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16 Cards in this Set

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puerperium
time from delivery until 6-12 wks after delivery
"milk let-down factor"
oxytocin stimulates myoepithelial cells (which surround the alveoli, which produce milk) to contract==>
eject milk into lactiferous ducts
colostrum
after birth, for first 2-4 days, colostrum comes out of breast (rich in Ig, protein, lactose)
nl Phys and Endocrinology of Lactation (Obj 1)
-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
what is main source of energy in breast milk
glucose
benefits of lactation
1. imrpoved health for baby
2. incr neonatal resistance to infxn
-breast milk and colostrum has lots sIgA

3. improved contraception
contradindications to breast feedng
1. maternal infxn, esp HIV and HepB
2. maternal drugs-amphetamines, lithium
(most drugs are okay)
3. breast reconstruction/reduction (breast augmentation OK)
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
when do uterus and cervix involute to nl size
6 weeks postpartum
Physiological Changes of Pregnancy (Obj 2): Time porstpartum to return to nl
*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
uterine changes after pregnancy
-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
when can resume sex activity?
when bleeding has stopped ad perineal pain resolved
exercise after giving birth
-can begin aerobic exercise soon after delivery
-does NOT affect lactation
-decr anxiety levels
common postpartum complications
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
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
postpartum woman presents with very high fever (104), myalgias, and pain and redness in breast. What does she have, and what is Tx?
Mastitis
caused by SA or Strep
Tx: CONTINUE BREASTFEEDING, give Penicillin or dicloxacillin (most resolve without abscess)