The Postpartum Period Flashcards
Define the post-partum period
Period from delivery of placenta to 6 weeks
What is involved in post natal care?
Midwife visits = <10 days post delivery
Health visitor = assess baby and mum, until 5 years old
What occurs during a post natal examination?
~ 6 weeks after delivery
By GP
Mothers mental health, physical health
Assess feeding and behaviour of baby
Urinary, bowel and sexual function
? Anxiety re sexual intercourse
BP, urinalysis, breast, abdo, pelvic/perineal exam = has uterus involuted adequately, has perineal trauma healed?
Contraception discussed
How does the lower genital tract change after delivery
Reduction in size of vulva, vagina and cervix
Poor lubrication of vagina
Transformation zone of cervix withdraws into endocervix
Internal os is closed
Why does the lower genital tract change after delivery?
Secondary to low oestrogen levels
When will the endometrium be ready for a new bleed?
Lactation = ovarian activity suppressed, bleed delayed by several months
No lactation = new by 3/52, 1st period due by 6/52
How does Hb change postpartum?
Increased
Desribe the WBC levels postpartum?
Very high immediately postpartum
How does platelet count change postpartum?
Rises back to non-preg levels
After caesarean delivery it may rise to high levels
How does serum, ferritin, transferrin and iron change postpartum?
Significantly low before delivery
Return to normal 5-8 weeks
How do LFTs change postpartum?
Increase after delivery
How does plasma cholesterol change postpartum?
Very high before delivery
Return to non-preg levels over many months
How does prolactin levels change postpartum?
Remain high for 2-3 weeks, then drop to normal
How does thyroxine levels change postpartum?
Return to non-preg state by 6 weeks
Briefly outline the postnatal ‘high’
Positive feelings
Satisfaction
Increased closeness to partner/mother
Gradual ‘falling in love’ with baby
What -ve feeling may the mother feel when postpartum?
Anxiety about baby
Disappointment/distress over delivery
rejection or ambivalence about the baby
jealousy about the baby being the centre of attention
fears of harming the baby
Overwhelming responsibility
What causes hypertrophy of the pre-existing alveolar-lobular breasts?
Progesterone, oestrogen, prolactin, GH, adrenal steroids
What inhibits milk product during preg?
Oestrogen and progesterone
What triggers prolactin release?
Action of suckling at the nipple
What effect does oxytocin have on the breast?
Contraction of myoepithelial cells situated around the alveolae = expel milk into milk-collecting ducts
What is colostrum?
First secretion from the mammary glands after birth
High fat content
High Igs
What are the components of breast milk?
has a much lower salt content
has a higher energy content
has less protein
has more lactose
is more digestible by the human baby
Outline the functions of breast milk
Food/nutrients for first 6 months
Lactoferrin = bind iron preventing proliferation of e.coli
Bactericidal enzymes
Lymphocytes = cell mediated immunity
IgA
Which immunoglobulin is transmitted via breast milk?
IgA
Describe problems that may result from breast feeding
Nipple sensitivity and pain
Engorgement
Mastitis
Breast abscess
Breast lumps- benign or malignant
Breast lump must always be investigated
Self-examination- outside menstruation
Define puerperium
Period of ~6 weeks postpartum
Mothers reproductive organs return to original non-preg condition
Outline some possible problems of puerperium
Postpartum haemorrhage (PPH)- primary or secondary
Retained placenta/placental tissue
Uterine inversion
Perineal trauma and sequelae
Maternal collapse
Cardiac arrest
Thromboembolic disease
Puerperal pyrexia/sepsis- sources; genital tract; urinary tract; lactation ducts
Define postpartum haemorrhage
Loss of more then >500ml of blood within the first 24hrs following childbirth
What is the most common cause of postpartum haemorrhage?
70% uterine artery
Inability of uterus to contract may lead to continous bleeding
Retained placental tissue and infection may contribute
What is postpartum depression?
Mood disorder – symptoms similar to depression outside of preg
Symptoms occur within 4/52 of delivery
Describe puerperal psychosis
Symptoms = anxiety, mania, paranoid thoughts, delusions
Raises suicide and infanticide risk
Define dyspareunia
Difficult/painful sexual intercourse
Due to = low oestrogen and other causes
