The Post-Partum Period Flashcards
Define the post partum period
The period from delivery of the placenta → 6 weeks after this
How is a new mum looked after at home following birth?
Statuatory visits from midwives for at least 10 days post delivery, up to 28 days if necessary
What kind of things are checked at the 6 week post natal examination?
- Asssess woman’s mental and physcial health
- BP, breasts, abdominal, pelvic and perineal examination
- Questions about urinary bowel and sexual function
- Any issues of anxiety from the mother
What 2 important things should be discussed with a post partum mother regarding their health?
- Perform a cervical smear if one was due whilst pregnant
- Contraception
What drives the anatomical and changes in the post partum period?
Low oestrogen
What anatomical changes occur in the lower genital tract the post partum period?
Reverting to pre-pregnancy state:
- Reduction in size of vulva, vagina and cervix
- Poor lubrication of vagina
- Transformation zone of the cervix withdraws into endocervix
- Internal os closes
How does post partum bleeding change?
- Initially bleeding is heavy (lochia rubra)
- Changes from red-brown → red pink → heavy white (lochia alba)
- Passage of clots is not normal
- Menstrual bleeding usually returns by 6th week post partum but can be delayed several months if breastfeeding
How do levels of prolactin change in the lactating women vs the non lactating women, post birth?
If lactatating levels of prolactin remain elevated
If non-lactating levels of prolactin fall to normal by weeks 2-3 post partum
What are 4 of the causes of Post partum haemorrhage?
‘The 4 Ts’
- Tone e.g. inadequate uterine category
- Tissue e.g. retained placenta
- Thrombin (clotting disorder)
- Trauma
How does secondary haemorrhage occur post partum?
Typically presents in priary care as prolonged/ excessive period once mother has returned home.
Typicallu caused by infection (endometritis) and/ or retained products of conception
What is the difference in time period between primary and secondary haemorrhage?
Primary: from birth til 24hrs after
Secondary: 24hrs to 6 weeks later
What is the postnatal high?
The hours after childbirth characterised by a degree of elation
What is the baby blues?
A period after delivery where mood is altered due to hormonal changes that occur
Usually peaks at day 4/5 and occurs in 85% of women
What is post-partum depression?
Occurs within 4 weeks of delivery with similar symptoms of depression outside of pregnancy
Occurs in 13% of women
What is puerperal psychosis?
A rare psychiatric emergency including symptoms of anxiety, mania, paranoia and delusions
Occurs within 4 weeks of delivery, 30% of cases occur in women with pre-exisiting mental illness
How common is PTSD in post partum women?
Occurs in 1.5% of women
Identify the features of the lactating breast
How do hormonal changes affect the the breast post partum?
Progesterone, oestrogen, prolactin, growth hormone and adrenal steroids cause hypertrophy of pre existing alveolar-lobar structures in the breast
Formation of new alveolae by budding from the milk ducts and proliferation of milk collecting ducts
What is the main driver for prolactin release?
Action of baby suckling at the nipple
Which hormone cases milk let down and how?
Oxytocin
Causes contraction of the myoepithelial cells around the alveolae so they expel milk into milk collecting ducts
What is colostrum?
The initial milk volume that is produced that is high in fat and immunoglobins
How does beast milk protect a baby from infection?
It contains:
- Lactoferrin - binds Fe2+ to prevent proliferation of E.coli
- Populates neonatal gut with non-pathogenic flora
- Contains bacteriocidal enzymes
- Contains immunoglobins
- Contains lymphocytes (mainly T cells) and granylocytes
The immunoglobins that are present in breast milk are formed where?
In the Peyer’s patches of the mothers gut
Which is the main immunoglobin passed to the baby by breastfeeding?
IgA
Explain the let down reflex in the delivery of breast milk
- Baby suckling stimulates mechanoreceptors in the nipple releasing oxytocin
- Ascending sensory information sent to the hypothalmus
- Neurones in the arcuate nucleus and preoptic area of the hypothalmus are inhibited and GnRH levels fall → inhibits ovarian cycle
- Prolactin inhibiting hormone is inhibited causing levels of prolactin to rise
- Prolactin increases milk secretion in the breast
What medical indications are there for formula feeding?
- severe maternal illness
- maternal HIV
- mothers medication contra indicated when breastfeeding
What is puerperal mastitis?
A condition where milk accumulation in the breast can lead to inflammation (+/- infection)
Occurs when the mother does not breastfeed with both breasts so milk builds up in the lactiferous ducts of the unused breast
Which organism typically causes infection in puerperal mastitis?
Staphylococcus aureus
Can cause abscesses
Which hormone antagonises prolactin?
Dopamine
