S8.2 Post-partum Period

Question 1

Define the PPP

Answer 1

Period from the delivery of placenta to 6 weeks post-natal

Question 2

Why is the post-natal exam carried out 6 weeks after delivery?

Answer 2

By six weeks postpartum most of the pregnancy-induced changes in maternal physiology have returned to normal.

Question 3

What anatomical changes occur to the mum post-partum?

Answer 3

Reduction in size of vulva, vagina and cervix. Internal os is closed

Question 4

What problems can occur during the PPP?

Answer 4

Postpartum haemorrhage 
Retained placenta (uterus shall be firm on palpation)
Uterine inversion 
Post-partum depression 
PTSD

Question 5

What is post-partum haemorrhage?

Answer 5

Loss of > 500ml blood within the first 24h following childbirth.
Usually caused by poor contraction of the uterus following childbirth, also from poor blood clotting or a tear in uterus.

Question 6

Describe the structure of a normal breast

Answer 6

Breasts are modified sebaceous glands.
Mammary glands are lobulated masses of tissue embedded in breasts. Surrounding is fibrous and adipose tissue.
Lobes, alveoli and lactiferous ducts come together just posterior to the nipple leading to lactiferous sinus then a pore.

Question 7

Describe the hormonal control of milk production

Answer 7

Suckling stimulates mechanoreceptors in the breast which send a signal to the hypothalamus to inhibit dopamine allowing prolactin secretion.

Question 8

Describe milk let down galactokinesis (the let-down reflex)

Answer 8

Stimulation of nipple receptors feeds back to hypothalamus, PP releases oxytocin, acts on myoepithelial cells surrounding the alveoli to contract to eject milk out of the breast.

Question 9

What can cause cessation of lactating?

Answer 9

Lost feedback from no suckling.
Suppression of prolactin from eg diuretics
Age related - shrinking of mammary glands