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Pueperium care

This guide offers detailed insights into the postpartum period, focusing on the physiological changes in the body, the role of hormones in lactation, and strategies for promoting recovery and breastfeeding. Topics include breast changes, hormone regulation, milk production, and the importance of support for mother and infant. With a comprehensive overview of colostrum, breast milk, and immune benefits, this resource aims to empower new mothers with the knowledge needed for a healthy postnatal experience.

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Pueperium care

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  1. Pueperium care Facilitator: Pawin Puapornpong

  2. Definition • After 3rd stage – normal • 6 weeks • Follow up

  3. Anatomy & Physiology • Uterus • Size • Immediate – Umbilicus or lower, 1 Kg • Serosa, Myometrium, Basal decidua • 1 week – ½ > SP, 500 g • 2 weeks – not palpable, 300 g • 4 weeks – normal size

  4. Uterus • Decidua • Superficial layer -> Lochia • Basal layer, endometrial gland – endometrium 10 days • Placental site • Immediate – palm • 2 weeks – 3-4 cm • Vessels - thrombosis

  5. Uterus • Vessels • Decreased size • In myometrium – hyalin change • Cervix & Lower segment • Decreased size • Lateral tear of external os – parous cervix • Lower segment – isthmus

  6. Vagina • Decreased size • Rugae – 3 weeks • Hymen – myritiform caruncles • Peritoneum & Abdominal wall • Loosen ligaments • Exercise • Remained striae • Diastasis recti

  7. KUB system • Bladder • Overdistension • Risk – Prolonged labour, Procedures, Epidural block, Pain • Intermittent catheter • Renal pelvis • Normal size – 2-8 weeks • Normal GFR & RPF – 6 weeks • CrClearance – 1st week • Glycosuria – 2-3 days

  8. Breasts • Lobe : separated by septum • Nipple : 15-20 lactiferous ducts • 10-100 Alveoli • Alveolar cells : prolactin => produce milk • Myoepithelial cells : oxytocin => contraction

  9. Breasts • Areola : smooth muscle • Cooper’s ligament : between lobes, skin, pectoral fascia • Breast :200 g => 400-600 g during pregnancy => 600-800 g during feeding

  10. Hormone • Estrogen : duct growth • Progesterone : alveolar growth • Prolactin : • High during pregnancy but inhibited by estrogen & progesterone (lactogenesis inhibition) • precolostrum during 2nd trimester

  11. Postpartum • Decreased estrogen & progesterone from placenta • Increased prolactin from sucking • Oxytocin • Sucking => nerve at nipples => hypothalamus => oxytocin => milk let down

  12. Lactogenesis : Initiation of milk secretion • 1st : 12 weeks before delivery • Breast enlargement • 2nd : postpartum • Decreased progesterone • High prolactin • 2-3 days : not depend on feeding • 3-4 days : depend on feeding • Rapid during 36-96 hours postpartum

  13. Galactopoiesis • Continuation of feeding • Supply-dependent response • Galactorrhea • Postpartum, post breastfeeding • For weeks, months, years • 30 % high prolactin

  14. Neuroendocrine control of milk secretion andejection • Prolactin reflex • Sucking => anterior lobe of pituitary gland => prolactin =>alveolar cells => milk • High prolactin during sucking 30 minutes => baseline within 3 hours : frequency of feeding • Milk for next meal • Prolactin night > day • Sufficient for at least 2 infants • 2 infants => same time • Not influenced by other stimulation

  15. Neuroendocrine control of milk secretion and ejection • Milk ejection reflex, Oxytocin reflex • Posterior lobe of pituitary gland => oxytocin => myoepithelial cells => contraction • Influenced by stimulation • Pain, stress => inhibition • Contracted uterus => after pain during 1st week

  16. Colostrums • Protein • Immunity : secretary IgA • Minerals • Vitamins : A, K • Less fat and sugar

  17. Colostrums • 58-67 calories/100 cc (17 calories/ounce) • Yellowish : carotene • 1st day : 37 cc/day (7cc/meal) • 2nd day : 84 cc/day (14cc/meal) • 3rd-4th day : 200-400 cc/day

  18. Colostrums • Decreased neonatal sepsis (rate 10%) • Secretary IgA • 1st day : 11000 mg/day • Decrease to 1000 mg/day in 1-2 months • Lactoferrin

  19. Immunity in breast milk(mg/24hrs)

  20. Colostrums • Fat soluble vitamins • Vitamin A : 3 times higher • Carotene : 10 times • Vitamin E : 2-3 times • Vitamin K : Supplement to prevent Hemorrhagic disease of the newborn • Epithelial growth factor : 5 times • Laxative : prevent jaundice

  21. Full term milk • Colostrum 0-7 days • Premature milk • Colostrum 3 weeks • Colostrum : prevent infection

  22. Breast milk • Protective components • Immunity : Ig, WBC, lactoferrin, lysozyme • Maturation : epidermal growth factor, IGF, cytokines, immunomodulator • GI & Hormones : Bile salt Stimulated Lipase, enzymes • Nutrients • Macronutrient : carbohydrate, fat, protein • Micronutrient : vitamins, minerals

  23. Strategy • Effective suckling • Frequency • Stimulate oxytocin reflex • No stress • Supporting environment • Healthy mother & infant : nutrition • Prevent breast engorgement

  24. ANC, during pregnancy • Serology • HIV : within 12 hours postpartum => breast binding, combined high dose pills (bid, 5 days) • Knowledge • Benefits • Process • Working mother • Diet • Activities • Supporting family

  25. Labor room • Skin to skin contact • Within 30 minutes • First sucking • Bonding • Oxytocin => prevent PPH • Decreased breast engorgement

  26. Postpartum • Avoid drugs • Rooming-in, bedding-in • Sucking ½ -1 hour • Frequency q 2-3 hours • Hand wash • Positioning, latch on • Pillow • Sitting, lying

  27. Anti-infectives • Penicillins, cephalosporins, erythromycin, trimethoprim, acyclovir, mebendazole • Analgesics & NSAIDs • Paracetamal, codeine, diclofenac, ibuprofen, mefenamic acid • Anticonvulsants • Diazepam,MgSO4, phenobarbetal, phenytoin, valproic acid • Hormonal contraceptives • Progestogen-only pills • DMPA ?

  28. Diuretics • Spironolactone • Thyroid hormones & antithyroid drug • Thyroxine, PTU • Corticosteroids • Mammoplasty (silicone) • no contraindication

  29. Contraindication • Amiodarone • Antineoplastic agents • Bromocriptine • Chloramphenicol • Gold salts • Tetracycline • Combined pills

  30. Maternal contraindicaitons • Drug addiction • HIV • Active TB • Cytomegalovirus

  31. Cardiovascular system • Normal – 2-3 weeks • Immediate – increased cardiac output, increased venous return

  32. Respiratory system • Increased residual volume • Decreased vital capacity, inspiratory capacity • 2-3 days – increased pCO2 • 3 weeks - normal pH

  33. HPO axis • Decreased placental hormone • Undetectable hPL in 1st day • hCG < 1 IU/ml in 2-4 days • hCG < 100 mIU/ml in 7 days • UPT negative • 7 days – latex agglutination • 11-16 days - radioimmunoassay

  34. Increased LH – ovulation week 4-8 • 10-15 % - week 6 • 30% - 90 days • Early – day 36 • In abortion or ectopic pregnancy – day 14 • Delayed ovulation in breastfeeding

  35. Endocrine system • Decreased hPL & growth hormone • Decreased insulin demand • Normal – 6-8 weeks • Glucose tolerance test • Increased thyroid hormone – decreased TBG • Decreased corticosteroid & testosterone – normal in 1st week

  36. After pain (uterine contraction after delivery) • Lochia • Lochia rubra – 3 days • Lochia serosa – 10 days • Lochia alba • Increased urine – day 2-5 • Decreased weight 7-9 kgs, normal in 6 months

  37. Postpartum blues • 2-3 days • > 10 days – Psychiatrist • Anti-D immune globulin • Rubella • Discharge 48 hours, C/S 3-5 days

  38. Contraception • Follow up 4-6 weeks • Pap • Advice

  39. อ่านเพิ่มเติมได้จากหนังสือรอบรู้เรื่องการเลี้ยงลูกด้วยนมแม่อ่านเพิ่มเติมได้จากหนังสือรอบรู้เรื่องการเลี้ยงลูกด้วยนมแม่ Thank you

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