19 - Post Partum Period Flashcards

1
Q

What is the most common cause of a post-partum haemorraghe?

A

- Primary: uterine atony

- Secondary: Infection (endometriosis) and/or retained products of conception

  • 4 T’s
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2
Q

What is the definition of the post partum period?

A

Period from delivery of the placenta to six weeks after this where the body returns to the pre-pregnancy state

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3
Q

What medical input does a new mother get?

A
  • Initially home visits by community midwife who provides advice on contraception, breastfeeding and checks episiotomy
  • After few weeks health visitor will take over at home
  • Specific clinics once a week for 6 weeks so can assess mother and baby health and developmental progress (e.g immunisations and weight)
  • From 6 weeks to 5 years few visits every so often
  • At 6 weeks mother has to visit GP to get her B.P, breast, abdomen, pelvis and abdomen examined as well as her mental health
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4
Q

What are some changes that occur in the post-partum period?

A
  • Lower genital tract may reduce is size, internal os will close and may be poorly lubricated all due to low oestrogen
  • Haemotologically may have high white cell count and platelet
  • Endocrine changes back to normal like thyroid and prolactin if not breast feeding
  • CVS goes back to normal along with skeletal muscle and ligament laxity
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5
Q

What is bleeding post-partum called and what is abnormal?

A
  • Lochia
  • Only 1 in 10 women still bleeding after 6 weeks but should get gradually lighter and should be no clots
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6
Q

When does menstruation return after pregnancy?

A
  • Usually by 6 weeks if not breast feeding but delayed by several months if breast feeding
  • Discuss contraception with mother in health visits
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7
Q

What are some mental feelings the mother may have after birth?

A
  • Elation
  • Protectiveness
  • Anxiety
  • Overwhelming responsibility
  • Rejection of baby
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8
Q

Label the following parts of the lactating breast.

A
  • Lobules empty into ducts which then empties into the wider ampulla
  • 15 - 20 lobules in each breast and each lobule is help by suspensory ligaments
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9
Q

What are some common issues in post partum?

A
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10
Q

What are some mental health issues that may arise in the post-partum period?

A
  • Postnatal blues
  • Post partum depression
  • Puerperal Psychosis
  • PTSD (1.5% of women)
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11
Q

What are the characteristics of postnatal blues (baby blues)?

A
  • Mother feels more tearful and anxious and this is norml for 2 weeks following delivery
  • Usually peaks about day 4/5 and occurs in 85% of women
  • Reassurance and support
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12
Q

What are the characteristics of postpartum depression and how do we treat it?

A
  • Occurs within 4 weeks of delivery with similar symptoms to depression
  • 13% of women
  • Management depends on severity but pharmacological treatments if symptoms great than a month
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13
Q

What is puerperal psychosis?

A
  • Within 4 weeks of delivery but rare psychological emergency
  • 30% of cases are women with pre-existing mental illness
  • Anxiety, mania, paranoid thoughts and delusions
  • Suicide risk is 5% and infanticide risk is 4%
  • Need specialist care
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14
Q

What hormones stimulate the development of the breast in pregnancy?

A
  • High levels of oestradiol and progesterone
  • Gradual increase in prolactin and hPL
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15
Q

What are the different classes of hormones that act on the breast?

A
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16
Q

What is the let down reflex?

A
  • Prolactin released from anterior pituitary when suckling stimulus. Suckling also inhibits dopamine to maintain milk production. Prolactin makes sure there is a store
  • Oxytocin released on suckling that causes myoepithelial to contract and eject milk. GnRH also inhibited
17
Q

How does milk production change over time?

A
  • Volumes initially low and colostrum produced with high fat and immunoglobulins
  • When suckling continues more millk made, up to 800mk a day
18
Q

How does breast milk protect the baby from infection?

A
  • Lactoferrin binds iron to stop e.coli
  • Populates neonatal gut with non-pathogenic flora
  • Bacteriocidal enzymes
  • Contains specific immunoglobulins (IgA)
  • Contains lymhocytes and granulocytes
19
Q

When would formula feeding be encouraged?

A
  • Severe maternal illness
  • Maternal HIV
  • Medications that contraintradict breastfeeding
20
Q

What is puerperal mastitis?

A
  • Milk accumulation in breast leads to inflammation, usually if mother doesn’t use a breast build up on lactiferous fucts
  • If infection usually staph aureus and leads to abscess
  • Continue feeding and use unused side. If not change in 24 hours give antibiotics
  • Make sure you consider breast cancer
21
Q

How does lactation cease and how can we artificially cease it?

A
  • Accumulation of milk in alveoli causes distension and atrophy of glandular epithelium
  • Can give dopamine agonist like bromocriptine
22
Q

Why are women encouraged to think about contraception after birth?

A
  • Ferility can return before first menstruation
  • Reduces maternal and infant deaths
  • Reduces risk of pre term birth and low birthweight babies
23
Q

Why may a woman not want to have sex after birth?

A
  • Perineal trauma
  • Dyspareunia due to low oestrogen
  • Worried about being pregnant again
  • Altered perception of body
24
Q

What hormones stimulate lactation?

A
  • Decreased progesterone and oestrogen allow breast to be sensitive to prolactin
  • Increased oxytocin and prolactin