Post Partum Flashcards
Define post partum period
Period from delivery of placenta to 6 weeks after during which the mother’s body returns to a pre pregnancy state
Describe the post natal examination
- at 6 weeks
- most pregnancy induced changes have returned to normal
- assessment of woman’s mental + physical health as well as feeding + behaviour of baby
- direct questions about urinary, bowel + sexual function
- BP, urinalysis, breast, abdominal + pelvic exam
What changes occur to the lower genital tract during the post partum period?
Due to low oestrogen levels:
- vulva, vagina + cervix return to original size
- poor lubrication of vagina
- transformation zone of cervix withdraws into endocervix
- internal os is closed
What changes occur in regards to bleeding in the post partum period?
- bleeding is initially heavy + reduces gradually
- bleeding normally stops by 6th week
- passage of clots is not normal
Positive psychological feelings post partum
- gradual falling in love with baby
- increased closeness to partner (parents now too)
- increased closeness to own mother
- protective feeling towards baby
Negative psychological feelings post partum
- distress over delivery process
- anxiety
- jealous of baby being centre of attention
- fears of harming baby
- overwhelming responsibility
- resentment of loss of freedom
Types of hormones which affect the breast + their role
- mammogenic: promote proliferation of alveolar + duct cells
- lactogenic: promote initiation of milk production
- galactokinetic: promote contraction of myoepithelial cells
- galactopoietic: maintain milk production
What hormones are involved in the full development of breasts during pregnancy?
High levels of oestradiol + progesterone
Gradual increase in levels of prolactin + human placental lactogen
Where is prolactin released from?
Anterior pituitary
Describe the release of prolactin + milk production
- suckling stimulates neurons from spinal cord inhibits dopamine release
- prolactin released by anterior pituitary
- leads to stimulation of milk production by breast
- suckling maintains milk production
What does adequate milk secretion require?
- Intact neuroendocrine axis
- Adequate emptying of breast with infant feeding
Describe the delivery of breast milk
- oxytocin released in response to suckling, seeing/hearing baby
- causes myoepithelial cells to contract
- milk is expelled into milk collecting duct
- ‘let down reflex’
What is oxytocin release inhibited by?
Emotional stress
Anxiety
Positive feedback loop of breast feeding
- baby suckles at breast
- stimulates hypothalamus
- oxytocin released from posterior pituitary
- oxytocin stimulates mammary glands
- more milk produces
- repeats
Where is oxytocin produced + released from?
Produced in hypothalamus
Released by posterior pituitary
How does breast milk volume change over time?
- initially milk volumes are low
- colostrum is produced (high fat + immunoglobins)
- as suckling continues, milk volume increases to ~ 800ml per day
How does the breast milk protect the baby from infection?
- lactoferrin: prevents proliferation of E. coli
- populates neonatal gut with non-pathogenic flora
- presence of bacteriocidal enzymes
- immunoglobins
- T lymphocytes + granulocytes
How does lactoferrin from breast milk protect the baby?
Bind iron which prevents proliferation of E. coli (iron dependent organism)
Types of post partum haemorrhage
- primary: loss of >500ml from genital tract within 24 hours post birth
- secondary: excessibe bleeding from genital tract between 24 hours to 6 weeks post birth
What are the 4 Ts of primary PPH?
- tone: inadequate uterine tone (most common)
- trauma: laceration e.g. tears or episiotomies
- tissue: retained placental tissue
- thrombin: hypocoagulability
How can uterine atony cause primary PPH?
- normally, uterine walls contract to cut off blood supply to placenta
- insufficient tone of muscles > placenta is delivered without cut off blood supply > vessels bleed freely
Causes of secondary PPH
Retained tissue
Endometriosis
Causes of maternal collapse
What can this cause?
- Hypovolaemia after PPH
- Hypoglycaemia
- Amniotic fluid embolism
(Can cause cardiac arrest)
Describe the structure of the breast
- made up of secretory lobules which empty into ductules which converge into mammary ducts
-
ampulla acts as temporary storage of milk until
lactiferous duct secretes milk out of
