibit prolactin?
Oestrogen and progesterone
What stimulates the production of prolactin?
Suckling of the nipple
What hormone is important in the delivery of breast milk?
Oxytocin
What affect does oxytocin have on the breasts?
Stimulates the myoepithelial cells around the alveolar to contract
Also stimulates the longitudinal muscle to contract in the milk collecting ducts
What hormone is important in milk production?
What hormone is important in milk delivery?
Production = prolactin
Delivery = oxytocin
Why is colostrum such low volume?
High fat content and high in immunoglobulins
What happens to volume of breast milk as suckling continues?
Increasing until fully established to about 800ml per day
What are some contents of breast milk?
High energy content
Fat
Protein
Vitamins and minerals
Antibodies water
How is lactoferrin a protective substance in breast milk?
It binds to iron preventing the proliferation of E.coli which is an iron dependant organism
Therefore encourages non pathogenic microbes to colonise the neonatal gut
How are immunoglobulins important in breast milk?
They are transferred to the infant gut where it stays and attaches to the specific environmental pathogens that the mother has been exposed to
What are some medical indications for a baby to be formula fed and not breast fed?
Severe maternal illness
Maternal HIV
Mothers on Meds that are contraindicated when breast feeding
What are some problems that may occur with the breast?
Nipple sensitivity and pain
Engorgement
Mastitis
Breast abscess
Breast lumps
What is engorgement?
What is mastitis?
When the breasts become overly full and painful
Mastitis = when the breast tissue becomes inflammed
What is another term for the post partum period?
Puerperium
What are the 4 Ts for causes of post partum haemorrhage?
Tone (Atony)
Trauma (perineal tears)
Tissue (placenta left inside after delivery)
Thrombin (hypocoagulablity disease)
What are the 2 types of post partum haemorrhage?
Primary
Secondary
What is primary post partum haemorrhage?
Loss of more that 500mls of blood from the genital tract within 24hrs of the birth of the baby
What is atony?
When the uterus doesn’t contract after birth to clamp down on the open blood vessels/sinuses left by the placenta leading to lots of bleeding
What is secondary post partum haemorrhage?
Abnormal/excessive bleeding form the genital tract between 24hrs to 12weeks postnatally
Could be due to retained tissue like the placenta leading to sepsis
How can we try and achieve haemostasis with uterine atony?
Mechanical measures by bimanual uterine compression (put hand in)
Pharmacological measures like syntocinon
Surgical
Why is syntocinon a useful drug to achieve haemostasis in atony?
Contains oxytocin stimulating the uterus to contract
What is the leading cause of direct maternal death?
DVT
VTE
Leading to PE
How are DVTs and VTEs treated generally?
Anticoagulation like heparin, warfarin
Managed by assessing risk factors
What are some mental health issues related to the post partum period?
Postnatal baby blues (need reassurance and support)
Post partum depression
PTSD
Puerperal psychosis
What sexual issues can arise in the postpartum period?
Dyspareunia due to low oestrogen
Perineal trauma
Worried about getting pregnant again
What essentially happens in the post partum period?
Body returning back to pre-pregnancy state
