Post Partum

Question 1

What is the let down reflex?

Answer 1

Latching on/suckling = stimulation of mechanoreceptors on intercostal nerves

Impulses to dorsal root ganglion then to hypothalamus

Inhibits Dopamine release

Increases Prolactin = lactogenesis

Increase in Oxytocin from posterior pituitary = contraction of myoepithelial cells which pushes milk into ducts

Question 2

What is colostrum and when is it produced?

Answer 2

Low:
Fat
Water
Sugar

High:
IgM
IgA
IgG
White Cells

Laxative! So baby can pass meconium.

Produced at 0-3 days

Question 3

What is the composition of breast milk and when is it produced?

Answer 3

High:
Fat
Lactose
Vitamins (NOT D)

Low:
Vitamin D

Also has endocannabinoids and casein (can’t digest so also laxative)

Question 4

Which drugs are contraindicated during breastfeeding? (6)

Answer 4

• Alcohol
• Chloramphenicol
• COCP
• Lithium
• Nicotine
• Tetracyclines

Question 5

What are 6 features of mastitis?

Answer 5

Unilateral breast pain

Erythematous

Pain on examination

Firm and swollen area in a wedge shape

Fever may be present

Nipple fissure

Question 6

What is the management of mastitis?

Answer 6

Continue to breastfeed but get rid of any infected milk

Simple analgesia

Only get antibiotics IF:
No symptom relief within 12-24 hours of removing milk
Breast abscess/nipple fissure
Breast milk culture is positive
Use flucloxacillin OR erythro/Clarithromycin