Post-partum Period Flashcards
What is the definition of the post-partum period?
Period from the delivery of the placenta to 6/52 post natal
When does the post natal examination take place?
6 weeks post partum
What occurs as part of the post natal examination?
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
What are the anatomical changes?
Reduction in size of vulva, vagina + cervix
Poor lubrication of vagina
Transformation zone of cervx withdraws into endocervix
Internal os closes
What causes the anatomical changes?
Low oestrogen levels
What are the physiological changes?
Initial heavy bleeding = lochia rubra
Changes to pink/white = lochia alba
When is period due if no lactation?
By 6/52
When is period due if there is lactation?
Menses delayed by a few months as ovarian activity suppressed
What changes occur to haemoglobin post partum?
Rises
What changes occur to the white cell count post partum?
Very high
What happens to the LFTs post partum?
Increase
What happens to the cholesterol/triglyceride levels post partum?
Elevated at term, fall slowly
What hormones cause hypertrophy of breast tissue?
Progesterone Oestrogen Prolactin Growth hormone Adrenal steroids
What happens with hypertrophy of breast tissue?
Formation of new alveolae budding from milk ducts
Why is milk not produced with high levels of prolactin in pregnancy?
Oestrogen and progesterone inhibit the effects
What action releases prolactin?
Suckling of the nipples
What is the effect of oxytocin?
Contraction of the myoepithelial cells around the alveolae causing the expulsion of milk into the ducks
What is the ‘let down’ reflex?
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
How does breast milk differ from normal milk?
Lower salt content Higher energy content Less protein More lactose More digestible by a human baby
What is foremilk?
Milk produces at the start of suckling and has a higher water content
What is hind milk?
Milk at the end of suckling that is higher in fats and iron
What does breast milk contain for protection?
Lactoferrin
Bactericidal enzymes
Lymphocytes
IgA
What is lactoferrin?
Glycoprotein that binds with iron - preventing the proliferation of E coli which is iron dependent
This encourages colonisation of the gut flora
What are early problems within the post partum period?
Postpartum haemorrhage Retained placenta Uterine inversion Thromboembolic disease Puerperal sepsis
What is post partum depression?
Depression occurring within 4 weeks of birth
What is puerperal psychosis?
Mental health condition occurring after birth
What are the symptoms of puerperal psychosis?
Restlessness Anxiety Mania Paranoid thoughts Delusions
What medication can be used to suppress lactation?
Cabergoline
