Normal Puerperium Flashcards
Why is immediate cord clamping after delivery not recommended?
Reduces the red blood cells that an infant receives by more than 50%
With delayed cord clamping, there is a higher red blood cell flow to vital organs in the first week - what effects does this have?
Less infant anaemia at 2 months and increased duration of early breastfeeding
Delayed cord clamping should be carried out unless what is necessary?
Immediate resuscitation
Cord clamping should be delayed by how long after delivery?
3 minutes
What are the advantages of skin-skin contact after birth?
Keeps the baby warm and calm and is thought to improve transition to life outside the womb
What is the current recommendation for skin-skin contact after birth?
Uninterrupted skin-skin contact for 1 hour following birth
Expulsion of the placenta usually occurs how long following birth? Up to when would be considered normal?
5-10 minutes / 30 minutes
What are some signs of placental separation in the 3rd stage of labour?
Uterus contracts, hardens and rises / umbilical cord lengthens / gush of blood occurs (variable in amount)
What is placental separation?
The placenta separates at the spongey layer of the decidua basalis due to shearing force
What is the major advantage of active management of the third stage of labour?
Reduces risk of PPH by 60%
What drugs are used to actively manage the 3rd stage of labour?
Uterotonic drugs which increase uterine muscle tone
What are the two ways that uterotonic drugs can be given in the active management of 3rd stage?
10U oxytocin IM alone or 5U oxytocin with 500microgram ergometrine IM (Syntometerine)
Both ways of giving uterotonic drugs are equally effective at what?
Reducing risk of PPH > 1l
What is the a) advantage and b) disadvantage of using Syntometerine over oxytocin alone as active management of the 3rd stage?
a) Better at reducing small haemorrhages b) side effects include nausea and vomiting
Apart from uterotonic drugs, what are some other ways of actively managing the 3rd stage of labour?
Cord clamping and cutting, controlled cord traction and bladder emptying
What is a normal blood loss in delivery? What would be abnormal? What would be significant?
< 500mls / > 500mls / > 1l
If there is any blood loss in labour apart from the initial ‘show’ what should be done?
Referral to a consultant led unit
What is the puerperium and how long does it last?
A period of repair and recovery, the return to a non-pregnant state which takes around 6 weeks
What is lochia? How long does it last?
Vaginal discharge containing blood, mucus and endometrial castings / lasts 4-6 weeks
What type of vaginal discharge is seen 3-4 days after delivery?
Rubra (fresh blood)
What type of vaginal discharge is seen 4-14 days after delivery?
Serosa (brownish-red, watery blood)
What type of vaginal discharge is seen 10-20 days after delivery?
Alba (yellow)
In a non-breastfeeding woman, when does menstruation begin following delivery?
Around 8 weeks
Why is menstruation delayed in women who are breastfeeding?
Prolactin inhibits FSH production and prevents ovulation
When after delivery does the uterus begin to return to its non-pregnant state?
Immediately after delivery of the placenta
What happens in uterine involution?
Shortening of muscle fibres and death of excess myometrial cells
The fundal height returns from umbilical to pelvic after how long?
2 weeks
Failure of involution can be caused by what?
Retained placental fragments and infection
What are some areas of the body which never return to their pre-pregnancy state?
Cervix, vagina and perineum
What happens to the decidua after delivery?
It is shed and replaced with new endometrium
What does breast milk provide babies with?
Passive immunity and nourishment
What initiates lactation?
Expulsion of the placenta and a reduction in oestrogen and progesterone
When do the breasts become capable of producing milk? Why does this not happen?
20 weeks of pregnancy, but is inhibited by progesterone and oestrogen inhibiting prolactin
What is colostrum?
A thick, yellow fluid produced in the first few days of the baby’s life
What is found in colostrum?
Immunoglobulins and growth factors to mature the gut
