The Post-Partum Period Flashcards
What is the Post-Partum Period?
Period from delivery of Placenta to 6 Weeks after this
Body returns to a pre-pregnant state
Initially, how is post-natal care done?
Initially provided at home by a midwife
After the fist few weeks, a health visitor takes over including an initial visit to mother at home
After the health visitor takes over, how often are mother encouraged to attend specific clinics with thei babies?
Once a week until 6 weeks of age
After this, attendance at the clinic decreases with age of child, but continues until age of 5
When is a post-natal examination performed? By who?
What are 4 things assessed here?
At 6 weeks, usually by mother’s GP
- Blood Pressure
- Breast, Ab, Pelvic, Perineal examinations
- Mental health
- Adjustment to motherhood
The Post-Partum Period is characterised by low Oestrogen levels and changes to multiple systems. (Lower genital, Endocrine, Haematological, CVS, MSK)
What is Iochia? How does it change as time progresses?
Iochia: Bleeding Post-Partum Period
It gradually reduces, with only 10% of women still bleeding at 6 weeks
When does Menstruation return in the Post-Partum Period?
- Usually by week 6, if not breast-feeding
- Can be delayed by several months in nursing mothers
List some psychological changes that can be seen in the Post-Partum Period
- Elation
- Protectiveness
- Anxiety
- Overhwelming responsibility
- Rejection of baby
Describe the structure of the breast
- Consists of Secretory Lobules which empty into Ductules
- Ductules from 15-20 Lobules combine into a duct, which widens at the Ampulla (a small reservoir)
- Lactiferous Duct carries secretions to the outside
Suggest a potentially fatal condition that can be caused by inadequate uterine contraction
Post-Partum Haemorrhage (PPH)
It is an emergency and needs urgent management
List 4 causes of PPH
‘The 4 Ts’
- Tone
- Tissue (retained placenta)
- Thrombin (clotting disorder)
- Trauma
List 8 complications that occur during the Post-Partum Period
- Haemorrhage
- Retained placenta/ placental tissue
- Uterine inversion
- Perineal trauma
- Maternal collapse/ cardiac arrest
- Thromboembolic disease
- Pyrexia/ Sepsis
- Mental health problems
List 4 mental health problems that can occur during the Post-Partum Period.
- Postnatal blues (Baby blues)
- Post-Partum Depression
- Puerperal Psychosis
- PTSD (in 1.5% of women, psychological therapies)
Describe Postnatal/ Baby Blues
When does it peak?
(Managed by support and reassurance)
- Common, considered normal up to 2 weeks after delivery
- Altered mood due to hormonal changes
- Mother feels more tearful or anxious
- Peaks at day 4/5
Describe Post-Partum Depression
(Important to ask about as mothers may be reluctant to share that they’re feeling depressed)
When can pharmacological managements be started?
- Occurs within 4 weeks of delivery, and in 13% of women
- If symptoms last longer than a month
Describe Puerperal Psychosis (Considered a psychiatric emergency)
- Rare, occurs within 4 weeks of delivery
- 30% of cases in women with a pre-existing mental illness
- Specialist care, mainly pharmacological
What are 4 symptoms of Puerperal Psychosis?
What are the % risks of suicide and infanticide
- Anxiety
- Mania
- Delusions
- Paranoid thoughts
Suicide risk: 5%
Infanticide risk: 4%
Full development of the breast occurs under the influence of what?
- High levels of Estradiol and Progesterone
- Gradual increase in PRL and hPL levels
List 4 types of hormones that affect the breast and what they do
- Mammogenic: Promote proliferation of alveolar + duct cells
- Lactogenic: Promote initiation of milk production
- Galactokinetic: Promote contraction of myoepithelial cells
- Gelactopoietic: Maintain milk production
PRL is needed for milk production.
How does sucking stimulate PRL release?
Normally, Dopamine inhibits PRL release
- Suckling stimulates neurons from spinal cord to inhibit Dopamine release, thus increasing PRL levels
- This leads to stimulation of milk production by breasts
Thus, suckling maintains milk production
Neurons from the spinal cord stimulate Oxytocin release.
How does this stimulate the ‘Let-Down’ Reflex?
- Neurons stimulate oxytocin release
- Causes myoepithelial cells to contract and eject milk
How is the Ovarian Cycle inhibited?
- Neurons in Arcuate Nucleus and Preoptic area of HT are inhibited are inhibited
- This leads to a fall in GnRH levels
With reference to suckling, what 2 things determine length of a ovulation and amenorrhea?
Intensity and frequency
Describe the changes in milk volumes and content as production is established
Initially;
- Low milk volumes
- Colostrum is made (High amounts of fat and Immunoglobulins)
As production is established;
- 800ml of milk is made per day
- Content changes
What are 5 way breast milk protects the baby from infection?
- Lactoferrin (antioxidant)
- Populates baby’s gut with non-pathogenic flora
- Presence of Bacteriocidal enzymes
- Contains specific Immunoglobulins
- Contains Lymphocytes and Granulocytes
What is Puerperal Mastitis?
What is the cause typically?
- Milk accumulation in breast leads to inflammation, with or without infection
- If mother doesn’t feed with both breasts, so milk builds up in Lactiferous ducts of unused breast
In Puerperal Mastitis, if infection is present, what is the usual organism present and what can it lead to?
What is treatment of Puerperal Mastitis?
Staph aureus, can lead to abscess formation
First line;
- Continue feeding and increase frequency especially on affects side
No improvement after 24hrs;
- Antiobiotics
What happens when lactation ceases?
- Milk accumulates in alveoli of breast causing
- Distension and atrophy of glandular epithelium
Thus effects of local mechanical factors suppress milk secretion rather than hormonal changes
What drugs can be given to artificially suppress lactation?
Suggest 1 example
Dopamine agonists
E.g Bromocriptine
Can women get pregnancy before the return of menstruation?
Yes
After delivery, secondary haemorrhage can occur.
How does it usually present?
What are 2 typical causes?
Prolonged or excessive bleeding once mother has returned home
- Infection (Endometritis)
- Retained products of conception
Which cells make milk and which cells release milk
Which hormones stimulate the cells
Make: Mammary alveolar cells stimulated by PRL
Release: Myoepithelial cells stimulated by Oxytocin
