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human development > puerperium and breast feeding > Flashcards

puerperium and breast feeding Flashcards

1
Q

what is the puerperium?

A

time after childbirth lasting approximately 6-8 months

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2
Q

what are the key hormonal effects and physiological changes?

A
  • Involution of the uterus
  • Characteristics of lochia
  • Haematological changes
  • Cardiovascular changes
  • Respiratory and metabolic changes
  • Renal function, urinary structures and H2O metabolism
  • Changes in GIT, neuromuscular, and integumentary systems
  • Lactation & Breastfeeding
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3
Q

what is involution of the uterus?

A

when the uterus returns to its pre-pregnant state

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4
Q

why cant you palpate the fundus of the uterus 10 days after birth?

A

its reduced in size below the pubic symphysis

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5
Q

how long does involution last?

A

6 weeks

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6
Q

what does involution of the uterus involve?

A

changes to the myometrium and endometrium

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7
Q

how does the myometrium return to its normal thickness?

A
  • ischaemia - contraction of the empty uterus = reduction of blood supply to the uterus = deoxygenation and ischaemia
  • autolysis - proteolytic enzymes self-ingest myometrial cells –> removal of redundant muscle fibres and cytoplasm
  • phagocytosis: phagocytes engulf and remove waste products from kidneys
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8
Q

what layer is a new source of the endometrium?

A

basal layer adjacent to the myometrium which remains intact

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9
Q

what layer is removed in locia?

A

superficial decidua layer

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10
Q

what is locia?

A

consists of RBCs, lucocytes, shreds of decidua and organism

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11
Q

what are the different types of locia?

A

o Lochia Rubra (Red) Up to 3 days
o Lochia Serosa (Pink) Up to 10 days
o Lochia Alba (Yellowish-white) Diminishes over 3-6 weeks

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12
Q

what haematological changes occur during puerperium?

A
  • increase in coagulation
  • Hb and haematocrit levels increase in the first few days post-partum
  • increase in WBCs
  • withdrawal of oestrogen = reduction in plasma volume
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13
Q

how long does it take for plasma volume to return to normal?

A

1 week after delivery

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14
Q

what cardiovascular changes occur during puerperium?

A
  • reduction in plasma volume = reduction in blood circulatory volume
  • Reduction in CO, HR and SV to pre-labour value
  • decrease in progesterone –> removal of excess tissue fluid –> tissues return to normal vascular tone by 2 weeks
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15
Q

what respiratory changes occur during puerineum?

A
  • no more shortness of breath bc reduction in lung compression bc reduction in uterine size –> allows for full inflation of lungs
  • no more hyperventilation - less O2 demand bc reduction in cardiac work and circulatory volume
  • all respiratory values return to normal within 6 weeks
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16
Q

why do you experience no more shortness of breath after delivery?

A

Reduction in compression of lungs due to reduction in uterine size –> full inflation of the lungs

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17
Q

why do you no longer experience hyperventilation after delivery?

A

Less oxygen demand bc reduction in cardiac work and circulatory volume

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18
Q

what renal changes occur?

A
  • Dilatation of renal tract resolves
  • Renal organs return to their pre-pregnant state
  • Displaced bladder, dilated ureters and renal pelvis return to normal size within 8 wks.
  • Increased diuresis (physiological diuresis) occurs between 2nd & 5th day
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19
Q

what GIT changes occur?

A
  • GI motility, food absorption and lower oesophageal sphincter pressure are decreased during pregnancy
  • Slower gastric emptying time during labour –> gastric volume is increased
  • GI changes go back to non-pregnant state within 6 weeks
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20
Q

what neurological changes occur?

A

CNS and PNS are more sensitive

returns to normal 36hrs postpartum

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21
Q

what changes occur to the integumentary syste,s?

A
  • Relaxin causes ligamentous relaxation + softening of collagenous tissues –> lordosis during pregnancy. (up to 5 months to return back to normal. )
  • Abdominal wall and ligaments and hyperpigmentation of certain body parts e.g. face, beck and midline of the abdomen, require about 6 weeks to return to non-pregnant state
22
Q

what hormones prevent lactation during pregnancy and how?

A

oestrogen and progesterone

inhibit milk synthesis

23
Q

describe the anatomy of the breast

A
  • 15-25 lobes
  • 20-40 lobules
  • Alveoli
  • Milk ducts
  • Lactiferous sinuses
  • They contain – glandular & connective tissue, myoepithelial cells, blood, lymph, nerve & fat.
24
Q

what is mamogenesis?

A

Mammary duct-gland growth & development

25
Q

what is lactogenesis?

A

Initiation of milk secretion in alveoli

26
Q

what is galactogenesis?

A

Removal of Milk from the breast

27
Q

what hormones are involved in mamogenesis and when do they start to increase?

A

oestrogen, progesterone, prolactin and human placental lactogen

increase from 6th week

28
Q

what does oestrogen do in mamogenesis?

A

growth of lactiferous ducts and tubules and increase in breast size

29
Q

what do progesterone, prolactin and human placental lactogen (HPL) do in mamogenesis?

A

proliferation and enlargement of alveoli, promote fat deposition and stimulates development of lobes and lobules

30
Q

describe what happens at 12, 16 and 24 weeks of mamogenesis?

A
  • 12th week – nipple and aerola become more pigmented. Montgomery’s tubercles begin secreting lubricants
  • 16th week – colostrum (first milk) formed under influence of HPL and prolactin
  • 24th week – secondary alveoli have formed
31
Q

what is lactation?

A

physiological completion of the reproductive cycle

32
Q

what are the 3 stages of lactogenesis and what occurs in each of them?

A

o Lactogenesis I – initiation of milk secretion in breast tissue during pregnancy
o Lactogenesis II – following 3rd stage, production of colostrum and transitional milk following the fall in plasma progesterone and high levels of prolactin
o Lactogenesis III – begins about day 10 – maintenance of established lactation and removal of milk by baby

33
Q

where is prolactin secreted from?

A

anterior pituitary

34
Q

where is oxytocin secreted from?

A

posterior pituitary gland

35
Q

where do milk ejection signals go? what triggers them?

A

brain to nipple

triggered by sight, sound, smell and touch of baby

36
Q

what are the breast feeding benefits to the baby?

A
  • natural food designed for the baby
  • protection from infection and disease
  • less chance of vomiting, diarrhoea and constipation
  • better survival during first year
  • right balance of nutrients
  • less chance of obesity
  • reduced allergies
  • free, readily available and right temperature
37
Q

what are the benefits of breast feeding to the mother?

A
  • Lowers risk of breast and ovarian cancer
  • Naturally uses up to 500 calories a day
  • saves money
  • build a strong physical and emotional bond between mother and baby.
  • can give you a great sense of achievement
38
Q

what are the disadvantages of breast feeding?

A
  • Unable to measure the amount of milk baby is getting
  • Some women find difficult, tiring and stressful
  • Difficult to leave baby for long periods except expressing
  • Father unable to feed baby
  • Sometimes difficult to wean baby off the breast
39
Q

how should a mother position a baby for successful breastfeeding?

A
  • Mother should hold baby close to breast not breast to baby.
  • Baby should be on his side, with head, neck & body in a straight line.
  • Nose to nipple.
  • Baby’s whole body should be supported.
40
Q

how do you get a baby to attach to the breast?

A
  • C – Close to mum facing breast
  • H – Head free able to tilt head back
  • I – In line (baby head and body straight)
  • N – Nose to nipple – brush top lip with nipple
  • Wide open mouth
  • Suckling & swallowing
  • Head is free
  • Not painful for mother
41
Q

what problems can occur with positioning and attachment of the baby?

A

sore nipples from friction
engorgement
mastitis

42
Q

what is the solution for sore nipples from friction of breastfeeding?

A

correct attachment – Nipple at top back of mouth

43
Q

what causes engorgement?

A

build-up of milk in ducts bc of insufficient emptying of the breast bc of incorrect positioning or restricted feeding. Hard for baby to latch on

44
Q

describe the appearance of an engorged?

A

Breast feels hard, lumpy, painful, shiny and can result in flat nipple

45
Q

what is the solution to engorged breasts?

A

Correct attachment, massage, hand expressing, unrestricted feeding

46
Q

what is mastitis?

A

milk stasis and infection – if milk isn’t removed then it will back track

47
Q

what are symptoms of mastitis?

A

breast pain, swelling, redness, fever, enlargement, changed nipple sensation, discharge, itching, tenderness and/or breast lump

48
Q

what should you do if you have mastitis?

A
  • Continue to feed, affected side first, unrestricted feeding, massage, hand expressing, analgesia, anti-inflammatory, hot/cold packs
  • Antibiotics if no improvement in 12-24 hours
49
Q

how should the perineum be managed during puerperium?

A
  • Keep clean and dry to aid healing and avoid infection

* Remember pelvic floor exercises

50
Q

how should the bowels be managed during the puerperium?

A

advice on diets and fluids

51
Q

what can cause haemorrhoids and how are they treated?

A
  • May be caused by the strain of pushing or worsen.
  • Avoid long periods of standing
  • Use topical analgesia

human development (20 decks)

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