Puerperium Flashcards
(45 cards)
What is puerperium?
period between delivery and 42d after birth
constitutes multifactorial changes to maternal body
Why is puerperium important?
biggest causes of maternal death fall within this period:
- sepsis
- VTE
- pre-eclampsia/eclampsia
- haemorrhage
What is the most common direct cause of maternal death from pregnancy?
VTE
What is the major cause of indirect maternal death?
cardiovascular disease (from ageing and other co-morbidities)
What are the main reasons for patient complains in postnatal care?
- understaffed
- poor staff attitude/lack of interest
- lack of info/access to care
What is the purpose of post-natal care?
- facilitate normality for mother and baby (bonding and feeding routine)
- identify, Ix and Mx abnormalities
- support with lactation: prescribing e.g.
- contraceptive advice
- make plans for next pregnancy
What are the immediate hormonal changes postnatally?
placental hormones fall very quickly: E2, P, hPL, cortisol
- uterine involution
- CVS changes
- coagulation changes
- metabolic changes
What does UTERINE INVOLUTION postnatally involve?
- autolysis by D10
- postnatal bleeding (lochia) stops
- menstruation is resumed as HPO axis in reinstated
What CVS CHANGES occur postnatally for the mother?
- CO reduces to normal
- TPR increases to normal
- BP returns to normal baseline
normalised by 2wks postnatally
What is LOCHIA?
- vaginal discharge after birth
- contains blood, mucus and uterine tissue
- typically continues for 4-6 wks after childbirth
What COAGULATION changes occur postnatally for the mother?
- fibrinolysis back to normal within 30’
- pro-coagulant state remains (due to increases clotting factors increased)
What METABOLIC changes occur postnatally for the mother?
- INS resistance goes immediately
How is lactation promoted in the mother postnatally?
Breast development: E2, P, hPL, PRL
Development of:
- Glandular tissue
- supporting stroma
Pre-labour: high E2 inhibits PRL activity
What hormonal changes promote lactation POST-DELIVERY?
- reduced E2 = no PRL inhibition
- increased PRL activity -> mild secretion in glandular cells
- suckling: oxytocin release -> milk ejection reflex
What is colostrum?
- produced in the first 48h after birth
Contains:
- IgA (provides neonatal immunity for neonatal period)
- lysozyme and macrophages
- moderate carb, fat and protein content
When does milk production in the mother occur?
- milk comes in ~3-4d after birth
Milk contains:
- increased carb, fat and protein content
- lactose
- lactalbumin/casein
What is the function of lactalbumin in breast milk?
- important role in milk production
- produced in the epithelia of mammary glands
- helps to convert maternal glucose -> lactose (via lactose synthase)
What are the PROS of breast feeding?
- easy, free and convenient
- promotes bonding
- reduced atopy
- reduced infections (esp. GI tract)
- reduced breast Ca
- mild contraceptive
- promotes weight loss
What are the CONS of breastfeeding?
- can be difficult
- can be inconvenient
- some may find embarrassing
- painful
- transmission of drugs (e.g. anti-thyroid: carbimazole)
- perinatal infection transmission (e.g. HIV)
- cannot delegate to someone else
What lactational problems may occur?
- failure of lactation RARE
- cracked nipples and pain COMMON
- acute mastitis (usually after cracked nipple)
- Breast abscess (complication of untreated mastitis)
What is acute mastitis?
- usually occurs following cracked nipple
- painful, red, hot breast and fever
- caused by S. Aureus (skin commensal)
- Mx: maintain feeding/expressing
- Mx: Abx usually flucloxacillin
How is a breast abscess managed?
- maintain feeding/expressing if possible
- flucloxacillin
- may need incision and drainage (I+D)
What are the puerperal abnormalities?
- haemorrhagic (PPH)
- VTE
- lactational
- puerperal pyrexia
- psychological
What is postpartum haemorrhage?
= blood loss > 500ml from genital tract
5% cases are underestimated
classified into:
- PRIMARY: first 24h
- SECONDARY: 24h-42d
- TERTIARY: >42d
causes significant maternal morbidity and mortality
