The Post Partum Period

Question 1

Define the post partum period. (1)

Answer 1

The period six weeks after delivery of the placenta.

Question 2

Describe post partum haemorrhage. (7)

Answer 2

Can be primary (up to 24 hours) or secondary (2 or 3 weeks later with clots).
Primary cause by the 4 t’s: Tone (lack of uterine ability to contract and block off the blood vessels), Trauma (of birth), hypocoagulability causing lack of Thrombi, and retention of placental Tissue.
Secondary is commonly caused by endometritis or retained placenta.

Question 3

Explain one consequence of PPH relating to the anterior pituitary gland. (3)

Answer 3

Sheehan’s syndrome is necrosis of the anterior pituitary due to increased growth and blood supply during pregnancy, and hypovolaemia due to PPH.

Question 4

Describe 5 other common post partum problems. (10)

Answer 4

Uterine inversion - the uterus turns inside out when delivering the placenta, a medica, emergency.
Perineal trauma - bruises, tears, episiotomies.
Maternal collapse - amniotic fluid emboli, hypoglycaemia, hypotension, hypovolaemia.
Cardiac arrest
Sepsis - genital tract, urinary tract, lactation duct.

Question 5

Describe the structure of the breast. (5)

Answer 5

Secretory lobules > ductules > duct > ampulla is temporary storage > lactiferous duct secretion.

Question 6

What four chemicals contribute to breast development during pregnancy? (4)

Answer 6

Oestrogen
Progesterone
Prolactin
Human placental lactogen

Question 7

Explain how suckling encourages milk production. (4)

Answer 7

Normally, prolactin release from the anterior pituitary is inhibited by dopamine. Suckling inhibits dopamine, so allows the release of prolactin, so encourages milk production.

Question 8

Explain how oxytocin release is related to breastfeeding and ovulation. (5)

Answer 8

As dopamine is inhibited, oxytocin is stimulated, and this causes the myoepithelial cells in the breast to contract and eject milk.
Neurones in the hypothalamus are inhibited so GnRH falls which stops the ovulation cycle.

Question 9

Describe advantages of breastfeeding to the baby and to the mother. (6)

Answer 9

To the baby:
Lactoferrin - bactericidal and iron-binding peptides
Populates the neonatal gut with good flora
Presence of bacteriocidal enzymes.
Contains specific immunoglobulins
Contains T cells and granulocytes that give examples of what to create.

To the mother:
Bonding

Question 10

Describe one condition relating to breastfeeding. (5)

Answer 10

Puerperal mastitis is when milk accumulates in the breast leading to inflammation with or without infection, occurring in an unused breast, so decreased in severity if the breast is used - obviously not if it’s infected.

Question 11

Describe the “baby blues”. (3)

Answer 11

Normal depression of mood following hormonal changes. Typically tearful and anxious lasting around 2 weeks. Reassure and support.

Question 12

Describe Post-partum depression (3)

Answer 12

Usually occurs within 4 weeks of delivery with symptoms similar to depression. Occurs in 13% of women.

Question 13

Define Puerperal psychosis

Answer 13

Within 4 weeks of delivery, presents with anxiety, paranoia, delusions and mania. High risk of suicide and infanticide, and often occurs in mothers with pre-existing mental health conditions.

Question 14

What mental health condition can occur following particularly traumatic births?

Answer 14

PTSD

Question 15

Explain why it is important to get mothers on contraception as soon as possible. (3)

Answer 15

Helps reduce maternal and infant deaths. Reduces risk of premies, low birthweight and small babies because it gives mother time to replenish stores needed before being pregnant again.