Physiology of the Puerperium Flashcards
What 3 things aid the involution of the uterus?
- Contractions
- Autolysis
- Epithelial regeneration and proliferation
What is ischaemia?
Tissue death caused by the constriction of uterine blood vessels following delivery
What is autolysis?
The use of proteolytic enzymes to ingest redundant ischaemic muscle fibres
What are the 3 types of lochia?
- Lochia Rubra
- Lochia Serosa
- Lochia Alba
Describe lochia rubra
- Red in colour
- Fresh blood from placental site
- Lasts 3-4 days
Who may experience less lochia?
Women who had a CS
Describe lochia serosa
- Pink in colour
- Lasts 10-14 days
- May have slightly sweet odour
Describe lochia alba
- Cream/white in colour
- Lasts 4-8 weeks
What may happen around day 7?
A fresh loss of red blood due to the fibrin mesh being shed from the placental site
What hormonal changes occur following delivery?
- Decreased oestrogen and progesterone
- Increased prolactin and oxytocin
- FSH and LH will eventually increase to recommence ovulation
What is lactational amennorhoea?
The absence of a period due to breastfeeding - this does not mean they cannot get pregnant
Why is urinary output decreased in the first 48 hours?
- Decreased oestrogen levels reduces the plasma volume of the blood so less water is absorbed
- Decreased progesterone levels causes unbalanced aldosterone levels
What should be done postnatally to check for urine retention?
Women must give a sample of at least 250ml of urine within 6 hours of delivery
What should be done if not enough urine is produced after 6 hours?
- Ask them to drink lots of water and try again when desperate
- If still not enough, bladder scan +/- catheterise
Describe the levels of separated recti muscles
1cm = normal 2cm = no abdominal exercise for up to 12 weeks 3cm = refer to physio
What are the 5 conditions that should be explained to the mother before discharge?
- DVT
- Infection
- Preeclampsia
- PPH
- Mastitis
What should all women be advised to take postnatally?
10mcg vitamin D
What is stress incontinence?
Urine leaking when sneezing/coughing/laughing
What is urge incontinence?
Frequent and sudden urges to pass urine
When should a paediatrician do a baby’s NIPE?
- APGARs <6
- Premature
- Suspected abnormality
How long do women have to pass urine after delivery/ removal of catheter?
6 hours to pass 250ml
What must all red safeguarding cases have postnatally?
Discharge planning meeting
When should the postnatal Anti-D injection be given if baby is Rh+?
Within 72 hours
When should ferinject be given?
Hb <90
When should SATS be performed?
6 hours after birth
When should the NIPE be performed?
Within 72 hours
How should DVT be explained to the mother?
- Unusual lumps in 1 leg (or both)
- Pain/ redness/ swelling (unilateral usually)
- Chest pain = call 999
How should PET be explained to the mother?
- Headaches and/or visual disturbances
- Epigastric pain
- Swelling in hands/feet
How should PPH be explained to the mother?
- Soaking pads every hour
- Clots bigger than a 50p piece
- Large increase in bleeding
How should infection be explained to the mother?
- Pain/ redness/ swelling
- Feeling unwell
- Yellow/green discharge
- Unpleasant smell
How should mastitis be explained to the mother?
- Pain/ red patches/ swelling
- Feeling unwell
- Pain when feeding
- Breasts hard/ shiny
Why do some babies have swollen nipples?
Mother’s circulating hormones
