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SA reproductive > S8) The Post-natal Period > Flashcards

S8) The Post-natal Period Flashcards

1
Q

Provide 3 definitions of the post-natal period

A
  • 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

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2
Q

Describe the hormonal control of growth and development of mammary tissues

A
  • 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
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3
Q

There are high levels of lactogenic hormones (prolactin and hPL) in pregnancy.

Why are only minimal amounts of milk are formed?

A

Oestrogen and progesterone inhibit the effects of lactogenic hormones

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4
Q

How is prolactin released in the post-natal period?

A

Prolactin is released by the action of suckling at a nipple that has become exquisitely sensitive post-delivery

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5
Q

What is the determining factor for milk production?

A

Prolactin levels and milk production are dependent on the frequency and duration of suckling

highest in early puerperium and then slowly reduces

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6
Q

When are prolactin levels at their highest?

A

Prolactin levels are at their highest in the early puerperium and reduce slowly, only returning to normal after weaning

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7
Q

Identify another determining factor for milk secretion

A
  • 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
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8
Q

In 4 steps, describe the hormonal control of the let down reflex

A

⇒ 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

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9
Q

Describe the neuroendocrine mechanism controlling the production of milk

A
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10
Q

Describe the neuroendocrine mechanism controlling the secretion of milk

A
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11
Q

What effect does stress have on oxytocin release?

A
  • 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
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12
Q

Describe the anatomical position of the breast

A
  • 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
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13
Q

Describe the topography of the breast

A
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14
Q

What is the most prominent gland in the breast?

A

Sebaceous gland

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15
Q

how long after do you have a post natal check up

A

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

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16
Q

what are some physiological changes

A
  • characterised by low oestrogen levels
  • lower genital tract
  • reaction in vulva, vagina and cervix
  • poor lubrication of the vagina
  • internal os closed
17
Q

when does menstruation return after post partum

A
  • normally after 6 weeks
  • BEFORE:
  • can get heavy bleeding, should not be passing clots though
18
Q

what are the 4 main reasons for PPH

A

Tone (atony)

Tissue (retained placenta)

Thrombin (clotting disorder)

Trauma: Uterus turns inside out, perineal trauma, maternal collapse, sepsis

19
Q

what mental health conditions can arise after giving birth

A
  1. postnatal blues → altered mood
  2. depression → occurs within 4 weeks
  3. puerperal psychosis → occurs within 4 weeks, rare, due to a pre - existing mental illness, anxiety, mania, paranoid thought and delusions
  4. PTSD
20
Q

What is the role of mammogenic hormones

A

promote proliferation of alveolar and duct cells

21
Q

what are the roles of lactogenic hormones

A

promote initiation of milk production

22
Q

what is the role of galactokinetic hormone

A

promote contraction of my-epithelial cells

23
Q

what is the role of gelactopoietic hormone

A

maintain milk production

24
Q

Prolactin

A

PRL is essential for milk production

suckling is a powerful stimulus

25
Q

what is the milk production like

A
  1. initially low and colostrum is produced
  2. contains high fat and immunoglobulin
  3. 800ml a day should be produced
26
Q

how does breastmilk protect baby

A
  1. lactoferrin
  2. populates neonatal gut with non pathogenic flora
  3. bactericidal enzymes
  4. contains specific immunoglobulins
  5. contains lymphocytes
27
Q

what are the components of breast milk

A
  1. lower salt content
  2. higher energy
  3. less protein
  4. more lactose
  5. milk at start has more water
  6. milk at end is higher in fats and iron
28
Q

cessation of lactation

A
  1. is ceases
  2. milk accumulates in alveoli
  3. distension and atrophy of glandular epithelium
  4. local mechanical factors suppress milk secretion
29
Q

why is immunoglobulin A given to baby via great milk important

A
  1. passes into infant gut
  2. can defend itself against endemic environmental pathogen
30
Q

when should you not breast feed

A
  1. HIV
  2. severe maternal illness
  3. mothers on certain meds
31
Q

what are some breast problems that can arise from breastfeeding

A
  1. nipple sensitivity and pain
  2. engorgment
  3. mastitis
  4. breast abscess
  5. breast lump
32
Q

difference between primary and secondary PPH

A
  • primary: loss of 500mls from genital tract within 24 hours of birth
  • secondary: bleeding after 24hrs - 12 weeks after
33
Q

haemostasis

A

blood can pool up in the uterus

34
Q

what is the leading cause for direct maternal death

A

DVT

SA reproductive (22 decks)

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