Lactation and puerperium Flashcards Preview

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Flashcards in Lactation and puerperium Deck (27):
1

Definition of puerperium?

6 weeks after completion of labour

2

Name 3 normal symptoms a woman might have in the puerperium

Afterbirth pains a few days after labour
Lochia - red/brown/mucus-y vaginal discharge up to 1 month after birth
Increased urination (need to lose fluid built up during preg)

3

Name 5 components of breast milk

Fat
Sugar
Protein (including IgA antibodies)
Minerals
Enzymes, growth factors
Cellular material (leukocytes, antibodies)

4

Name 5 benefits of breastfeeding to the baby

Nutrition
Reduced obesity and HT
Higher IQ
reduced SIDS (can't overfeed and aspirate and die)
Decreased NEC in preterm
Decreased immunological disease (atopy, infection)

5

Name 3 benefits of breastfeeding to the mother

Faster return to pre-pregnancy weight
Oxytocin release = faster involution of uterus, less blood loss
Reduction in breast and ovarian cancer
Contraception
Economic AND environmental benefits (!!!)

6

What are the WHO guidelines for breastfeeding?

Exclusive breastfeeding for first 6 months

7

Name 2 contraindications for breasteeding

HIV
Antineoplastic agents (cross into breastmilk)

8

Name 3 non-pharmacological strategies to improve breast feeding

Antenatal education
Early breast feeding after delivery
Demand feeding
Avoid supplemental feeds and dummies
Encourage rooming in

9

Go through the physiology of lactation (in terms of breast enlargement, milk production and release, and maintenance of production)

Hormones during pregnancy = breast enlargement (oestrogen, progesterone, prolactin, HPL). Fall in progesterone after delivery = allows release of milk driven by oxytocin release upon suckling. Feeding increases prolactin and oxytocin = more milk production (+ve feedback cycle)

10

What is the name of the fluid that is released in the first few days of breastfeeding? What is it enriched in? When does normal breastmilk start to be released?

Colostrum - rich in Igs. Normal milk usually released by 3-4 days after birth

11

Name 5 common breastfeeding problems

Engorgement (filling of breasts with milk) - is normal, but can be painful so women don't breastfeed
Low supply
Sore nipples (babies suck hard)
Mastitis
Blocked ducts (infection, surgery - breast implants)

12

Name 3 behaviours of a baby that suggests the mother may have low supply

Baby feeds more often but takes less time in each feed
Baby swaps between breasts a lot
Unsettled baby, settles better on formula
Growth slows after 3 months

13

What is mastitis? Name 3 signs of mastitis. If a woman has mastitis, should she keep breastfeeding or stop?

Mastitis = blocked duct leading to infection of breast tissue.

Indurated, painful area around nipple +/- fever, swelling (could be breast abscess)

She should keep breastfeeding - helps rid the infection

14

What is the usual management of a well, post-partum woman depending on her mode of delivery, in terms of length of stay, and monitoring?

Vaginal - 2 days inpatient
LUSCS - 4 days inpatient

Monitor for general appearance, vitals, uterus involution (palpation, lochia), wound appearance, urinary and bowel function, breast nipple symptoms and signs, allied health review

15

Name 5 postpartal complications

Postpartum sepsis (endometritis, wound infection, mastitis, UTIs) - T > 38 24 hrs after delivery. Often caused by infection of uterus or retained POC
Postpartum depression
Genital tract trauma
C/S complications

16

What hormonal contraception can you offer a woman breastfeeding? What can't you offer and why?

Can offer progesterone-only medications; combined OCP = reduced milk production, and can cross milk into baby

17

When would you recommend a woman recommence other forms of contraception after she stops breastfeeding?

21 days after cessation - ovulation takes minimum 25 days to recommence after breastfeeding

18

Name 3 risk factors for postpartum sepsis

PROM
Instrumentation (forceps, ventouse, catheters)
C/S
Trauma during delivery (lacerations)
Prolonged labour
PPH

19

What is a non-infectious case of postpartum pyrexia?

VTE

20

Name 2 common causes of secondary PPH. When after birth does it usually happen?

Infection, retained POC

Often happens in 2nd week postpartum

21

Name 3 signs of secondary PPH on examination

Uterine enlargement/tenderness
Fever/tachycardia
Blood, necrotic placenta in cervix
Cervical dilatation
Purulent discharge

22

Name 3 aspects of management of secondary PPH

Restore haemodynamic status - give fluid, blood, correct coagulation deficits
Get rid of cause of bleeding - antibiotics, uterotonics or D&C, embolisation
If really bad - hysterectomy

23

Name 3 ways to prevent secondary PPH

Active management of 3rd stage
Careful inspection of placenta
Antibiotics during labour if woman at risk of endometritis

24

What is the difference between postpartum blues and postpartum depression?

Postpartum blues - affects 80% women, usually a few days after pregnancy, become emotionally labile

Postpartum depression - happens later (weeks after pregnancy), symptoms are worse and affect quality of life

25

Name the 4 degrees of perineal lacerations

First degree - lac of vag mucosa
Second - vag mucosa + perineal skin or body
3rd - vag mucosa, perineal body + external anal sphincter
4th - vag mucosa, perineal body, external anal sphincter + anal canal or rectal mucosa

26

Name 2 short term and long term consequences of genital tract trauma

Short term - pain, wound infection, anaemia
Long term - dyspareunia, anal incontinence

27

Name 5 complications of a C/S

Anaesthetic - aspiration, hypotension, spinal headache
Bleeding - uterine atony, placenta praevia/accreta in next preg, laceration
Endomyometritis
Wound infection
General post-op comps: atelectasis, ileus, UTI, VTE