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Reproductive System > Post Partum > Flashcards

Post Partum Flashcards

1
Q

Define post partum period

A

Period from delivery of placenta to 6 weeks after during which the mother’s body returns to a pre pregnancy state

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2
Q

Describe the post natal examination

A
  • at 6 weeks
  • most pregnancy induced changes have returned to normal
  • assessment of woman’s mental + physical health as well as feeding + behaviour of baby
  • direct questions about urinary, bowel + sexual function
  • BP, urinalysis, breast, abdominal + pelvic exam
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3
Q

What changes occur to the lower genital tract during the post partum period?

A

Due to low oestrogen levels:
- vulva, vagina + cervix return to original size
- poor lubrication of vagina
- transformation zone of cervix withdraws into endocervix
- internal os is closed

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4
Q

What changes occur in regards to bleeding in the post partum period?

A
  • bleeding is initially heavy + reduces gradually
  • bleeding normally stops by 6th week
  • passage of clots is not normal
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5
Q

Positive psychological feelings post partum

A
  • gradual falling in love with baby
  • increased closeness to partner (parents now too)
  • increased closeness to own mother
  • protective feeling towards baby
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6
Q

Negative psychological feelings post partum

A
  • distress over delivery process
  • anxiety
  • jealous of baby being centre of attention
  • fears of harming baby
  • overwhelming responsibility
  • resentment of loss of freedom
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7
Q

Types of hormones which affect the breast + their role

A
  • mammogenic: promote proliferation of alveolar + duct cells
  • lactogenic: promote initiation of milk production
  • galactokinetic: promote contraction of myoepithelial cells
  • galactopoietic: maintain milk production
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8
Q

What hormones are involved in the full development of breasts during pregnancy?

A

High levels of oestradiol + progesterone
Gradual increase in levels of prolactin + human placental lactogen

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9
Q

Where is prolactin released from?

A

Anterior pituitary

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10
Q

Describe the release of prolactin + milk production

A
  • suckling stimulates neurons from spinal cord inhibits dopamine release
  • prolactin released by anterior pituitary
  • leads to stimulation of milk production by breast
  • suckling maintains milk production
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11
Q

What does adequate milk secretion require?

A
  • Intact neuroendocrine axis
  • Adequate emptying of breast with infant feeding
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12
Q

Describe the delivery of breast milk

A
  • oxytocin released in response to suckling, seeing/hearing baby
  • causes myoepithelial cells to contract
  • milk is expelled into milk collecting duct
  • ‘let down reflex’
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13
Q

What is oxytocin release inhibited by?

A

Emotional stress
Anxiety

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14
Q

Positive feedback loop of breast feeding

A
  • baby suckles at breast
  • stimulates hypothalamus
  • oxytocin released from posterior pituitary
  • oxytocin stimulates mammary glands
  • more milk produces
  • repeats
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15
Q

Where is oxytocin produced + released from?

A

Produced in hypothalamus
Released by posterior pituitary

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16
Q

How does breast milk volume change over time?

A
  • initially milk volumes are low
  • colostrum is produced (high fat + immunoglobins)
  • as suckling continues, milk volume increases to ~ 800ml per day
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17
Q

How does the breast milk protect the baby from infection?

A
  • lactoferrin: prevents proliferation of E. coli
  • populates neonatal gut with non-pathogenic flora
  • presence of bacteriocidal enzymes
  • immunoglobins
  • T lymphocytes + granulocytes
18
Q

How does lactoferrin from breast milk protect the baby?

A

Bind iron which prevents proliferation of E. coli (iron dependent organism)

19
Q

Types of post partum haemorrhage

A
  • primary: loss of >500ml from genital tract within 24 hours post birth
  • secondary: excessibe bleeding from genital tract between 24 hours to 6 weeks post birth
20
Q

What are the 4 Ts of primary PPH?

A
  • tone: inadequate uterine tone (most common)
  • trauma: laceration e.g. tears or episiotomies
  • tissue: retained placental tissue
  • thrombin: hypocoagulability
21
Q

How can uterine atony cause primary PPH?

A
  • normally, uterine walls contract to cut off blood supply to placenta
  • insufficient tone of muscles > placenta is delivered without cut off blood supply > vessels bleed freely
22
Q

Causes of secondary PPH

A

Retained tissue
Endometriosis

23
Q

Causes of maternal collapse
What can this cause?

A
  • Hypovolaemia after PPH
  • Hypoglycaemia
  • Amniotic fluid embolism

(Can cause cardiac arrest)

24
Q

Describe the structure of the breast

A
  • made up of secretory lobules which empty into ductules which converge into mammary ducts
  • ampulla acts as temporary storage of milk until
    lactiferous duct secretes milk out of
25
Q

What problems can occur during the post partum period?

A
  • PPH
  • DVT + PE
  • retained placental tissue
  • perineal trauma
  • sepsis
  • maternal collapse
  • cardiac arrest
  • domestic abuse
  • mental health issues
26
Q

Why can breast feeding prevent ovulation?

A
  • high levels of prolactin can disrupt the HPG axis by suppressing GnRH secretion
  • low levels of FSH + LH > disrupts ovulatory cycle
27
Q

What is mastitis?

A

Inflammation of breast tissue

28
Q

What is mastitis caused by?

A
  • Infection (staph aureus) entering through skin break
  • or due to stasis of milk in breast
29
Q

Treatment of mastitis

A
  • warm compress
  • continue breastfeeding to relieve pressure
30
Q

What are the post natal baby blues?

A
  • mild depression after birth due to hormonal changes as body returns to non pregnancy state
  • feeling tearful, irritable, anxiety
  • normally self limiting (<14 days) but provide support + reassurance
31
Q

What is post natal depression?

A

Depression symptoms within 4 weeks of delivery, lasting for months

32
Q

Treatment of post natal depression

A
  • self help
  • medications e.g. antidepressants
  • support + reassurance
33
Q

What is puerperal psychosis?

A
  • rare syndrome of anxiety, paranoia, mania + delusions developing within 4 weeks post birth
  • psychiatric emergency - high rate of maternal suicide or infanticide
34
Q

Benefits of preventing unwanted pregnancy in post partum period

A
  • helps improve maternal mental health
  • reduces risk of preterm labour
  • reduces risk of low weight baby
  • reduces risk of maternal anaemia

As allows mother time to reset after birth

35
Q

Why may breastfeeding mothers go longer without a period than a mother who isnt?

A

High levels of prolactin inhibit FSH > no egg can be matured

36
Q

What is the perineum?

A

The portion of skin between her vagina and anus

37
Q

What organism most commonly causes mastitis?
Why?

A
  • Staphylococcus aureus
  • common skin commensals which can enter breast tissue through crack on nipple
38
Q

What is the most common cause of primary PPH?

A

Uterine atony

39
Q

Medical indications of formula feeding

A
  • severe maternal illness
  • maternal HIV
  • mothers on medications that are contraindicated when breast feeding
40
Q

Breast problems in the post partum period

A
  • nipple sensitivity + pain
  • mastitis
  • breast abscess
  • breast lump
41
Q

What is the difference between foremilk and hindmilk?

A
  • foremilk: at start of sucking |higher water content
  • hindmilk: higher fats + iron

Reproductive System (20 decks)

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