Flashcards in Lactation and puerperium Deck (27)
Definition of puerperium?
6 weeks after completion of labour
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)
Name 5 components of breast milk
Protein (including IgA antibodies)
Enzymes, growth factors
Cellular material (leukocytes, antibodies)
Name 5 benefits of breastfeeding to the baby
Reduced obesity and HT
reduced SIDS (can't overfeed and aspirate and die)
Decreased NEC in preterm
Decreased immunological disease (atopy, infection)
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
Economic AND environmental benefits (!!!)
What are the WHO guidelines for breastfeeding?
Exclusive breastfeeding for first 6 months
Name 2 contraindications for breasteeding
Antineoplastic agents (cross into breastmilk)
Name 3 non-pharmacological strategies to improve breast feeding
Early breast feeding after delivery
Avoid supplemental feeds and dummies
Encourage rooming in
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)
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
Name 5 common breastfeeding problems
Engorgement (filling of breasts with milk) - is normal, but can be painful so women don't breastfeed
Sore nipples (babies suck hard)
Blocked ducts (infection, surgery - breast implants)
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
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
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
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
Genital tract trauma
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
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
Name 3 risk factors for postpartum sepsis
Instrumentation (forceps, ventouse, catheters)
Trauma during delivery (lacerations)
What is a non-infectious case of postpartum pyrexia?
Name 2 common causes of secondary PPH. When after birth does it usually happen?
Infection, retained POC
Often happens in 2nd week postpartum
Name 3 signs of secondary PPH on examination
Blood, necrotic placenta in cervix
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
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
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
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
Name 2 short term and long term consequences of genital tract trauma
Short term - pain, wound infection, anaemia
Long term - dyspareunia, anal incontinence