Puerperium Flashcards
was is defined as puerperium?
time from delivery until anatomic and physiologic changes have resolved - appx 6w
what is lochia?
- bleeding after delivery of baby + placenta for 1st day
- sero-sanginous for upto 7-10 days
- clear for 6w
what do you understand by uterine involution?
- up to at level of umbilicus after delivery
- becomes a pelvic organ by 10 days due to contractility
- Os closed by 3w - opened initially for passage of products
what is the physiology of lactation?
- oestrogen stimulates duct growth
- progesterone simulates alveolar growth
- placental lactogen affects growth of epithelium in alveoli
- initiation dependent on fall in oestrogen, stimulates release of prolactin from hypothalamus
- milk ejection need oxytocin from posterior pituitary
- colostrum produced for first 3 days - clear, turbid colour
- this is establishment of mils secretion - continued lactation dependent on suckling of baby
when does menstruation commence post pregnancy for non-lactating women?
- resumption of menstruation approximately 8 weeks
- first ovulation at 10 weeks
- about 40% of first cycles are ovulatory
when does menstruation commence post pregnancy for lactating women?
- if for <1month → menstruation resumes in approximately 10 weeks
- if breast feed after first month → average interval to first ovulation in 16 weeks
*breast feeding not secure contraception beyond 9 weeks postpartum!!
how is puerperium managed?
- inform GP to arrange midwife and health visitor
- anti-D if indicated
- discuss contraception
- discuss breast feeding
- perineal care and postnatal exercise
- vaginal loss/ Hb check
*at postnatal visit in 6w
- to discuss any problems and assess for faecal or urinary incontinence
how is puerperium complications investigated?
- temp, BP, pulse, RR, SATS
- uterine size and involution with abdo exam
- vaginal bleeding
- lochia and discharge
- abdominal wound
- perineum and para-vaginal tissue
- breast
- lower limbs for DVT
- enquire about bladder + bowel function
what contraception for puerperium?
- barrier
- IUCD
- tubal ligation - mini-laparotomy, laparoscopy
- after 3m post delivery
- hormonal
- mini pill or depot injection
- COCP
- reduces breast milk
- excreted in milk
- if not breast feeding → start COCP 3w postpartum as if given earlier increased risk of thrombosis
what are some advantages of breastfeeding for a new born?
- easily digested nutrients
- antibodies in colostrum
- lower incidence of gastro-enteritis
- respiratory infection
- otitis media
- NEC (lysozyme, lactoferrin and IgA)
- avoids milk allergy
- good nutrition (except Vit C, D and iron)
- cannot overfeed - feed on demand
- lower risk of hypocalcaemia
what are the advantaged of breastfeeding for the mother?
- promotes bonding
- improves uterine involution with release of oxytocin
- reduced risk of breast cancer + contraception
- safe and cheap
what are some difficulties of breastfeeding?
- nipple inversion - correct by Waller shields in late pregnancy
- maternal fatigue
- emotional stress
- mastitis
how would you advice someone who breastfeed?
- babies sleeping in same room as mothers encourage breast feeding
- if still, hungry weigh before and after feeding: can be fed more often or supplements added
- check if mother on medication
- contraindicated if active TB, HIV
- sore nipples are corrected by correcting baby’s position on breast
- express milk for babies in special care unit
what advice would you give in terms of medication in puerperium?
- virtually all meds are excreted in milk - 2% of total dose
- depends on moelcular weight, high lipid solubility, low protein binding
- try take meds after breast feeds to avoid peak concentration
- chemotherapeutics, iodides, lithium → absolute contraindications
what are some symptoms of mastitis?
fever, chills, malaise, pain, erythema, tenderness, induration, tender axillary lymphadenopathy, milk may be purulent
