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Repro > Lecture 18 - Post Partum Period > Flashcards

Lecture 18 - Post Partum Period Flashcards

1
Q

What is the definition of the post partum period?

A

Period from the delivery of the placenta to 6/52 post natal

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2
Q

Generally what happens in the post partum period?

A

When th exchanges that occured as a result of pregnancy revert to the pre pregnancy state

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3
Q

When does a GP do a post-natal exam?

A

6 weeks post partum

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4
Q

What is normally examined in the 6 week postnatal exam?

A

Woman’s mental + physical health
Feeding and behaviour of the baby

Urinary, bowel and sexual function, inconitnence
Dyspareunia or anxiety about intercourse

BP, urinalysis, general breast, abdominal and pelvic perineal exam as required

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5
Q

What are some anatomical changes that occur to the lower genital tract in the post partum period?

A

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

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6
Q

Why do anatomical changes occur in the postnatal period?

A

Oestrogen levels are low

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7
Q

What do you call the heavy bleeding that occurs post partum?

A

Lochia rubra

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8
Q

What is lochia alba?

A

Changing of red brown blood to red-pink heavy white blood

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9
Q

Should a post-partum lady be passing clots?

A

No pathological

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10
Q

If there’s no lactation post partum, when does new endometrium form and when will th effort period be due?

A

3/52

1st period by 6th week

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11
Q

If there’s lactation post partum, when does new endometrium form and when will th effort period be due?

A

Ovaria activity surpressed so menses delayed by several months

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12
Q

What occurs to the skeletal muscle, skeleton and cardiovascular function post partum?

A

In clevel of physcial activity
Pre pregnancy laxity returns in ligaments

Cardiovascular changes revert

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13
Q

What psychological changes can occur in the post partum period?

A

Protectiveness
Love
Elation

Dissatisfaction
Discomfort
Depression
Overwhelming responsibility

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14
Q

What happens to haemoglobin levels post partum?

A

Increased due to reduced plasma volume

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15
Q

What happens to the white cell count post partum?

A

Very high

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16
Q

What happens to platelet found post partum?

A

Rise

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17
Q

What happens to serum ferritin, transferrin and iron levels post partum?

A

Will increase back to normal levels

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18
Q

How do levels of GGT, AST and ALT change post partum?

A

All increase following pregnancy

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19
Q

How do prolactin levels change post partum?

A

Remain elevated in lactating women

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20
Q

What happens anatomically in preparation for lactation?

A

Hypertrophy in pre-existing alveolar-lobular structures in the breast (INC LACTIFEROUS LOBULES)

Formation of new alveloae by budding from milk ducts

21
Q

What gland produces prolactin?

A

Anterior pituitary

22
Q

What gland produces oxytocin?

A

Posterior pituitary

23
Q

What hormones inhibit prolactin?

A

Oestrogen and progesterone

24
Q

What stimulates the production of prolactin?

A

Suckling of the nipple

25
Q

What hormone is important in the delivery of breast milk?

A

Oxytocin

26
Q

What affect does oxytocin have on the breasts?

A

Stimulates the myoepithelial cells around the alveolar to contract

Also stimulates the longitudinal muscle to contract in the milk collecting ducts

27
Q

What hormone is important in milk production?

What hormone is important in milk delivery?

A

Production = prolactin

Delivery = oxytocin

28
Q

Why is colostrum such low volume?

A

High fat content and high in immunoglobulins

29
Q

What happens to volume of breast milk as suckling continues?

A

Increasing until fully established to about 800ml per day

30
Q

What are some contents of breast milk?

A

High energy content
Fat
Protein
Vitamins and minerals
Antibodies water

31
Q

How is lactoferrin a protective substance in breast milk?

A

It binds to iron preventing the proliferation of E.coli which is an iron dependant organism

Therefore encourages non pathogenic microbes to colonise the neonatal gut

32
Q

How are immunoglobulins important in breast milk?

A

They are transferred to the infant gut where it stays and attaches to the specific environmental pathogens that the mother has been exposed to

33
Q

What are some medical indications for a baby to be formula fed and not breast fed?

A

Severe maternal illness
Maternal HIV
Mothers on Meds that are contraindicated when breast feeding

34
Q

What are some problems that may occur with the breast?

A

Nipple sensitivity and pain
Engorgement
Mastitis
Breast abscess
Breast lumps

35
Q

What is engorgement?

What is mastitis?

A

When the breasts become overly full and painful

Mastitis = when the breast tissue becomes inflammed

36
Q

What is another term for the post partum period?

A

Puerperium

37
Q

What are the 4 Ts for causes of post partum haemorrhage?

A

Tone (Atony)
Trauma (perineal tears)
Tissue (placenta left inside after delivery)
Thrombin (hypocoagulablity disease)

38
Q

What are the 2 types of post partum haemorrhage?

A

Primary
Secondary

39
Q

What is primary post partum haemorrhage?

A

Loss of more that 500mls of blood from the genital tract within 24hrs of the birth of the baby

40
Q

What is atony?

A

When the uterus doesn’t contract after birth to clamp down on the open blood vessels/sinuses left by the placenta leading to lots of bleeding

41
Q

What is secondary post partum haemorrhage?

A

Abnormal/excessive bleeding form the genital tract between 24hrs to 12weeks postnatally

Could be due to retained tissue like the placenta leading to sepsis

42
Q

How can we try and achieve haemostasis with uterine atony?

A

Mechanical measures by bimanual uterine compression (put hand in)

Pharmacological measures like syntocinon

Surgical

43
Q

Why is syntocinon a useful drug to achieve haemostasis in atony?

A

Contains oxytocin stimulating the uterus to contract

44
Q

What is the leading cause of direct maternal death?

A

DVT
VTE
Leading to PE

45
Q

How are DVTs and VTEs treated generally?

A

Anticoagulation like heparin, warfarin

Managed by assessing risk factors

46
Q

What are some mental health issues related to the post partum period?

A

Postnatal baby blues (need reassurance and support)

Post partum depression

PTSD

Puerperal psychosis

47
Q

What sexual issues can arise in the postpartum period?

A

Dyspareunia due to low oestrogen
Perineal trauma
Worried about getting pregnant again

48
Q

What essentially happens in the post partum period?

A

Body returning back to pre-pregnancy state

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