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Human Development > The periuperium and breastfeeding > Flashcards

The periuperium and breastfeeding Flashcards

1
Q

what is the definition of the puerperium

A

The time after childbirth lasting approx.6-8 weeks

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2
Q

what does the puerperium include

A
  • includes physical and anatomical changes particularly to the reproductive, urinary and cardiovascular systems
  • adjustments to parenthood and its roles and responsibility as well as psychological adjustments
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3
Q

what are the key hormonal effects and physiological changes

A

Involution of the uterus

Characteristics of lochia

Haematological changes

Cardiovascular changes

Respiratory and metabolic
changes

Renal function, urinary structures and H2O metabolism

Changes in GIT, neuromuscular, and integumentary systems

Lactation & Breastfeeding

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4
Q

when can the fundus not be palpitated

A

Fundus cannot usually be palpated from 10 days following delivery as it has reduced in size to below the symphysis pubis

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5
Q

what is the process of involution

A

Involution is the process by which the uterus is transformed from pregnant to non-pregnant state

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6
Q

describe how involution take place and how long it takes

A
  • Usually lasts about 6 weeks

- Involves changes to the myometrium and endometrium

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7
Q

by what processes does the myometrium return to its normal thickness

A
  • ischaemia
  • autolysis
  • phagocytosis
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8
Q

describe how ischaemia causes the myometrium to return to its normal thickness

A
  • Contraction of empty uterus and apposition of uterine walls applying pressure to placental site
  • reduction of blood supply to uterus
  • resulting in de-oxygenation & ischaemia
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9
Q

describe how autolysis causes the myometrium to return to its normal thickness

A

Self-ingestion of myometrial cells by proteolytic enzymes resulting in reduction in size

Removal of redundant muscle fibres and cytoplasm

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10
Q

describe how phagocytosis causes the myometrium to return to its normal thickness

A

Phagocytes engulf and remove waste products which are eliminated by the kidneys

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11
Q

what are the changes to the endometrium

A
  • the basal layer adjacent to the myometrium remains intact and is the source of the new endometrium
  • the decidua which is the superficial layer becomes necrotic and is sloughed off in the locia
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12
Q

what does the locia consist of

A

Consists of red cells, leucocyte, shreds of decidua and organism

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13
Q

describes how the locia varies in duration amount and colour

A

Lochia Rubra (Red) Up to 3 days

Lochia Serosa (Pink) Up to 10 days

Lochia Alba (Yellowish-white) Diminishes over 3-6 weeks

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14
Q

what are the haematological changes that take place after birth

A

Haemoglobin & haematocit concentrations fluctuate during the 1st few days postpartum

Increase in white blood cells mainly due to granulocytes

Withdrawal of oestrogen
results in gradual reduction in plasma volume returning to normal 1 week after delivery.

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15
Q

what are the cardiovascular changes that take place after Birth

A

Reduction in plasma volume = to non-pregnant state by 7-10 days

Reduction in cardiac output, heart rate and stroke volume to pre-labour value after 24 to 72hrs declining to non-pregnant value by 10-14 days

Decrease in progesterone leads to removal of excess tissue fluid resulting in tissues returning to normal vascular tone by 2 weeks.

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16
Q

what respiratory changes take place after birth

A
  • no shortness of breath
  • less oxygen demand as reduction in cardiac work and circulatory volume - no more hyperventilation
  • all respiratory parameters return to non pregnant valves within 6 weeks postpartum
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17
Q

how long does it take for respiratory changes to take place after birth

A

6 weeks postpartum

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18
Q

what are the renal changes that take place after birth

A
  • Dilatation of renal tract resolves and renal organs return to their pre-pregnant state
  • Displaced bladder, dilated ureters and renal pelvis return to normal size within 8 wks.
  • Increased diuresis (physiological diuresis) occurs between the 2nd & 5th day following pregnancy for the excretion of broken down products placing extra work on kidneys
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19
Q

what happens to the GIT after birth

A

These gastrointestinal changes revert to non-pregnant state within 6 weeks although the mechanical effects of the gravid uterus on stomach resolve within a few days.

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20
Q

what happens to the neuromuscular and integumentary systems after birth

A

Increased sensitivity of the central and peripheral nervous system although not fully understood is thought to return to normal after 36hrs postpartum.

The hormone relaxin is responsible for both the generalized ligamentous relaxation and the softening of collagenous tissues causing lordosis during pregnancy. It can take up to 5 months to return to normal

Abdominal wall & ligaments and hyperpigmentation of certain parts of the body such as the face, neck, and midline of the abdomen, require about 6wks to return to non-pregnant state

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21
Q

what prevents lactation during pregnancy

A

High levels of oestrogen and progesterone prevent lactation during pregnancy by inhibiting milk synthesis

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22
Q

what happens once the placenta is delivered

A

Once the placenta is delivered the body quickly returns to it’s pre pregnant hormonal state.
- There is a reduction in the production of the oestrogen, progesterone and prolactin

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23
Q

describe the anatomy of the breast

A

The breast is made up of-

  • 15-25 lobes
  • 20-40 lobules
  • Alveoli
  • Milk ducts
  • Lactiferous sinuses
  • They contain – glandular & connective tissue, myoepithelial cells, blood, lymph, nerve & fat.
24
Q

what are the changes in the breast and lactation during pregnancy

A
  • mamogensis
  • lactogensis
  • galactokinesis
25
Q

what is mamogensis happen

A

Mammary duct-gland growth & development – growth and development of the breast

26
Q

what is lactogensis happen

A

Initiation Of milk secretion in alveoli – milk secretion

27
Q

what is galactokinesis happen

A
  • Removal of Milk from the breast
28
Q

what hormones lead to mamogenesis

A
  • Oestrogen leads to the growth of the lactiferous ducts & tubules and increase in breast size
  • Progesterone, prolactin & human placental lactogen (HPL) lead to the proliferation and enlargement of alveoli, promote fat deposition & stimulates development of lobes and lobules
29
Q

what does oestrogen do in mamogensis

A

Oestrogen leads to the growth of the lactiferous ducts & tubules and increase in breast size

30
Q

what does Progesterone, prolactin & human placental lactogen (HPL) do in mamogensis

A

lead to the proliferation and enlargement of alveoli, promote fat deposition & stimulates development of lobes and lobules

31
Q

describe how mamogensis happens

A

By 12th week – the nipple and areola become more pigmented. Montgomery’s tubercles begin secreting lubricants.

By 16th week – colostrum is formed under the influence of HPL and prolactin

By 24th week – secondary alveoli have formed.

32
Q

how much can each breast increased by

A

each breast can increase by 5cms in size and 1500gms in weight

33
Q

what are the 3 stages of lactogensis

A
  • lactogenesis I
  • lactogenesis II
  • lactogenesis III
34
Q

describe the 3 stages of lactogensis

A

Lactogenesis I: the initiation of milk secretion in breast tissue during pregnancy

Lactogenesis II: following 3rd stage - the production of colostrum and transitional milk following the fall in plasma progesterone and high levels of prolactin

Lactogenesis III: begins about day 10 - maintenance of established lactation and removal of milk by baby

35
Q

where is prolactin produced

A

Secreted in anterior pituitary gland

Impulses from the nipple to the brain during feeding

36
Q

how does prolactin make milk

A

Transported in the blood from brain to milk producing cells

Stay high for 90 mins to make milk for next feed

Level higher at night

37
Q

the more the baby feeds….

A

the more milk that is made

38
Q

where is oxytocin secretion

A

posterior pituitary gland

39
Q

what triggers oxytocin

A

Impulses to the brain from the nipple and also triggered by sight, sound, smell & touch of baby

40
Q

how does oxytocin release milk

A

Transported in the blood from brain to milk ducts to make milk flow

As baby feeds it ejects milk into baby’s mouth

Sometimes spontaneously ejects milk

41
Q

what does the WHO recommend in terms of breast feeding

A

WHO recommends exclusive breast feeding for the 1st 6 months

42
Q

what does breastmilk do in terms of immunity

A

Breastfeeding protects your baby from infections and diseases. – milk that provides baby with extra immunity from the mother

Fewer chest and ear
infections

Baby has less chance of diarrhoea & vomiting and therefore is less likely to be admitted to hospital

Better survival during the 1st year of life including a lower risk of sudden infant death syndrome

43
Q

what are the benefits of breast feeding to the foetus

A

It contains the right balance of nutrients in a very easily digested form

less chance of being constipated

less likelihood of becoming obese and therefore developing type 2 diabetesand other obesity-relatedillnesses later in life

Reduces incidence of allergies - eczema & asthma

It’s free.

It’s available whenever and wherever baby needs a feed.

It’s the right temperature.

44
Q

what is the benefits of breast feeding to the mother

A

lowers your risk of getting breast and ovarian cancer

naturally uses up to 500 calories a day (quicker weight loss)

saves money – infant formula, the sterilising equipment and feeding equipment can be costly

It can build a strong physical and emotional bond
between mother and baby.

It can give you a great sense of achievement.

45
Q

what are the disadvantages of breast feeding

A

Unable to measure the amount of milk baby is getting

Some women find difficult, tiring and stressful

Difficult to leave baby for long periods except expressing

Father unable to feed baby

Sometimes difficult to wean baby off the breast

46
Q

what are the key principles for successful breast feeding

A

positioning and attachment

47
Q

describe the positioning that the mother should have

A

Mother should hold baby close to breast not breast to baby.

Baby should be on his side, with head, neck & body in a straight line.

Nose to nipple.

Baby’s whole body should be supported

48
Q

what is the attachment that the mother should have

A

C – Close to mum facing breast
H – Head free able to tilt head back
I – In line (baby head and body straight)
N – Nose to nipple – brush top lip with nipple

Wide open mouth

Suckling & swallowing

Head is free

Not painful for mother

49
Q

what are the problems with positioning and attachment

A

Sore Nipples

Engorgement

Mastitis

50
Q

describe how sore nipples occurs and what is the solution to sore nipples

A
  • Friction – Incorrect positioning & attachment
  • If in doubt or in pain – reattach

Solution
- correct attachment – Nipple at top back of mouth – No friction No Pain!

  • Remember breastfeeding not nipple feeding
51
Q

describe how engorgement occurs and what is the solution

A

Engorgement
- Build up of milk in the ducts caused by insufficient emptying of the breast due to incorrect positioning or restricted feeding
- Can cause difficulty for baby to latch on
- Breast feels hard, lumpy, painful, shinny and can result in flat nipple
Solution
- Correct attachment, massage, hand expressing, unrestricted feeding

52
Q

what is mastitis

A

Milk stasis & infection – If milk is not removed it will back track

53
Q

what is the solution to mastitis

A
  • Continue to feed, affected side first, unrestricted feeding, massage, hand expressing, analgesia, anti-inflammatory, hot/cold packs
  • antibiotics if no improvement in 12-24 hours
54
Q

what do you do to fix the puerperium

A

Keep clean and dry to aid healing and avoid infection

Remember pelvic floor exercises

55
Q

when do you pass bowels

A

Usually by 3rd day after delivery

56
Q

what can cause haemorrhaoids

A

May be caused by the strain of pushing or worsen.

Avoid long periods of standing

57
Q

what can you do to fix haemorrhoids

A

Use topical analgesia

Human Development (28 decks)

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