The puerperium Flashcards
when is the puerperium period?
from delievery to 42 days post natal
what placental hormones change very quickly after delievery?
- oestrogen
- progesterone
- HPL
- cortisol
how does the uterus change?
Autolysis
bleeding stops
how long does it take the CVS system to adjust back to normal?
2 weeks
how long does it take for coagulation to go back to normal?
- fibrinolysis normal within 30 minutse
- clotting factors still increased for 6 weeks
how long does it take insulin resistance due to pregnancy to stop?
immediate stop
why can a breast feeding lady not take the COCP?
oestrogen suppresses lactation
why is suckling important after delivery for breast feeding?
- it causes a raise in prolactin
- it causes a release in oxytocin
how does the composition of breast milk change?
first 48 hours is colostrum
day 3-4 becomes milk
what is in colostrum?
- major source of IgA
- source of lysosomes and macrophages
- protein source
what is in breast milk from day 3/4?
increased protein levels
lactose
lactalbumin
casein
what immunoglobulin can cross the placenta?
IgG
what are advantages of breast feeding?
- easy
- free
- convenient
- promotes bonding
- reduces atopy in the baby
- reduces infections especially GI
- contraceptive effect
what is the normally cause of acute mastitis?
Due to cracked nipples allowing staph aureus in
how does acute mastitis present?
painful, red hot breast
what is the management of acute mastitis?
can carry on feeding
flucloxacillin
what is the amount of blood loss to be abornmal for PPH?
- over 500ml
what is the divisions of PPH?
- primary: first 24 hours
- secondary: >24 hours - 42 days
- tertiary: >42 days
what are causes of primary PPH?
- retained products (RPOC)
- uterus atony
- trauma
what are causes of secondary PPH?
- endometriosis
- retained products (RPOC)
what four T’s are linked to primary bleeding causes?
Tone
Tissue
Trauma
Thrombin
why is it important after delivery the uterus contracts properly?
because this pinches off the blood vessels and stops bleeding
what is the single biggest cause of maternal mortality?
pulmonary embolism
why is there a higher thrombo embolism risk in the puerperium?
The pro-coagulant state from pregnancy remains through this period
