Post-Partum Period Flashcards
What is the post-partum period
Period from delivery of the placenta to six weeks later
During the period, body returns to pre-pregnant state
What hormone level is characteristic of the post-partum period
Low oestrogen levels
What are some common problems with the post-partum period
Post-partum haemorrhage
Retained placenta/placental tissue - infection
Uterine inversion
Perineal trauma - bruises, tears
Maternal collapse - amniotic fluid embolism, hypoglycaemia, hypotension
Cardiac arrest and thromboembolic disease
Pyrexia/sepsis
What are the two types of PPH and what is the most common cause of PPH
Primary - immediately after baby born up until 24hrs after
Secondary - two or three weeks later with clots. Typically present in primary care with prologned or excessive bleeding. Typically caused by infection and retained products of conception
Most common cause is uterine atony
What physiological mechanisms help to prevent PPH
Uterine contraction constricts blood vessels in myometrium
Uterine contraction helps to push placenta out of uterus
What hormones affect the breast the types of hormones)
Mammogenic - promote proliferation of alveolar and duct cells
Lactogenic - promote initiation of milk production
Galactokinetic - promote contraction of myoepithelial cells
Galactopoietic - maintain milk production
What stimulates and what inhibits prolactin production
Promotes - suckling
Inhibition - dopamine
Describe the let-down reflex
Suckling stimulates receptors in the breast which sends signal to hypothalamus
Hypothalamus sends ON signal to posterior pituitary to release oxytocin
Hypothalamus sends OFF signal to neurones that produce dopamine which stops the inhibition of prolactin release so prolactin is produced
Oxytocin stimulates myoepithelial cell contraction
Prolactin causes production of milk by mammary glands
Why is the return of menstruation delayed in women who breast feed
Return of menstruation is delayed in women who breast feed because oxytocin inhibits neurones in the arcuate nucleus and preoptic area of the hypothalamus so levels of GnRH fall -> inhibits ovarian cycle
How does breast milk protect a mother’s baby from infection
Lactoferrin - binds iron to prevent E. coli proliferation
Populates neonatal gut with non-pathogenic flora
Has bactericidal enzymes
Contains immunoglobulins
Contains lymphocytes and granulocytes for cell mediated immunity
How does the composition of human milk differ to other mammalian milk
Has lower salt content
Has higher energy content
Has less proteins
Has more lactose
Is more digestible by the baby
What mental health conditions arise in the post-partum period
Post-natal blues
Post-partum depression
Puerperal psychosis
What is post-natal blues
Common after delivery and is where there is an altered mood experience due to hormonal changes
Mother feels more tearful or anxious
What is post-partum depression
Where mother has depression within 4wks of delivery
Important to ask mother about feelings of depression
Pharmacological treatment can be given if symptoms last longer than a month
What is puerperal psychosis
Usually occurs within 4wks of delivery
Rare in most women but occurs in 30% of women with pre-existing mental illness
Symptoms: anxiety, mania, paranoid thoughts, delusions
Has suicide risk and infanticide risk
