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45 Cards in this Set

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What is the puerperium?
The time from delivery until 6-12 weeks after delivery.
What are the five potential pathways of milk production in the alveolus?
1. Excodytosis for milk protein and lactose in golgi-derived secretory vesicles.
2. Milk fat secretion via milk fat globules (apocrine secretion)
3. Secretion of ions and water across the apical membrane
4. Pinocytosis/exocytosis of Ig's.
5. Paracellular pathways for plasma components and leukocytes.
How does prolactin affect ovulation?
Prolactin surges suppress LH, thereby inhibiting ovulation.
What is the most important galactokinetic hormone?
Oxytocin.
What does oxytocin do?
It appears to direct regional blood flow.
What is the main source of energy for milk production?
Glucose
What is the main source of carbon as a substrate for milk production?
Glucose
Does starvation alter breast milk composition?
No
How does a mother's diet change while breast-feeding?
1. Consume 800 kcal/day more
2. Increase vitamins/minerals 20-30%
3. Extra liter of fluid/day needed
What are some benefits of breast feeding?
1. Children have less obesity and long-term health problems
2. Children resist infection
How does breast milk contribute to resisting infection?
1. Breast milk contains high quantities os sIgA
2. Colostrum has high [sIgA]
3. Macrophages and T-cells trsferred to neonatal gut via breast milk
4. Breast milk has high [lactoferrin]; makes iron unavailable to pathogenic bacteria.
What drug can be used to suppress lactation?
Bromocriptine; no longer used b/c caused stroke, seizures, and MI.
When does the uterus return to its normal size?
Within 6 wks of delivery.
What are histologic changes of the uterus in the first 3 days after delivery?
The placental site infilitrated w/ granulocytes and mononuclear cells. Lasts 10 days presumably serves as inflammatory barrier against microbes.
What are histologic changes of the uterus during the 7th day after delivery?
Endometrial gland and stroma begin to regenerate.
When is the endometrium fully restored after delivery?
By the 16th day after delivery.
What is lochia?
Uterine discharge after delivery.
What is lochia rubra?
Uterine discharge the first few days after delivery (the first type of discharge)
What is lochia serosa?
Lasts 22 to 27 days (the second type of discharge)
What is lochia alba?
It may last several weeks.
When does the cervical epithelium regress?
Within 4 days.
What happens to the cervix by day 7?
Edema and hemorrhage are minimal.
When is involution of the cervix complete?
By 6 weeks.
When does ovulation resume in non-lactating women?
70 to 75 days (2.5 months)
When does ovulation resume in lactating women?
6 months
When does menses return in non-lactating women?
12 weeks (3 months)
When does menses return in lactating women?
36 months
What mediates puerperal ovarian suppression?
Elevated prolactin levels
When does venous tone return?
6 weeks postpartum
How long does CO remain elevated in women?
Up to 1 year after delivery
When does fibrinolytic activity increase?
In the first week postpartum, but rapidly returns to normal.
When is the highest level of coagulability in the woman?
In the first 48 hours postpartum.
How long does renal plasma flow stay increased postpartum?
It begins to decrease during the postpartum period, but can remain elevated for up to 5 years.
What happens to hair growth during the puerperium?
It slows; hair loss is common.
How long should postpartum women stay hospitalized?
Vaginal delivery = 2 days
Cesarean = 3-4 days
How long should pts avoid intercourse?
For 3-4 weeks (when bleeding has stopped and perineal pain has resolved).
When can the pt begin progestin-only OC's?
At time of delivery
When can depo-provery be administered?
Immediately postpartum
What is delayed postpartum hemorrhage due to?
Eschar sloughing at the placental implantation site ("Subinvolution of the placental site")
What defines postpartum infection?
A temp > 38 C (100.4 F), or any of the 2 first days after delivery (excluding first 24 hrs)
What's the most common cause of postpartum infection?
Endomyometritis
How do we diagnose mastitis?
Usually by very high fever (104 F), pain, redness, tenderness, myalgias.
What usually causes mastitis?
S. aureus or Streptococcus spp.
What is maternity blues?
A transiet state of terfulness, anxiety, irritation, and restlessness. Usu resolves in 2 wks.
What is postpartum depression?
Mild psychosis to suicide due to changes in HPA axis & CRH.