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Repro > The post-partum period > Flashcards

The post-partum period Flashcards

1
Q

When is the post partum period?

A

Period from delivery of placenta to 6 weeks after this

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2
Q

What happens during post partum period?

A

Body returns back to pre-pregnancy state

Decreased medical input compared to pregnancy so potential for things to go wrong

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3
Q

How is a new mum looked after?

A

Community midwife at home initially for at least 10 days (can be up to 28)- advice on contraception, breastfeeding and checking episiotomy healing, sexual function, cervical smear?
Then health visitor takes over assessing mother at home

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4
Q

What is a mother encouraged to do once a week until a baby is 6 weeks old?

A

Attend specific clinics locally so health visitors can offer support from mother and assess babys health - offer advice on jabs, development etc

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5
Q

For how long does a health visitor visit baby?

A

Until child is 5 - decreases in frequency as they age though

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6
Q

When does mother visit GP following birth?

A

Post natal exam at 6 week check

Assess physical health - BP, breast, abdo, pelvic and perineal exam
Mental health
Adjustment to motherhood

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7
Q

What anatomical changes happen to lower genital tract and why?

A

Reduction in vulva, vagina and cervix size
Poor lubrication of vagina
Transformation zone of cervix withdraws into endocervix
Internal os closed

= due to lower oestrogen

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8
Q

What happens to hormones in post partum period?

A

Low oestrogen levels - reverting back to pre-pregnancy state

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9
Q

What happens to body systems during PPP?

A

Lower genital urinary tract, endocrine system, haematological, CVS, skeletal muscle and ligament laxity are all reverting back to what they were prior to pregnancy

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10
Q

What is bleeding PP called?

A

Lochia - initially lochia rubra and then lochia alba

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11
Q

Bleeding post partum character

A

Gradually reduces from red/brown–> pink –> white
Only 1/10 women are still bleeding by 6 weeks
Clots not normal - unless one on day3/4

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12
Q

What does menstruation return for women PP?

A

Within 6 weeks if theyre not breastfeeding of course

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13
Q

Emotions you can experience in PP

A

Elation
Protectiveness
Anxiety
Overwhelming responsibility
Rejection for baby

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14
Q

What happens to breasts during pregnancy?

A

Hypertrophy of pre-existing alveolar lobular structures in breast
Formation of new alveolar-lobular structures in breast

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15
Q

Structure of lactating breast

A

Secretory lobules that empty into ductules

15-20 lobules empty into ductule then these combine into a duct which widens at the ampulla - small reservoir

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16
Q

What carries secretions from breast to outside?

A

Lactiferous duct

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17
Q

What is post partum haemorrhage?

A

Obstetric emergency - when a women loses 500ml of blood or more following birth

Can be primary - within 24hrs of delivery
Or secondary 24hrs - 12 weeks post partum

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18
Q

What can PPH lead to?

A

Hypovolaemic shock and death

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19
Q

What can cause PPH?

A

4 T’s -
Tone (atony - no uterine contractions)
Tissue - retained placenta
Thrombin - clotting disorder
Trauma

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20
Q

What is secondary haemorrhage often caused by?

A

Infection - endometritis and/or retained products of conception (like placenta)

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21
Q

Common problems associated with post partum

A

Haemorrhage

Retained placenta/tissue - infection/bleeding

Uterine inversion - uterus turns inside out, occurs when delivering placenta

Perineal trauma - bruises/tears, sequelae

Maternal collapse/cardiac arrest - amniotic fluid embolism, hypoglycaemia, hypotension, hypovolaemia

Thomboembolic disease - risk factors surgery, obesity, post partum, immobility

Pyrexia/sepsis - genital/urinary tract, lactation ducts

Mental health problems

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22
Q

4 mental health conditions new mums can develop

A

Post natal blues - baby blues
Post-partum depression
Puerperal psychosis
Post traumatic stress disorder PTSD

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23
Q

What are post natal blues - baby blues?

A

Very common following delivery
Altered mood due to hormonal changes
Mother is more tearful, anxious and can go on until 2 weeks after delivery

24
Q

When do the baby blues peak?

A

Day 4/5

25
Q

Management of baby blues

A

Reassurance and support

26
Q

When does post partum depression occur?

A

Usually within 4 weeks of delivery

27
Q

Is post partum depression common?

A

Affects 13% of women - important to ask them out their mood

28
Q

Management of PPdepression?

A

Depends on severity
Pharmacological treatment can be started if lasting longer than 1 month

29
Q

What is puerperal psychosis?

A

Rare but the psychosis usually occurs within 4 weeks of delivery and is a psychiatric emergency
Usually occurs in women with pre-existing mental illness

30
Q

Symptoms of puerperal psychosis?

A

Anxiety
Mania
Paranoid thoughts and delusions

31
Q

Risk of puerperal psychosis

A

Suicide - 5%
Infanticide - 4%

32
Q

Management of puerperal psychosis

A

Specialist care and pharmacological

33
Q

What stimulates the full development of the breasts for lactation?

A

High levels of oestrogen and progesterone, gradual increase of prolactin and human placental lactogen during pregnancy

34
Q

What are the hormones that affect the breast like?

A

Mammogenic - promote proliferation of alveolar and duct cells

Lactogenic - promote initiation of milk production

Galactokinetic - promote contraction of myoepithelial cells

Galactopoietic - maintain milk production

35
Q

What is prolactin for? What stimulates it?

A

Essential for milk production - suckling is a powerful stimulus for prolactin release

36
Q

How is PRL release inhibited?

A

Dopamine secreting neurones from hypothalamus prevents PRL release from ant pituitary

37
Q

Suckling effects on PRL

A

Stimulates neurones in spinal cord to inhibit dopamine release and the levels of PRL then increase

38
Q

Role of suckling

A

Allows PRL levels to rise by inhibiting dopamine release therefore maintains milk production - one feed suckling allows milk for the next feed to be made

39
Q

What else do the neurones in the spinal cord stimulate to be released?

A

Oxytocin

40
Q

Oxytocin role

A

Causes myoepithelial cells to contract and eject milk - ‘let down’

41
Q

What happens to neurones in the brain when oxytocin is released and explains why you can use breastfeeding as contraception?

A

Neurones in arcuate nucleus and preoptic area of the hypothalamus are inhibited
Levels of GnRH fall
Inhibits ovarian cycle

42
Q

What determines the length of anovulation and amenorrhoea in breastfeeding?

A

Suckling intensity and frequency

43
Q

What is breast milk like originally when breastfeeding?

A

Colostrum - high amounts of fat and immunoglobulins
But low volume produced

44
Q

What happens as milk production is established?

A

Content changes and 800ml of milk is produced per day

45
Q

How does breastmilk protect baby from infection?

A

Lactoferrin - protects against E-coli (iron dependent organism)
Populates neonate gut with non-pathogenic flora
Bacteriocidal enzymes
Specific immunoglobulins
Lymphocytes mainly T cells and granulocytes - cell mediated immunity

46
Q

What is puerperal mastitis?

A

Milk accumulation in the breast can lead to inflammation +/- infection
Typically occurs if mother does not breastfeed with both breasts and milk can build up in the lactiferous ducts of the unused breast

47
Q

Organism that causes puerperal mastitis if it is infected

A

Staphylococcus aureus - can lead to abscess

48
Q

Treatment for mastitis

A

Continue feeding and increase freq on affected side esp
Abx can then be given after 24 hrs if no improvement

49
Q

What happens when lactation ceases?

A

Milk accumulates in alveoli of breasts causing distension and atrophy of glandular epithelium
Local mechanical factors suppress milk secretion rather than hormonal things

50
Q

What can be given artificially to suppress lactation?

A

Dopamine agonists eg Bromocriptine (used often after baby loss to reduce trauma)

51
Q

Why is contraception important in PP?

A

Reduces maternal and infant deaths - unwanted?
Reduces risk of pre-term births, low birth weight and small-for-gestation babies

Fertility can return at any point esp if not breastfeeding

52
Q

What prevents milk production during pregnancy?

A

Oestrogen and progesterone inhibit

53
Q

Components of breast milk

A

Water
Protein
Carbohydrates - lactose
Fats
Antibodies - IgA esp
Hormones
800 strains of bacteria
Vitamins/minerals

54
Q

Why does breast milk differ from other mammalian milk?

A

Human milk - lower salt, higher energy, less protein, lactose, more digestable for human bodies

55
Q

Medical indications for not breastfeeding

A

Severe maternal illness
HIV
Medication that is contraindicated when breastfeeding

56
Q

Foremilk vs hindmilk

A

Fore milk at start has higher water
Hindmilk has higher fats and iron

57
Q

Leading cause of maternal death

A

VTE - post partum period is when you are at a time of highest risk
PE can occur and cause sudden death

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