The post-partum period Flashcards
(39 cards)
1
Q
How long does the post partum period last?
A
- From delivery of placenta until 6 weeks after giving birth
2
Q
Define the post partum period
A
- Period when changes that occurred as a result of pregnancy revert to the pre-pregnancy state
- Period of great changes/modifications in lifestyle, psychology, activities, relationships, responsibility
3
Q
What happens during the post partum period?
A
- Step-down of medical input if any required during pregnancy
- Potential for problem to occur
- Continue optimal management of any pre-existing medical conditions
4
Q
How is a new mum looked after?
A
- Post-natal care is initially provided at home by community midwife
- Provide advice on contraception, breast feeding, and checking episiotomy healing
- Health visitor then takes over - visits mother at home and mother attends weekly clinics until baby is 6 weeks old
5
Q
What is the role of the health visitor in the post partum period?
A
- Offer support to mother
- Assess baby’s health e.g. advising on immunisations
- Assess baby’s development e.g. weight gain and milestones
6
Q
Outline what questions should be asked in a post-natal examination
A
- 6 weeks post partum
- Normally done by GP
- Assess mother-infant interaction
- Assess woman’s mental and physical health
- Assess feeding and behaviour of baby
- Ask questions about urinary, bowel and sexual function, as well as incontinence
- Ask about dyspareunia and anxiety about sexual intercourse
7
Q
What examinations/tests should be done in a post-natal examination?
A
- Blood pressure and urinalysis
- General, breast, abdominal and pelvic/perineal exam
- Cervical smear
8
Q
What needs to be discussed with the patient in a post-natal examination?
A
- Contraception
- Excellent opportunity to discuss adjustment to parenthood and any anxieties
9
Q
What physiological and anatomical changes occur to the lower genital tract following birth?
A
- Secondary to low oestrogen levels
- Reduction in size of vulva, vagina and cervix
- Poor lubrication of vagina
- Transformation zone of cervix withdraws into endocervix
- Internal os is closed
10
Q
Outline how bleeding occurs following birth
A
- Initially heavy flow
- Flow gradually reduces
- Menstruation usually returns by 6th week post partum
- Unless mother is breast feeding - then menses is delayed by several months
11
Q
What other changes occur following birth?
A
- Ligament laxity resolves
- Cardiovascular function returns to normal 6 weeks post partum
- Skeletal muscle changes
- Endocrine changes
- Haematological changes
12
Q
What psychological changes occur during the post partum period?
A
- Elation
- Protectiveness
- Anxiety
- Overwhelming responsibility
- Rejection of the baby
13
Q
Give an overview of the lactating breast
A
- Consists of a series of secretory lobules
- These empty into ductules
- Ductules from 15-20 lobules combine into a duct which widens at the ampulla
- Lactiferous duct carries secretions to the outside
14
Q
How does postpartum haemorrhage occur?
A
- If inadequate uterine contraction occurs after delivery
- PPH is an obstetric emergency and needs urgent management
- Prevents major blood loss and cardiovascular shock
15
Q
What can follow on from post partum haemorrhage?
A
- Secondary haemorrhage can occur
- Typically presents in primary care as prolonged or excessive bleeding once the mother has returned home
- Typically caused by infection (endometritis) and/or retained products of conception
16
Q
What are the causes of PPH?
A
- 4 Ts
- Tone (atony)
- Tissue (e.g. retained placenta)
- Thrombin (clotting disorder)
- Trauma
17
Q
What are some common problems of the post partum period?
A
- Haemorrhage (primary or secondary)
- Retained placenta/placental tissue
- Uterine inversion
- Perineal trauma
- Maternal collapse/cardiac arrest
- Thromboembolic disease
- Pyrexia/sepsis
- Mental health problems
18
Q
What can retained placenta/placental tissue lead to?
A
- Infection
- Bleeding
19
Q
What is uterine inversion?
A
- Uterus turns inside out
- Occurs when delivering placenta
- Obstetric emergency
20
Q
What kind of perineal trauma can occur while giving birth?
A
- Bruises/tears
- Sequelae (e.g. involving perineal body and anal sphincter)
21
Q
What can cause maternal collapse/cardiac arrest?
A
- Amniotic fluid embolism
- Hypoglycaemia
- Hypotension/hypovolaemia
22
Q
What are the risk factors for new mums developing thromboembolic disease?
A
- Surgery
- Obesity
- Having just has a baby
- Immobility
23
Q
What can allow pyrexia or sepsis can occur in new mothers?
A
- Genital tract
- Urinary tract
- Lactation ducts
24
Q
Outline the postnatal blues
A
- Common after delivery
- Refers to altered mood caused by hormonal changes
- Mother typically feels more tearful or anxious
- Normal up to 2 weeks after delivery
- Very common
- Managed by reassurance and support
25
Outline post-partum depression
- Occurs within 4 weeks of delivery
- Similar symptoms to depression outside of pregnancy
- Occurs in 13% of women
- Important to ask as mother may be reluctant to share their feelings
- Management depends on severity
- Can be treated pharmacologically if symptoms persist
26
Outline puerperal psychosis
- Usually occurs within 4 weeks of delivery
- Rare
- Psychiatric emergency
- Women with pre-existing mental illness are more at risk
- Severe symptoms include anxiety, mania, paranoid thoughts, delusions
- Risk of suicide (5%) and infanticide (4%)
- Management requires specialist care and pharmacological treatment
27
What other mental illness can arise after birth?
- PTSD
28
What are the characteristics of hormones that affect the breast during lactation?
- Mammogenic (promote proliferation of alveolar and duct cells)
- Lactogenic (promote initiation of milk production)
- Galactokinetic (promote proliferation of myoepithelial cells)
- Galactopoietic (maintain milk production)
29
Outline prolactin production
- Suckling is a powerful stimulation for release
- Normally release of prolactin from anterior pituitary is inhibited by dopamine
- Suckling stimulates neurones from spinal cord to inhibit dopamine release
- PRL levels increase
- Leads to stimulation of milk production
- Suckling maintains milk production
30
Outline the role of oxytocin in breastfeeding
- Neurons from spinal cord also stimulate oxytocin release
- Causes myoepithelial cells contract and eject milk (let-down reflex)
- Inhibits neurones in arcuate nucleus
- Levels of GnRH fall
- Ovarian cycle is inhibited
31
What determines the length of anovulation and amenorrhoea?
- Suckling intensity and frequency
32
What happens to breast milk production initially?
- Milk volumes are low
- Colostrum is produced, which contains high amounts of fat and immunoglobins
- As milk production is established, the content changes and 800 ml of milk is produced each day
33
How does breast milk protect the baby from infection?
- Lactoferrin
- Populates neonatal gut with non-pathogenic flora
- Presence of bacteriocidal enzymes
- Contains specific immunoglobulins
- Contains lymphocytes (mainly T cells) and granulocytes that play a role in cell-mediated immunity
34
What is puerperal mastitis?
- Milk accumulates in the breast and leads to inflammation
- With or without inflammation
- Typically occurs if mother only breastfeeds with one breast
- Milk builds ip in lactiferous ducts of unused breast
35
What organism is responsible for infection in puerperal mastitis?
- Staphylococcus aureus
- Can lead to abscess formation
36
What is the first line treatment for puerperal mastitis?
- Continue feeding
- Increase frequency of feeding on affected side
- Antibiotics can be given if no improvement after 24 hours
37
What happens when lactation stops?
- Milk accumulates in the alveoli of the breast
- Causes distension and atrophy of glandular epithelium
- Effects of local mechanical factors suppress milk secretion rather than hormonal changes
38
What drugs can be given to suppress lactation?
- Dopamine agonists e.g. bromocriptine
39
Why is it important to introduce contraception in the post-natal period?
- Family planning following childbirth helps to reduce both maternal and infant deaths
- Reduces risk of pre-term birth, low birthweight and small-for-gestational age babies
