S8) The Post-natal Period Flashcards
Provide 3 definitions of the post-natal period
- Period from the delivery of the placenta to 6/52 post natal
- Period when the pregnancy changes revert to the pre-pregnancy state
- Period of great changes/modifications in lifestyle, psychology, activities, relationships, responsibility, etc.
six weeks after delivery
Describe the hormonal control of growth and development of mammary tissues
- Progesterone, oestrogen, prolactin, GH and adrenal steroids cause hypertrophy in pre-existing alveolar-lobular structures in the breast
- There is also formation of new alveolae by budding from the milk ducts, with proliferation of milk-collecting ducts
There are high levels of lactogenic hormones (prolactin and hPL) in pregnancy.
Why are only minimal amounts of milk are formed?
Oestrogen and progesterone inhibit the effects of lactogenic hormones
How is prolactin released in the post-natal period?
Prolactin is released by the action of suckling at a nipple that has become exquisitely sensitive post-delivery
What is the determining factor for milk production?
Prolactin levels and milk production are dependent on the frequency and duration of suckling
highest in early puerperium and then slowly reduces
When are prolactin levels at their highest?
Prolactin levels are at their highest in the early puerperium and reduce slowly, only returning to normal after weaning
Identify another determining factor for milk secretion
- Milk secretion is also dependent on adequate emptying of the secreting glands
- Accumulation of milk inside the alveoli will cause distension and atrophy of the glandular epithelium
In 4 steps, describe the hormonal control of the let down reflex
⇒ Oxytocin stimulates myoepithelial cells around the alveolae
⇒ These cells contract and expel the milk into the milk-collecting ducts
⇒ The longitudinal muscle cells in the ducts are stimulated
⇒ These cells dilate to improve the free flow of milk towards the nipple ‘let down’ reflex
→ lobules empty into ductules combining into a duct
Describe the neuroendocrine mechanism controlling the production of milk
Describe the neuroendocrine mechanism controlling the secretion of milk
What effect does stress have on oxytocin release?
- Maternal stress reduces oxytocin release
- Increased levels of adrenaline & noradrenaline reduces mammary blood flow, oxytocin release from pituitary and myoepithelial cell contractile response to oxytocin
Describe the anatomical position of the breast
- Breast is located on the anterior thoracic wall and extends horizontally from the lateral border of the sternum to the mid-axillary line
- It spans between the 2nd and 6th intercostal cartilages and lies superficially to the pectoralis major and serratus anterior muscles
Describe the topography of the breast
What is the most prominent gland in the breast?
Sebaceous gland
how long after do you have a post natal check up
6 weeks after birth
to see if body has gone back to normal
assess feeding of baby, mothers mental and physical health
discuss contraception, breastfeeding, breast, abdominal and pelvic examination
what are some physiological changes
- characterised by low oestrogen levels
- lower genital tract
- reaction in vulva, vagina and cervix
- poor lubrication of the vagina
- internal os closed
when does menstruation return after post partum
- normally after 6 weeks
- BEFORE:
- can get heavy bleeding, should not be passing clots though
what are the 4 main reasons for PPH
Tone (atony)
Tissue (retained placenta)
Thrombin (clotting disorder)
Trauma: Uterus turns inside out, perineal trauma, maternal collapse, sepsis
what mental health conditions can arise after giving birth
- postnatal blues → altered mood
- depression → occurs within 4 weeks
- puerperal psychosis → occurs within 4 weeks, rare, due to a pre - existing mental illness, anxiety, mania, paranoid thought and delusions
- PTSD
What is the role of mammogenic hormones
promote proliferation of alveolar and duct cells
what are the roles of lactogenic hormones
promote initiation of milk production
what is the role of galactokinetic hormone
promote contraction of my-epithelial cells
what is the role of gelactopoietic hormone
maintain milk production
Prolactin
PRL is essential for milk production
suckling is a powerful stimulus
what is the milk production like
- initially low and colostrum is produced
- contains high fat and immunoglobulin
- 800ml a day should be produced
how does breastmilk protect baby
- lactoferrin
- populates neonatal gut with non pathogenic flora
- bactericidal enzymes
- contains specific immunoglobulins
- contains lymphocytes
what are the components of breast milk
- lower salt content
- higher energy
- less protein
- more lactose
- milk at start has more water
- milk at end is higher in fats and iron
cessation of lactation
- is ceases
- milk accumulates in alveoli
- distension and atrophy of glandular epithelium
- local mechanical factors suppress milk secretion
why is immunoglobulin A given to baby via great milk important
- passes into infant gut
- can defend itself against endemic environmental pathogen
when should you not breast feed
- HIV
- severe maternal illness
- mothers on certain meds
what are some breast problems that can arise from breastfeeding
- nipple sensitivity and pain
- engorgment
- mastitis
- breast abscess
- breast lump
difference between primary and secondary PPH
- primary: loss of 500mls from genital tract within 24 hours of birth
- secondary: bleeding after 24hrs - 12 weeks after
haemostasis
blood can pool up in the uterus
what is the leading cause for direct maternal death
DVT
