Puerperium - Physiology and Lactation Flashcards
Define the puerperium
6W post delivery
What is the puerperium defined as
From delivery of placenta until last organ returns to pre-pregnancy state
What hormonal changes occur in puerperium
Decrease oestrogen and progesterone
Decrease hPL and bhCG
What happens to breast in puerperium
Engorge
Increase pigmentation alveolar
What happens to cardiac output in puerperium and why
Increase in CO - as blood from uterus returns
What happens to plasma volume in puerperium
Decreases, returns to normal 2-3W
What happens to HR in puerperium
Decreases
What is lochia
blood stained vaginal discharge that persists 3-6W post delivery
If lochia persists beyond 6W what should be done
US
What happens to breasts during pregnancy
Hypertrophy of duct-lobule-alveolar system
Alveoli are capable of producing mild
Why is there no secretion of milk during pregnancy
Due to high progesterone: oestrogen ratio, as placenta releases progesterone. This stimulates growth of alveolar cells opposed to secretion.
Define lactation
process where milk is secreted from mammary glands to feed the infant
What produces milk
alveolar epithelial cells
What is the main component of milk
water (90%)
What does the breast produce soon after birth
colostrum (40ml/day)
What does colostrum contain more of compared to ‘normal’ breast milk
protein and fat-soluble vitamins
What hormone is responsible for breast milk production
prolactin
What prevents breast milk secretion
dopamine
Explains what happens at birth
placenta is delivered decreasing concentration of progesterone. Enabling alveolar cells to respond to prolactin
Where is prolactin released from
anterior pituitary
What inhibits prolactin released
dopamine
What stimulates prolactin release
suckling
Explain suckling and production of milk
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
What does suckling produce milk for
suckling produces milk for the next feed
what reflex causes release of milk
let-down
explain let-down reflex
suckling stimulates release of oxytocin from posterior pituitary gland which causes contraction of myoepithelial cells causing milk release
what can let-down reflex also be triggered by
babies crying
what is role of prolactin in producing milk
prolactin causes production of milk
what is role of oxytocin in producing milk
oxytocin causes release of milk
what is advantage of breast feeding for women
- Decrease breast cancer
- Decrease ovarian cancer
- Decrease osteoporosis
- Increase bonding
- Improve uterine involution
- Lacatiional amenorrhoea can be used as contraception
what is advantage of breast feeding for foetus
- Reduce giardiasis
- Reduce childhood leukaemia
- Protect against infections
what are two contraindications to breast feeding
HTLV-1
HIV
what is a way to remember 4 antibiotics that cannot be breast fed with
2CTS
what antibiotics cannot be breast fed with
Ciprofloxacin
Chloramphenicol
Tetracycline
Sulphonamides
what is a mnemonic to remember drugs cannot breast feed with
CAMCAS
what drugs cannot be breast fed with
Cytotoxic drugs Aspirin Methotrexate Carbimazole Aspirin Sulphonylurea
