Puerperium Flashcards
Over what time period is the puerperium?
6 weeks post-delivery
What are the 3 main features of the puerperium?
- Involution of genital organs
- Establishment of lactation
- Psychological adjustment to motherhood
From what weight, to what weight, does the uterus shrink back to during this 6 weeks?
1kg to 100g
When is the uterus no longer palpable post-delivery?
10 days post-partum
By when, post-delivery, the internal os of the cervix close?
3 days
What is lochia?
A mixture of erythrocytes, leukocytes, decidual remnants and fibrinous products lost from the uterus post-delivery
For how long does lochial loss last?
Mean = 21 days, but can vary between 10 and 42
In what time, post-delivery, does the CO and plasma volume return to pre-pregnant levels?
Within a week of delivery
What is colostrum?
Yellow fluid containing fat-laden cells, protein (including immunoglobulin A) and minerals
When does milk replace colostrum?
3 days post-delivery
How much breast milk can be produced?
Up to 1L a day
What hormone brings about breast milk secretion, and from where is it produced?
Prolactin, produced by the anterior pituitary
Why is breast milk not secreted during pregnancy?
Because oestrogen and progesterone antagonise prolactin, therefore it is only post-delivery, when oestrogen and progesterone levels rapidly decline, that breast milk begins to be secreted
Which hormone is responsible for breast milk ejection, as part of the ‘let-down’ reflex?
Oxytocin
Where is oxytocin synthesized?
Posterior pituitary
What are the advantages to baby of breast feeding?
- Protection against infection
- Not dehydrating (like some formula milks)
- Decreased risk of some adult pathologies
- Bonding
What are the advantages to the mother of breast feeding?
- Decreased risk of breast/endometrial cancer
- Cost saving
- Readily available/OD
- Decreased risk of PPH, since suckling promotes uterine contraction
- Promotes weight loss
- Contraceptive (though it is unreliable)
What are the main problems encountered during breast feeding?
- Insufficient supply
- Engorgement
- Mastitis
- Nipple trauma - e.g. fissures
How many calories per day does breast feeding burn?
~500kcal
How does the calorific intake compare between breast milk and formula milk?
70kcal/100ml breast milk vs. 60kcal/100ml in formula milk
What is the usual bacterial cause of mastitis?
S.aureus
What should be the positioning of the babies head be for breast feeding?
Lower-lip planted below the nipple, chin touching the underside of the breast. Nose should be barely-touching/not touching the skin
Within what time period can a primary PPH occur?
Within 24 hours post-delivery
Within what time period can a secondary PPH occur?
Between 24 hours and 6 weeks post-delivery
What are the most common causes of post-partum pyrexia?
- Genital tract infection
- UTI
- Mastitis
- Respiratory infection
- Other infection - e.g. perineal/wound infection
- If no infection present, consider the possibility it is the low-grade pyrexia associated with DVT
