Puerperium

Question 1

What is the puerperium
What happens to the
-uterus
-perineum
-breast
-abdomen
-blood
-MH

What can go wrong

Answer 1

6-8wks, return to non pregnant state

Uterus

• involution (PPH if atonic)
• lochia (infection, discharge not sterile)

Perineum
-healing from episiotomy, stretch (pain, dyspareunia, infection

Breast
-lactation (pain, infesction, mastitis)

Abdomen

• healing from CS, stretch (pain, infection)
• weakened pelvic floor (SM still realxed) => urinary incontinence, retention, constipation

Blood

• decreased BV (anaemia if PPH)
• immunity and clotting returns to normal (infection, sepsis, thrombosis)

MH

• adjusting
• anxiety, fatigue, baby blues (PN depression, PTSD, puerperial psychoses)

Question 2

What are the signs and symptoms of puerperal sepsis

Answer 2

Fever
Diarhhoea, vomit
Breast redness
Abdo/pelvic pain
Wound infection, foul discharge
Urinary symptoms
Delay on involution
Heavy lochia

Question 3

What are the signs and symptoms of PET

Answer 3

HTN
Headaches
Proteinuria
Edema
Visual changes

Question 4

What are the signs and symptoms of PN depression
What are the signs and symptoms of PNPTDS
What are the signs and symptoms of puerperal psychosis

How would you manage this

Answer 4

Common with depression
Problems bonding

Common with PTSD

Common with psychoses
Self harm and baby

Self help
Therapy
Meds

Question 5

What is the leading cause of maternal death during this period

Answer 5

Thrombosis

Maternal suicide

Question 6

Describe the route of milk

How does the breast prepare for breastfeeding

Answer 6

Lobule => duct => ampule that holds milk => nipple

Grows in pregnancy => increase in milk producing cells

Question 7

Describe the onset of lactation

• antenatally
• postnatally

Answer 7

Antenatal

• PRL secretion increases during pregnancy
• no response as P and O is high, stops actions

Postnatal

• PRL decreases but steady prod maintained
• suckling increases PRL => increased milk

Question 8

What is colostrum
-why is this important

What is the main component of breast milk

Answer 8

1st milk
gold thick conc milk
-immunoglobulin rich

Lipid and sugar rich

Question 9

How is milk production stimulated

-how does the strength of the suck affect production

Answer 9

Suckling => positive feedback
Hypothalamic VIP production stimulated => increased PRL, decreased D

Strength of suck determines amount of PRL produced, vol of milk produced

Question 10

How is milk ejected

What can this response be conditioned by

Answer 10

Suckling => OXY release
Myoepithelial cells contract around lobule
Milk ejected out of nipple

Can be conditioned by crying