Peuperium & Lactation

Question 0

Hormonal changes placental hormones

Answer 0

hPL is absent from blood in 2 days
hCG is absent from urine within 7-10 days
Estrogens return to nonpregnant level by 7 days
Progesterone returns to follicle levels by 7 days

Facilitating return of body systems to normal function

Question 1

Define peuperium

Answer 1

6-8 wk transitional phase following birth
Hormonal changes
Physiological changes 
Involution
Healing 
Lactation

Question 2

Hormonal changes: pituitary gland

Answer 2

Gonadotropin (LH & FSH) production remain low in first 2 weeks returns by 4-6 weeks

Prolactin remains high after birth
Lactating: levels drop ~6 wk
Non lactating: within 2 weeks

Oxytocin: increase in response to nipple stimulation

Question 3

HPA negative feedback:

Answer 3

Axis returns where cortisol goes back to releasing a negative effect on the release of ACTH

Question 4

Involution

Answer 4

Process of gradual return to non pregnant state of reproductive organs

Question 5

Involution do Cx

Answer 5

Dilated, bruised, oedemous possible lascetations
Dilation reduces by half in first day
1cm after first week
Slit by 4 weeks

Question 6

Involution of vagina

Answer 6

Oedematous and relaxed w decreased tone

Decreases in size and increases in tone, endothelium is restored by 6-10wk

Question 7

Involution of perineum

Answer 7

Initial healing: 2-3 weeks

Can take up to 4-6 months

Question 8

Involution of uterus

Answer 8

• Contract and ischemia
• Autolysis of extra cellular material reducing size (and number) of myometrial cells
• Regeneration of endometrium:
  
  • decidua divides in to basal and superficial layer
  • superficial layer invaded by leukocytes and is shed as basal layer begins regeneration
  • placental site healing occurs first, the endometrial regeneration
• stage of Involution is reflected by lochia

Question 9

Types of lochia

Answer 9

Rubra
Serosa
Alba

Question 10

Lochia rubra:

Answer 10

> 7 days

Blood from placental site, decidua/endometrium cells, chorion and amnion, vernix, lanugo & meconium

Question 11

Lochia serosa

Answer 11

2-3 weeks

Blood, wound exudate, RBCs, WBCs, cervical mucus, micro organisms, shreds of decidua.

Question 12

Lochia alba

Answer 12

WBCs, and decidual cells

Question 13

Involution of the breasts

Answer 13

• Non lactating women undergo breast Involution in the peuperium.
• Distension and stasis of breasts cause engorgement after 2-4 days
• W/out suckling and milk removal prolactin will decrease and granular tissue will return to resting state.
• Breasts never return to pre pregnant state

Question 14

Cardiovascular changes

Answer 14

• blood loss at delivery
• after delivery CO increases immediately:
  removal of placental blood flow, loss of pressure on IVC increases return to heart
• diuresis occur of 48h to remove excess plasma volume, reducing CO to non pregnant level over 1st week
• smooth muscle reacts to drop in progesterone

Question 15

Respiratory system

Answer 15

• Tidal volume drops with reduced BMR & CO

- reduced size of uterus will remove compression of thoracic cavity

Question 16

Renal system

Answer 16

Micturation may be difficult at first due to tissue damage