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Obstetrics > Puerperium - Physiology and Lactation > Flashcards

Puerperium - Physiology and Lactation Flashcards

1
Q

Define the puerperium

A

6W post delivery

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2
Q

What is the puerperium defined as

A

From delivery of placenta until last organ returns to pre-pregnancy state

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3
Q

What hormonal changes occur in puerperium

A

Decrease oestrogen and progesterone

Decrease hPL and bhCG

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4
Q

What happens to breast in puerperium

A

Engorge

Increase pigmentation alveolar

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5
Q

What happens to cardiac output in puerperium and why

A

Increase in CO - as blood from uterus returns

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6
Q

What happens to plasma volume in puerperium

A

Decreases, returns to normal 2-3W

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7
Q

What happens to HR in puerperium

A

Decreases

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8
Q

What is lochia

A

blood stained vaginal discharge that persists 3-6W post delivery

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9
Q

If lochia persists beyond 6W what should be done

A

US

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10
Q

What happens to breasts during pregnancy

A

Hypertrophy of duct-lobule-alveolar system

Alveoli are capable of producing mild

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11
Q

Why is there no secretion of milk during pregnancy

A

Due to high progesterone: oestrogen ratio, as placenta releases progesterone. This stimulates growth of alveolar cells opposed to secretion.

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12
Q

Define lactation

A

process where milk is secreted from mammary glands to feed the infant

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13
Q

What produces milk

A

alveolar epithelial cells

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14
Q

What is the main component of milk

A

water (90%)

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15
Q

What does the breast produce soon after birth

A

colostrum (40ml/day)

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16
Q

What does colostrum contain more of compared to ‘normal’ breast milk

A

protein and fat-soluble vitamins

17
Q

What hormone is responsible for breast milk production

A

prolactin

18
Q

What prevents breast milk secretion

A

dopamine

19
Q

Explains what happens at birth

A

placenta is delivered decreasing concentration of progesterone. Enabling alveolar cells to respond to prolactin

20
Q

Where is prolactin released from

A

anterior pituitary

21
Q

What inhibits prolactin released

A

dopamine

22
Q

What stimulates prolactin release

A

suckling

23
Q

Explain suckling and production of milk

A

suckling stimulates region in brainstem that decreases dopamine release (inhibits prolactin) and increases vasoactive intestinal protein (stimulates prolactin) release, leading to increased prolactin secretion which stimulates alveolar epithelial cells to produce milk

24
Q

What does suckling produce milk for

A

suckling produces milk for the next feed

25
Q

what reflex causes release of milk

A

let-down

26
Q

explain let-down reflex

A

suckling stimulates release of oxytocin from posterior pituitary gland which causes contraction of myoepithelial cells causing milk release

27
Q

what can let-down reflex also be triggered by

A

babies crying

28
Q

what is role of prolactin in producing milk

A

prolactin causes production of milk

29
Q

what is role of oxytocin in producing milk

A

oxytocin causes release of milk

30
Q

what is advantage of breast feeding for women

A
  • Decrease breast cancer
  • Decrease ovarian cancer
  • Decrease osteoporosis
  • Increase bonding
  • Improve uterine involution
  • Lacatiional amenorrhoea can be used as contraception
31
Q

what is advantage of breast feeding for foetus

A
  • Reduce giardiasis
  • Reduce childhood leukaemia
  • Protect against infections
32
Q

what are two contraindications to breast feeding

A

HTLV-1

HIV

33
Q

what is a way to remember 4 antibiotics that cannot be breast fed with

A

2CTS

34
Q

what antibiotics cannot be breast fed with

A

Ciprofloxacin
Chloramphenicol
Tetracycline
Sulphonamides

35
Q

what is a mnemonic to remember drugs cannot breast feed with

A

CAMCAS

36
Q

what drugs cannot be breast fed with

A 
Cytotoxic drugs 
Aspirin
Methotrexate
Carbimazole
Aspirin
Sulphonylurea

Obstetrics (27 decks)

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