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Normal Puerperium & Lactation Flashcards

1
Q

a normal puerperium lasts how long?

A

postpartum period lasting 6-12 wks

changes of pregnancy are reversed

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2
Q

immediate puerperium occurs when?

A

first 24 hrs after parturition

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3
Q

early puerperium occurs when?

A

24 hrs to 1 wk postpartum

breast milk comes in

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4
Q

remote puerperium occurs when?

A

period of time required for genital organ involution & return of menses; usually 1st wk to 6th wks

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5
Q

what happens during the immediate puerperium period?

A

dictated by events of delivery, type of anesthesia or analgesia, complications during delivery
BP & pulse every 15 minutes (preeclampsia can occur up to 6 wks postpartum)
maternal temp at least every 4 hrs (big one is endometritis)
post anesthesia care provided by anesthesiologist or obstetrician

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6
Q

why do we take mom’s temp so often after delivery?

A

watching for endometritis

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7
Q

what are some of the physical changes that occur during immediate puerperium

A

placental delivery & involution begins
uterine involution- UCs regular, strong, coordinated, begin to decrease about 12 hrs postpartum
postpartum chills may last up to 60 min

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8
Q

bladder issues during immediate puerperium

A

urinary stasis
proteinuria
incomplete bladder emptying for 1-2 days

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9
Q

after pains

A

cramping that occurs during breast feeding- means uterus is contracting down on self

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10
Q

what occurs during early puerperium

A 
cervix gradually closes
vagina, perineum, pelvic musculature decrease to nml size, increase in tone
episiotomy/tears heal
lochia rubra
lochia serosa
lochia alba
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11
Q

lochia rubra

A

postpartum vaginal d/c heavies in the first 3-4 days

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12
Q

lochia serosa

A

more serous, mucopurulent vaginal d/c from 3-4 days to 2-3 wks postpartum

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13
Q

lochia alba

A

thicker, mucoid, yellowish-white vaginal d/c from 2-3 wks to 5-6 wks postpartum

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14
Q

what occurs during remote puerperium

A

uterine involution complete by 6-8 wks
lochia ceases about 5-6 wks postpartum
striae fade from red to silver but are permanent
hair pattern returns to nml over 6-15 months pp(postpartum)

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15
Q

when does ovulation begin after birth

A

can begin as early as 27 days after delivery
avg. 70-75 days in nonlactating woman
avg 6 mo in lactating woman

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16
Q

when doe menstruation begin after birth

A

at 7-12 wks in nonlacting mothers & as late as 36 mo in breastfeeding mothers

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17
Q

postpartum care

A

encourage early father/partner involvement
skin-to-skin contact w/ baby should occur in <1hr; rooming-in should be encouraged & supported; support & reassurance to new parents is important; imp. for mother to sleep & regain strength, recover from labor; regular diet ad lib; stool softener PRN; early ambulation encouraged to prevent thrombophlebitits; shower ad lib; IV rehydration PRN

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18
Q

care of the vulva

A

teach pt to cleanse vulva from anterior to anus, look for signs of infxn; apply ice bag to perineum 1st 24 hrs post delivery; warm sitz baths beginning 24 hrs after delivery; oral analgesics often required; pelvic muscle exercises may be helpful

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19
Q

care of bladder

A

encourage pt to void as ASAP after delivery; cath placement may be necessary if voiding is too difficult: trauma to bladder during L&D, regional anesthesia, vulvar/perneal pain/swelling or episiotomy

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20
Q

care of breasts

A

if going to bf, it is ideal to begin on-demand bf <1 hr post delivery; well fitting brassiere very important;

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21
Q

what do you do if pt is not going to bf

A

ice packs & analgeisics for engorgement if not bf- lactation suppression meds discouraged
avoid nipple stim
milk prod. should stop w/in a wk

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22
Q

postpartum fever

A

temp >/= 38C (100.4F) on 2 occasions 6 hrs apart
nursery should be notified of maternal fever, esp. in 1st 24 hrs post delivery
look for s/sx of infxns

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23
Q

what are some s/sx of infxn w/ a postpartum fever

A 
enometritis
mastitis
UTI
thrombophlebitis
infected tear/ surgical site
complications of anesthesia
*labs: CBC, UA, others as indicated
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24
Q

suggestion for icing perineum

A

frozen giant maxipad with witch hazel frozen into it

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25
common postpartum (pp) complications
``` uterine hemorrhage preeclampsia/eclampsia infxns urinary retention thromboembolism/thrombophlebitis pelvic musculoskeletal pain neuropathy (pudendal nerve damage) sweat a lot/ pee a lot (way to get rid of extra fluid) ```
26
pp IMZ
300 mcg of anti-Rh(D) IG (RhoGAM) w/in 72 hrs of delivery if mother is Rh(D)-neg & baby is Rh(D)-pos; MMR postpartum if not already Tdap if due Hep B may be given
27
when can combination OCs be used in NON-bf women?
2-3 wks pp
28
what type of OC is safe in bf women?
progestin-only- depo-provera, levonorgestrel
29
tubal ligation
2nd MC method of contraception used in US | may be performed at time of c/s, 24-48 hrs after vaginal delivery, or immediately pp in women w/ epidural in place
30
when can IUD insertion be done pp?
at first pp visit (4-6 wks pp) | copper IUD or prgestin-containing IUD
31
hospital stay times
48 hrs for vaginal delivery 96 hrs for c/s doesn't include day of delivery
32
short stay criteria for early d/c
``` mother afebrile, VSS amt & color of lochia appropriate firm uterine fundus adeq. urine output no evid of infxn in wound/repair sites mother able to ambulate w/ ease no abnormal physical/emotional findings mother able to eat & drink pp f/u care arranged mother ready to care for self & baby pp hgb or hct nml ABO & Rh type are known IMZ have been administered PRN mother instructions for home care & f/u support persons are avail. in home ```
33
minimal caloric req. for adequate milk prod. on avg is?
1800 kcal/day
34
pp nutrition general info
fluid intake important balanced, nutritious diet ensures healthy mother & baby vit. supplements routinely not needed; may recommend to continue PNV Ca2+, vit B 12, vit D most imp iron given only PRN
35
pp considerations
no sex sooner than 2wks pp contraception methods reviewed at d/c mother should be given contact info if she has any questions/problems
36
pp d/c discussion should include
condition of newborn immed. needs of newborn feeding techniques, skin/umbilical cord care recognition of neonatal illnesses supprot systems available instructions in case of emergency/complications importance of CH IMZ
37
pp f/u care
support & reassurance are extremely important in pp period involvement of the newborn's father & extended family community & hospital support should be easily available for mother & newborn
38
pp visits for mom time fram
visit & exam 4-6 wks after uncomplicated vaginal delivery visit & exam 7-14 days after c/s or complicated delivery most women may resume regular work & activities by 4-6 wks pp
39
pp visits for mom should include?
``` interval hx: PE, wt, BP, thryroid, extremities, breasts, abdomen, pelvic adaptation to newborn bf issues discussed OCP reviewed pp depression eval labs PRN (Hgb, pap, TSH) counseling/education PRN- HPV vaccine? ```
40
what type of changes during pregnancy & puerperium do mammary glands undergo?
proliferation of alveolar epithelial cells formation of new mammary ducts develop. of lobular architecture epithelium differentiates for secretory activity increase in breast size (gain 400g each) hypertrophy of blood vessels, myoepithelial cells, connective tissue
41
3 stages of lactation
mammogenesis lactogenesis galactopoisesis *multiple, complicated hormonal interactions involved in lactation
42
mammogenesis
mammary growth & development | requires estrogen & progesterone
43
lactogenesis
initiation of milk secretion | requires prolactin
44
galactopoiesis
maintenance of milk secretion | requires prolactin, oxytocin (suckling)
45
when is lactation initiated?
when plasma estrogens, progesterones, and human placental lactogen levels fall after delivery
46
how do you maintain established milk secretion?
requires suckling & emptying of mammary ducts & alveoli
47
how long does it take for prolactin levels to return to nonpregnant levels in absence of suckling?
2-3 wks pp
48
colostrum general info
premilk secretion present in 1st 2-3 wks pp: yellowish alkaline secretion, may begin in last months of pregnancy
49
make up of colostrum
higher specific gravity, protein, vit A, Ig, Na, Cl content than mature breast milk lower carb, K, fat content than mature breast milk normal laxative action
50
what drives milk production?
prolactin | others: insulin, cortisol, etc
51
substrates for milk are derived from?
maternal gut & liver
52
what is the principal carb in breast milk?
lactose
53
mature human milk contains what?
``` 7% CHO as lactose 3-5% fat 0.9% protein minerals vit enzymes H2O 60-75 kcal/dL provided to infant ```
54
immune support & bf
maternal transfer of Ig thru breast milk provides immunologic defense for the newborn as the immune system develops: highest output during first wk all classes of Ig in breast milk (90% IgA) breast milk is highly anti-infective (primarily leukocytes) other factors that help protect the infant from dz & develop a nml immune system
55
what is the avg milk production in bf mother?
120 mL by the second pp day & increases to 300 mL/d by pp days 10-14
56
what are some things that may increase milk yield?
crying baby positive family or provider support of bf anticipation of nursing sexual stimuli (CNS modulated release of oxytocin)
57
bf recommendations
exclusive up to 6 months partial bf 6-12 mo or longer WHO suggests up to 2yrs or beyond ongoing practitioner support increases proportion of mothers who bf giving formula to new mothers at d/c from the hospital has been shown to discourage bf
58
maternal advantages of bf
``` convenient, economical emotionally satisfying/ bond w/ infant aids in uterine involution improves GI motility & abosrption delays ovulation may protect against ovarian CA increased wt loss pp ```
59
maternal disadvantages of bf
inconvenient for some yield may decrease if pumping a lot nipple tenderness, mastitis possible
60
what are CI to bf?
``` illicit drug use excess alcohol intake human T-cell leukemia virus type 1 HIV active breast CA active TB or varicella infxn galactosemia of newborn maternal intake of certain meds ```
61
advantages of bf in infants
easily digestivle, ideal composition & temp | free of contamination; good source of Ig; improved cognitive development & intelligence
62
infants have a decreased incidence of what with bf?
``` diarrhea lower RTIs necrotizing enterocolitis invasive bacterial infxns SIDS obesity CH allergies Type 1 DM Crohn's dz UC lymphoma ```
63
disadvantages of bf to infants
slightly increased risk of neonatal jaundice in 1st few wks not usually possible for infants that are weak, ill, or very premature (cleft palate, choanal atresia, PKU- may be fed expressed breast milk); mothers w/ CF have high Na content in milk
64
when is it ideal to begin bf?
within 1-2 hrs of delivery
65
when does milk usually come in?
3rd or 4th pp day | initial discomfort d/t engorgement
66
baby & getting milk
baby must latch on correctly to suckle effectively w/ the mouth entirely covering the areola; the tongue will milk to nipple to express the colostrum
67
bf & supplementation
best to avoid supplementing breast milk in the first 6-8 wks unless absolutely necessary-baby is losing wt, severe nipple or breast leasion, pregnant mother, severley ill mother
68
avoid using artificial nipples, which may_______infant's suckling reflex
weaken | may use a dropper or tube
69
preparing to bf
wash the hands w/ soap & water | clean the nipples & breasts w/ water
70
comfortable positions for nursing
upright or rocking chair mother lying on her side using pillow to prop the baby
71
allow infant to feed on demand how often?
q 3-4 hrs | always bf on both breasts
72
start bf w/_____min each breast/feeding, working up to________min/side/feeding
5 minutes | 5-10 min
73
what should you do to stimulate suckling reflex or keep baby awake?
stimulate infant's cheek or mouth | express some milk into mouth
74
how do you remove infant from breast?
gently open mouth by lifting outer border of the upper lip to break suction
75
you want to make sure you place the entire_____&_____ in infant's mouth
nipple & areola
76
bf should be initiated when after delivery?
< 1 hr post delivery
77
frequency & duration of feeds should be on demand, but may be?
every hour, 8-12x's/day in 1st few wks | typically 10-15 min each breast at each feed- depends on milk supply, efficiency of milk transfer, infant's behavior
78
feedings initiated based on infant cues
sleeping infant making suckling motions of the lips moving the mouth toward an object sucking on the hands irritation & crying *should wake newborns up to feed every few hrs
79
signs of infant satiety
release of the nipple relaxation of facial muscles, hands falling asleep while feeding
80
postpartum care concerning bf
evaluate mother & baby for adequacy of latchin on, suckling, milk production, and assessment of intake maternal knowledge & resources should be discussed ideally a lactation nurse will follow up w/ family 48 hrs after d/c
81
infant assessment of bf
urine output: 6 wet diapers/day stools: >4 soft stools/day wt gain/loss: expect 5-7% loss initially; regain birth wt @ 2 wks jaundice
82
mother assessment of bf
supplementation painful nipples engorgement mastitis
83
painful nipples
``` common! often occur 1st few wks of bf dry heat/application of expressed milk to nipples bet. feeds may help vaseline/lanolin/vit A&D ointment tx candida infxn if present nipple shields only as last resort ```
84
engorgement
occurs 1st wk pp | d/t vascular congestion & accumulation of milk
85
how do you help and prevent engorgement
breast massage & around-the-clock feedings
86
how else can you help relieve engorgement
oral analgesics cool compresses partial expression of milk before feedings will help relieve discomfort & engorgement
87
mastitis occurs most frequently in?
primiparous mother
88
what causes mastitis?
coagulase-positive S. aureus
89
what should be suspected in recurrent or bilateral mastitis?
neonatal strep infxn
90
what will you see in mastitis?
painful, erythematous lobule in an outer quadrant of 1 breast during 2nd or 3rd wk pp; Ab (antibody) coated bacteria in milk
91
in mastitis it is important to continue bf why?
prevents milk stasis
92
what Abx are used to tx mastitis
cephalosporins dicloxacillin methicillin *local heat, well fitted bras also help
93
what might develop if mastitis is left untreated?
breast abscess- pitting edema & fluctuance over the inflamed area; I&D abscess, start Abx; discontinue bf
94
indications for suppression of lactation
women who do not desire bf women who cannot bf failure of attempted bf fetal or neonatal death
95
methods of suppression of lactation
stop or do not begin bf, milk expression, or pumping avoid nipple stimulation wear supportive bra medical suppression w/ bromocriptine or estrogens is not recommended
96
complications of suppression of lactation
``` breast engorgement breast pain leaking breasts sx's will generally improve in 2-3 wks oral analgesics helpful ```

OB (13 decks)

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