Post-partum Period

Question 1

What is the definition of the post-partum period?

Answer 1

Period from the delivery of the placenta to 6/52 post natal

Question 2

When does the post natal examination take place?

Answer 2

6 weeks post partum

Question 3

What occurs as part of the post natal examination?

Answer 3

Assessment of mothers mental + physical health

• urinary/bowel/sexual function
• blood pressure
• urinalysis
• breast exam
• abdominal exam
• pelvic exam
• cervical smear if due

Feeding and behaviour of baby

Discuss contraception

Question 4

What are the anatomical changes?

Answer 4

Reduction in size of vulva, vagina + cervix
Poor lubrication of vagina
Transformation zone of cervx withdraws into endocervix
Internal os closes

Question 5

What causes the anatomical changes?

Answer 5

Low oestrogen levels

Question 6

What are the physiological changes?

Answer 6

Initial heavy bleeding = lochia rubra

Changes to pink/white = lochia alba

Question 7

When is period due if no lactation?

Answer 7

By 6/52

Question 8

When is period due if there is lactation?

Answer 8

Menses delayed by a few months as ovarian activity suppressed

Question 9

What changes occur to haemoglobin post partum?

Answer 9

Rises

Question 10

What changes occur to the white cell count post partum?

Answer 10

Very high

Question 11

What happens to the LFTs post partum?

Answer 11

Increase

Question 12

What happens to the cholesterol/triglyceride levels post partum?

Answer 12

Elevated at term, fall slowly

Question 13

What hormones cause hypertrophy of breast tissue?

Answer 13

Progesterone 
Oestrogen 
Prolactin 
Growth hormone
Adrenal steroids

Question 14

What happens with hypertrophy of breast tissue?

Answer 14

Formation of new alveolae budding from milk ducts

Question 15

Why is milk not produced with high levels of prolactin in pregnancy?

Answer 15

Oestrogen and progesterone inhibit the effects

Question 16

What action releases prolactin?

Answer 16

Suckling of the nipples

Question 17

What is the effect of oxytocin?

Answer 17

Contraction of the myoepithelial cells around the alveolae causing the expulsion of milk into the ducks

Question 18

What is the ‘let down’ reflex?

Answer 18

Oxytocin is released in response to suckling, hearing/seeing a baby cry, and emotional stress

90 minute cycle of ‘let down’ as oxytocin release is pulsatile

Question 19

How does breast milk differ from normal milk?

Answer 19

Lower salt content 
Higher energy content 
Less protein 
More lactose 
More digestible by a human baby

Question 20

What is foremilk?

Answer 20

Milk produces at the start of suckling and has a higher water content

Question 21

What is hind milk?

Answer 21

Milk at the end of suckling that is higher in fats and iron

Question 22

What does breast milk contain for protection?

Answer 22

Lactoferrin
Bactericidal enzymes
Lymphocytes
IgA

Question 23

What is lactoferrin?

Answer 23

Glycoprotein that binds with iron - preventing the proliferation of E coli which is iron dependent

This encourages colonisation of the gut flora

Question 24

What are early problems within the post partum period?

Answer 24

Postpartum haemorrhage 
Retained placenta 
Uterine inversion 
Thromboembolic disease
Puerperal sepsis

Question 25

What is post partum depression?

Answer 25

Depression occurring within 4 weeks of birth

Question 26

What is puerperal psychosis?

Answer 26

Mental health condition occurring after birth

Question 27

What are the symptoms of puerperal psychosis?

Answer 27

Restlessness
Anxiety
Mania 
Paranoid thoughts
Delusions

Question 28

What medication can be used to suppress lactation?

Answer 28

Cabergoline