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16 Cards in this Set
- Front
- Back
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puerperium
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time from delivery until 6-12 wks after delivery
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"milk let-down factor"
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oxytocin stimulates myoepithelial cells (which surround the alveoli, which produce milk) to contract==>
eject milk into lactiferous ducts |
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colostrum
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after birth, for first 2-4 days, colostrum comes out of breast (rich in Ig, protein, lactose)
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nl Phys and Endocrinology of Lactation (Obj 1)
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-by mid-preg, breast is ready to produce milk, but it does not b/c of inhibitory effect of progest
-breast feeding inhibits LH surge==>no ovulatin (Goljan: cheap birth control) -PRL=most imp galacopoeitic hormone (MAKE milk) -oxytocin=most imp galactoKINETIC hormones (MOVE milk) [just like oxytocin moves baby out of vagina, it moves milk out of breast) -oxytocin also directs regional blood flow -breast feeding==>incr CO and incr blood flow to mamaary glands, liver, GI -during each nursing episode: incr oxytocin and PRL, incr CO |
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what is main source of energy in breast milk
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glucose
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benefits of lactation
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1. imrpoved health for baby
2. incr neonatal resistance to infxn -breast milk and colostrum has lots sIgA 3. improved contraception |
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contradindications to breast feedng
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1. maternal infxn, esp HIV and HepB
2. maternal drugs-amphetamines, lithium (most drugs are okay) 3. breast reconstruction/reduction (breast augmentation OK) |
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EXAM-mean time to resume ovulation
EXAM-mean time to resume regular menses |
breast feeding delays the resumption of ovulation & reglar menses
OVULATION -non-lactating: 2.5 months -lactating: 6 months REGULAR MENSES -non-lactating: 3 months -lactating: 3 yrs |
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when do uterus and cervix involute to nl size
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6 weeks postpartum
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Physiological Changes of Pregnancy (Obj 2): Time porstpartum to return to nl
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*48 hrs: highest risk for thromboembolism d/t
---incr coag ---vessel trauma & immobility *4 wks: T3, T4 *6 wks: --uterine & cervix size --venous tone ---GFR, Cl(Cr) *12 wks: thyroid volume *1 year: CO |
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uterine changes after pregnancy
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-takes 6 wks to return to nl size
-Lochia=uterine discharge after delivery 1. Lochia rubra (red): first few days after delivery, then... 2. Lochia serosa: lasts 22-27 days, then... 3. Lochia alba (white): lasts several wks |
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when can resume sex activity?
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when bleeding has stopped ad perineal pain resolved
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exercise after giving birth
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-can begin aerobic exercise soon after delivery
-does NOT affect lactation -decr anxiety levels |
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common postpartum complications
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1. Delayed Postpartum Hemorrhage
(AKA "subinvolution of placental site") -heavy bleeding 7-14 days after birth 2. Postpartum infxn MCC=emdomyometritis Tx= IV antibiotics 3. Mastitis Sx: very high fever (104 F), pain, redness, myalgias Et: SA, Strep Tx: CONTINUE breastfeeding!, Tx w/penicillin, dicloxacillin (most resolve w/o abscess) 4. Post-partum depression severity: mild to psychosis to suicide Risk factors: -labor complication/pregnancy loss -mother is poor, young (<20), poor parental support -previous Hx of Postpartum depression (50-100% risk of recurrence) -Hx of depression outside of reg (30% risk) -Tx: SSRI -Prevention: SSRI 2-3 wks after delivery in woman with Hx of postpartum dep |
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Post-partum depression:
Sx? how manage? risk factors? |
severity: mild to psychosis to suicide
Risk factors: -labor complication/pregnancy loss -mother is poor, young (<20), poor parental support -previous Hx of Postpartum depression (50-100% risk of recurrence) -Hx of depression outside of reg (30% risk) -Tx: SSRI -Prevention: SSRI 2-3 wks after delivery in woman with Hx of postpartum dep |
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postpartum woman presents with very high fever (104), myalgias, and pain and redness in breast. What does she have, and what is Tx?
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Mastitis
caused by SA or Strep Tx: CONTINUE BREASTFEEDING, give Penicillin or dicloxacillin (most resolve without abscess) |
