Puerperium

Question 1

Over what time period is the puerperium?

Answer 1

6 weeks post-delivery

Question 2

What are the 3 main features of the puerperium?

Answer 2

1. Involution of genital organs
2. Establishment of lactation
3. Psychological adjustment to motherhood

Question 3

From what weight, to what weight, does the uterus shrink back to during this 6 weeks?

Answer 3

1kg to 100g

Question 4

When is the uterus no longer palpable post-delivery?

Answer 4

10 days post-partum

Question 5

By when, post-delivery, the internal os of the cervix close?

Answer 5

3 days

Question 6

What is lochia?

Answer 6

A mixture of erythrocytes, leukocytes, decidual remnants and fibrinous products lost from the uterus post-delivery

Question 7

For how long does lochial loss last?

Answer 7

Mean = 21 days, but can vary between 10 and 42

Question 8

In what time, post-delivery, does the CO and plasma volume return to pre-pregnant levels?

Answer 8

Within a week of delivery

Question 9

What is colostrum?

Answer 9

Yellow fluid containing fat-laden cells, protein (including immunoglobulin A) and minerals

Question 10

When does milk replace colostrum?

Answer 10

3 days post-delivery

Question 11

How much breast milk can be produced?

Answer 11

Up to 1L a day

Question 12

What hormone brings about breast milk secretion, and from where is it produced?

Answer 12

Prolactin, produced by the anterior pituitary

Question 13

Why is breast milk not secreted during pregnancy?

Answer 13

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

Question 14

Which hormone is responsible for breast milk ejection, as part of the ‘let-down’ reflex?

Answer 14

Oxytocin

Question 15

Where is oxytocin synthesized?

Answer 15

Posterior pituitary

Question 16

What are the advantages to baby of breast feeding?

Answer 16

1. Protection against infection
2. Not dehydrating (like some formula milks)
3. Decreased risk of some adult pathologies
4. Bonding

Question 17

What are the advantages to the mother of breast feeding?

Answer 17

1. Decreased risk of breast/endometrial cancer
2. Cost saving
3. Readily available/OD
4. Decreased risk of PPH, since suckling promotes uterine contraction
5. Promotes weight loss
6. Contraceptive (though it is unreliable)

Question 18

What are the main problems encountered during breast feeding?

Answer 18

1. Insufficient supply
2. Engorgement
3. Mastitis
4. Nipple trauma - e.g. fissures

Question 19

How many calories per day does breast feeding burn?

Answer 19

~500kcal

Question 20

How does the calorific intake compare between breast milk and formula milk?

Answer 20

70kcal/100ml breast milk vs. 60kcal/100ml in formula milk

Question 21

What is the usual bacterial cause of mastitis?

Answer 21

S.aureus

Question 22

What should be the positioning of the babies head be for breast feeding?

Answer 22

Lower-lip planted below the nipple, chin touching the underside of the breast. Nose should be barely-touching/not touching the skin

Question 23

Within what time period can a primary PPH occur?

Answer 23

Within 24 hours post-delivery

Question 24

Within what time period can a secondary PPH occur?

Answer 24

Between 24 hours and 6 weeks post-delivery

Question 25

What are the most common causes of post-partum pyrexia?

Answer 25

1. Genital tract infection
2. UTI
3. Mastitis
4. Respiratory infection
5. Other infection - e.g. perineal/wound infection
6. If no infection present, consider the possibility it is the low-grade pyrexia associated with DVT