PHYSIOLOGICAL PUERPERIUM PATHOLOGICAL PUERPERIUM
🔹
COMPLICATIONS OF THE PUERPERIUM
Postpartum Infection (Endometritis, Episiotomy infection, CS. Wound infection, UTI, Mastitis or
definition The puerperium is the 6- to 8-week-period following birth during which the reproductive tract, as well asthe rest of the body,
returns to the nonpregnant state. 🔹
Pneumonia)
🔹 Postpartum Hemorrhage
🔹 Puerperal venous thrombosis and pulmonary embolism
Puerperal psychosis
Postpartum Hemorrhage
Definition
Postpartum hemorrhage denotes excessive bleeding (> 500 mL in vaginal delivery) following
delivery of fetus. Hemorrhage may occur before, during, or after delivery of the placenta.
🔹
Classified into:
Primary((early)) postpartum hemorrhage:
🔸Urinary 🔹
Blood lost during the first 24 hours after delivery
Secondary or late postpartum hemorrhage :
🔸
🔸
Uterine Changes
Tract Changes
Occur between 24 hours and 6 weeks after deliver
🔸 Relaxation of the Vaginal Outlet and Prolapse of the Uterus
▪️ Incidence:
🔸Peritoneum and Abdominal Wall
Blood and Fluid Changes
5-8 % following vaginal delivery Constitute third cuase of maternal death in USA
Clinical aspect of the 🔹
COMPLICATION OF PPH:
1- can lead to post partum hypotention which lead to necrosis of anterior lobe of pituitary
Puerperium 🔸
PHYSIOLOGY OF THE PUERPERIUM
Involution of the Uterus: 🔹
glandand sheehan syndrome with failure of lactation and amenorrhea.
2-complication associated with transfusion therapy (eg, viral infection, transfusion reactions) is
🔹
-The uterus weighs approximately 1000 g and has a volume of 5000 mL immediately after delivery, compared with its non infrequent but significant
pregnant weight of approximately70 g and capacity of 5 mL. 3- In extreme hemorrhage, sterility will result from hysterectomy performed to control
-Uterine involution is caused by autolysis of intracellular myometrial protein, resulting in a decrease in cell size but not in cell intractable postpartum hemorrhage.
number.
🔸 Position of uterus
Immediately after delivery, the fundus of the uterus is easily palpable halfway between the pubic symphysis and the umbilicus.
GENERAL RISK FACTORS OF PPH
1)Coagulopathy.
2)history of hemorrhage.
The immediate reduction in uterine size is a result of delivery of the fetus, placenta, and amniotic fluid, as well as the loss of 3)blood transfusion during a previous pregnancy.
hormonal stimulation. 4)anemia during labor.
5)grand multiparity.
6)multiple gestation
7) large infant; polyhydramnios; dysfunctional labor.
8) oxytocin induction or augmentation of labor; rapid labor.
9) severe preeclampsia or eclampsia.
10) vaginal delivery after previous cesarean birth general anesthesia for delivery; and forceps
delivery
4Ts
🔷
Causes of PPH
1-TONE(UTERINE ATONIA)
🔸
Changes in the uterine vessels
Caliber of extrauterine vessels:
Atony is the most common cause of postpartum hemorrhage (50% of cases). Predisposing causes
include :
🔸
decrease to equal size of prepregnant state after delivery
Blood vessels within puerperal uterus:
obliterated by hyaline change replaced by smaller vessels
1-excessive manipulation of the uterus.
2-general anesthesia (particularly with halogenated compounds).
3- uterine overdistention (twins or polyhydramnios),
4-prolonged labor
🔸
Changes in the Cervix & Lower Uterine Segment 5- grand multiparity
Cervical opening contracts slowly and for a few days immediately after labor (= 2fingers) 6-uterine leiomyomas
🔸
:by the end of the 1st wk - it has narrowed 7- operative delivery and intrauterine manipulation.
🔸 As the opening narrows the cervix thickens and a canal reforms. 8-oxytocin induction or augmentation of labor.
🔸Bilateral depression at the site oflacerations remain as permanent changes that characterize the parous cervix 9-previous hemorrhage in the third stage.
Markedly thinned-out lower uterine segment: 10-uterine infection, extravasation of blood into the myometrium (Couvelaire uterus), and intrinsic
contracts & retracts myometrial dysfunctions
- uterine isthmus located between the uterine corpus above and the internal cervical os below- over the course of few weeks
🔷 2-Trauma (Obstetric Lacerations)
CONSTITUTE 20% OF CASES BLEEDING CAN BE EITHER FROM EPISIOTOMY OR VAGINAL
🔸
after pains
🔸 Primiparas: puerperal uterus tends to remain tonically contracted
🔹
,CERVICAL, TEAR
Persistent bleeding (especially bright red) and a well-contracted, firm uterus suggests
Uterine Changes 🔸-->afterpain
Multiparas: contracts vigorously at interval - afterpain
Infant suckles --> oxytocin release--> Ut.contraction
🔹
bleeding from a laceration or from the episiotomy.
When cervical or vaginal lacerations are identified as the source of postpartum hemorrhage,
🔸Occasionally severe enough to require an analgesic: usually become mild by the 3rd postpartum day repair is best performed with adequate anesthesia.
Lochia
🔷 3-TISSUE (RETAINED PRODUCT)
🔸
Early in the puerperium, sloughing of decidual tissue --> vaginal discharge of variable quantity 🔹
Retained placental tissue and membranes cause 5–10% of postpartum hemorrhages.
Retention of placental tissue in the uterine cavity occurs in :
🔸
🔸
lochia rubra:first few days after delivery blood in lochia
lochia serosa: after 3 or 4 days becomes progressively pale in color
lochia alba: after 10th day white or yellowish-white color, lasted for approximately 2weeks after delivery
-placenta accreta
-manual removal of the placenta
-mismanagement of the third stage of labor
🔸
-unrecognized succenturiate placenta.
dilated renal pelvis &ureters: DX Ultrasonographic findings of an echogenic uterine mass strongly support a diagnosis of
🔸
return to prepregnantstate 2-8 weeks after delivery retained placental products.
Puerperal diuresis:
🔷
🔸
physiological reversal of pregnancy-induced increase in extracellular water : regularly occurs between 2nd and 5th day 4-THROMBIN ((COAGULATION DEFECT))
Puerperal bladder create optimal condition for development of UTI: 1-Hypofibrinogenemia
increased capacity & relative insensitivity to intravesical fluid pressure -->overdistention, incomplete emptying, excessive 2-Thrombocytopenia
residual urine 3-disseminated intravascular coagulation.
4- Transfusion of more than 8 U of blood in itself may induce a dilutional coagulopathy.
puerperium
5-Von Willebrand's disease, autoimmune thrombocytopenia, and leukemia may occur in pregnant
women.
▪️ Vagina and vaginal outlet gradually diminishes in size
🔸Rugae : reappear by the 3rd week
but rarely returns to nulliparous dimensions
🔸 hymen: represented by several small tags of tissue, which
🔸
are converted into the myrtiform caruncles
Relaxation of the Relaxation of vaginal outlet:
extensive laceration or overstretching of perineum during
vaginal outlet and
🔸
delivery
prolapse Changes in pelvic supports during parturition :
predispose to uterine prolapse & urinary stress incontinence --> operative correction is usually postponed until childbearing is
🔸
end
Abdominal wall:
return to normal -->requires several weeks (aided by exercise): usually resumes its prepregnancy state except for silvery
striae
🔸byleukocytosis and thrombocytosis occur during and after labor:
blood and Fluid Changes
🔸Cardiac output remains elevated for atleast 48 hours postpartum (due to increased stroke volume from venous return)
1-2 week after delivery, blood volume return nearly to nonpregnant level
🔸 Management
🔸
1 Vital signs (P,BP,Temp,R.R) + contraction of the uterus(uterine involution) + Lochia (amount; colour,and odour)
🔸
=Every 5 min. for 1% hours , then every 1% hourly for 2 hours, then transfer the mother to the postnatal ward and observation Prevention by identify pt. at risk of PPH
🔸
every 2 hours for 6 hourly; then 6 hourly till discharge BLOOD FOR GROUPING AND CROSS MATCHING LARGE PORE CANULA INSERTED 18 g OR 16g
🔸🔸🔸 🔸 Following delivery of the infant, the uterus is massaged in a circular or back-and-forth motion
2 Breast examination+lawer limb examination for the detection of signs of DVT every day. Prior to placental separation, gentle steady traction on the cord combined with upward
3 The mother should be encouraged to pass urine. pressure on the lower uterine segment (Brandt-Andrews maneuver)
🔸
4 Early mobilization.
🔹
5 Management of episiotomy; and perennial tears. ACTIVE MANAGEMENT OF THIRD STAGE
Management of normal Care of the Vulva Should be instructed to cleanse vulva from anterior to posterior (vulva- anus) ice bag applied to perineum Uterotonic agents can be administered as soon as the infant's anterior shoulder is delivered. 10
🔸🔸 🔹
Warm sitz bath :beginning about 24 hours after delivery Tab bathing after uncomplicated delivery is allowed oxytocin UNITS GIVEN IM
puerperium 6 In normal delivery the mother can go home 48 hours after delivery ;and 10 days in C.S. (ERGOMETRINE)Ergot alkaloids should not be used in hypertensive women or in women with
🔹
7 Diet regime: cardiac disease.
No dietary restrictions for women who have been delivered vaginally 2 hours after normal vaginal delivery, (if, no Cx) 10 units oxytocine can be injected into the umbilical cord to placental side
•lactating women : should be increased in calories and protein Manual Removal of the Placenta IF NOT SEPARATED WITHIN 30 MINUTES AFTER DELIVERY OF
🔸🔸
•not breast feeding: dietary requirement as for a nonpregnant woman
🔹
FETUS
📍
8 postnatal visit. prophylactic antibiotics can be given at the timeof manual removal of the placenta
9
🔸 Advising for contraception and spacing of pregnancy
10 Coitus Median interval between delivery and intercourse :5 weeks (1~12 weeks)
If there is retained products we advice to do currttage by bango currette
🔶 Preparation for lactation
-Lactation can occur by 16 weeks' gestation.
-Lacto genesis is initially triggered by the delivery of the placenta (E & P decrease and prolactin).
-the prolactin levels decrease and return to normal within 2-3 weeks (not breast feeding)
-The colostrums (the first 2-4 days)
-The milk continues to change throughout the period of breastfeeding to meet the changing demands of the baby.
🔶 Pituitary ovarian relationship
🔸
the plasma levels of placental hormones declined rapidly following delivery.
📍 The onset of the first mensrual period following delivery:
📍Ifnotlactating: Menstruate afterthe baby stop lactation or even before
lactating mensrruate in 6-12 weeks
🔶
🔸 Milk production
1 .MAMOGENESIS:
Uterine atonia
If uterotonic agents failed to control atonia we do bimanual compression for 30 minutes Folyes
during puberty the Duct system was formed under the influence of Estrogen, Adrenal gland and Growth hormones, while in catheter must be inserted first
pregnancy the Lobuloalveolar system of the breasts was formed under the influence of Estrogen, Progesterone, Prolactin,
🔸
Adrenal gland and Growth hormones.
2.LACTOGENESIS:
Repair of Lacerations`
IN prescence of firm uterus check with good ligth the cervix and vagina and vulva for laceration
BREAST FEEDING
With delivery due to withdrawal of inhibitory effect of both Estrogen and Progesterone in addition to the effect of Prolactin,
Glucocorticoides, Thyroid, Insulin and Growth hormones the well developed mammary glands stimulate lactose syntheses and 📍
or tear Epsiotomy must be repaired Pack of gauze inside vagina keep the field dry for stitch.
If hematoma extend to broad ligament laparatomy is neededd
🔸
ultimately increased milk lactose.
3.GALACTOKINESIS:
when the baby suck, afferent signals from the breast ascended to the Supraoptic nucleus, and via the pituitary hypothalamic
Operative management
Internal Iliac Artery Ligation
pathway to the Posterior pituitary gland to secrete Oxytocin which causing contraction of myoepithelial cells in the alveoli and Pressure Occlusion of the Aorta
small milk ducts leading to Milk ejection, or "letting down B-Lynch Brace Suture
🔶 colostrum :
Colostrum, the premilk secretion, is a yellowish alkaline secretion that may be present in the last months of pregnancy and for
Uterine Artery Ligation
finally hysterictomy
the first 2-3 days after delivery. It has a higher specific gravity (1.040-1.060); a higher protein, vitamin A, immunoglobulin, and
sodium and chloride content; and a lower carbohydrate, potassium, and fat content than mature breast milk. Colostrum has a
normal laxative action and is an ideal natural starter food.
🔶
🔸 Advantages of Breastfeeding
🔸 1-Breastfeeding is convenient, economical, and emotionally satisfying to most women.
2- It helps to contract the uterus and accelerates the process
🔸
of uterine involution in the postpartum period, including decreased maternal blood loss.
🔸 3-lt promotes mother-infant bonding and self-confidence
🔸 4- Maternal gastrointestinal motility and absorption are enhanced.
🔸5-Ovulatory cycles are delayed with non supplemented breastfeeding.
6-According to epidemiologic studies, breastfeeding may help to protect against premenopausal cancer and ovarian cancer.
by fatema okoff
🔹
COMPLICATIONS OF THE PUERPERIUM
Postpartum Infection (Endometritis, Episiotomy infection, CS. Wound infection, UTI, Mastitis or
definition The puerperium is the 6- to 8-week-period following birth during which the reproductive tract, as well asthe rest of the body,
returns to the nonpregnant state. 🔹
Pneumonia)
🔹 Postpartum Hemorrhage
🔹 Puerperal venous thrombosis and pulmonary embolism
Puerperal psychosis
Postpartum Hemorrhage
Definition
Postpartum hemorrhage denotes excessive bleeding (> 500 mL in vaginal delivery) following
delivery of fetus. Hemorrhage may occur before, during, or after delivery of the placenta.
🔹
Classified into:
Primary((early)) postpartum hemorrhage:
🔸Urinary 🔹
Blood lost during the first 24 hours after delivery
Secondary or late postpartum hemorrhage :
🔸
🔸
Uterine Changes
Tract Changes
Occur between 24 hours and 6 weeks after deliver
🔸 Relaxation of the Vaginal Outlet and Prolapse of the Uterus
▪️ Incidence:
🔸Peritoneum and Abdominal Wall
Blood and Fluid Changes
5-8 % following vaginal delivery Constitute third cuase of maternal death in USA
Clinical aspect of the 🔹
COMPLICATION OF PPH:
1- can lead to post partum hypotention which lead to necrosis of anterior lobe of pituitary
Puerperium 🔸
PHYSIOLOGY OF THE PUERPERIUM
Involution of the Uterus: 🔹
glandand sheehan syndrome with failure of lactation and amenorrhea.
2-complication associated with transfusion therapy (eg, viral infection, transfusion reactions) is
🔹
-The uterus weighs approximately 1000 g and has a volume of 5000 mL immediately after delivery, compared with its non infrequent but significant
pregnant weight of approximately70 g and capacity of 5 mL. 3- In extreme hemorrhage, sterility will result from hysterectomy performed to control
-Uterine involution is caused by autolysis of intracellular myometrial protein, resulting in a decrease in cell size but not in cell intractable postpartum hemorrhage.
number.
🔸 Position of uterus
Immediately after delivery, the fundus of the uterus is easily palpable halfway between the pubic symphysis and the umbilicus.
GENERAL RISK FACTORS OF PPH
1)Coagulopathy.
2)history of hemorrhage.
The immediate reduction in uterine size is a result of delivery of the fetus, placenta, and amniotic fluid, as well as the loss of 3)blood transfusion during a previous pregnancy.
hormonal stimulation. 4)anemia during labor.
5)grand multiparity.
6)multiple gestation
7) large infant; polyhydramnios; dysfunctional labor.
8) oxytocin induction or augmentation of labor; rapid labor.
9) severe preeclampsia or eclampsia.
10) vaginal delivery after previous cesarean birth general anesthesia for delivery; and forceps
delivery
4Ts
🔷
Causes of PPH
1-TONE(UTERINE ATONIA)
🔸
Changes in the uterine vessels
Caliber of extrauterine vessels:
Atony is the most common cause of postpartum hemorrhage (50% of cases). Predisposing causes
include :
🔸
decrease to equal size of prepregnant state after delivery
Blood vessels within puerperal uterus:
obliterated by hyaline change replaced by smaller vessels
1-excessive manipulation of the uterus.
2-general anesthesia (particularly with halogenated compounds).
3- uterine overdistention (twins or polyhydramnios),
4-prolonged labor
🔸
Changes in the Cervix & Lower Uterine Segment 5- grand multiparity
Cervical opening contracts slowly and for a few days immediately after labor (= 2fingers) 6-uterine leiomyomas
🔸
:by the end of the 1st wk - it has narrowed 7- operative delivery and intrauterine manipulation.
🔸 As the opening narrows the cervix thickens and a canal reforms. 8-oxytocin induction or augmentation of labor.
🔸Bilateral depression at the site oflacerations remain as permanent changes that characterize the parous cervix 9-previous hemorrhage in the third stage.
Markedly thinned-out lower uterine segment: 10-uterine infection, extravasation of blood into the myometrium (Couvelaire uterus), and intrinsic
contracts & retracts myometrial dysfunctions
- uterine isthmus located between the uterine corpus above and the internal cervical os below- over the course of few weeks
🔷 2-Trauma (Obstetric Lacerations)
CONSTITUTE 20% OF CASES BLEEDING CAN BE EITHER FROM EPISIOTOMY OR VAGINAL
🔸
after pains
🔸 Primiparas: puerperal uterus tends to remain tonically contracted
🔹
,CERVICAL, TEAR
Persistent bleeding (especially bright red) and a well-contracted, firm uterus suggests
Uterine Changes 🔸-->afterpain
Multiparas: contracts vigorously at interval - afterpain
Infant suckles --> oxytocin release--> Ut.contraction
🔹
bleeding from a laceration or from the episiotomy.
When cervical or vaginal lacerations are identified as the source of postpartum hemorrhage,
🔸Occasionally severe enough to require an analgesic: usually become mild by the 3rd postpartum day repair is best performed with adequate anesthesia.
Lochia
🔷 3-TISSUE (RETAINED PRODUCT)
🔸
Early in the puerperium, sloughing of decidual tissue --> vaginal discharge of variable quantity 🔹
Retained placental tissue and membranes cause 5–10% of postpartum hemorrhages.
Retention of placental tissue in the uterine cavity occurs in :
🔸
🔸
lochia rubra:first few days after delivery blood in lochia
lochia serosa: after 3 or 4 days becomes progressively pale in color
lochia alba: after 10th day white or yellowish-white color, lasted for approximately 2weeks after delivery
-placenta accreta
-manual removal of the placenta
-mismanagement of the third stage of labor
🔸
-unrecognized succenturiate placenta.
dilated renal pelvis &ureters: DX Ultrasonographic findings of an echogenic uterine mass strongly support a diagnosis of
🔸
return to prepregnantstate 2-8 weeks after delivery retained placental products.
Puerperal diuresis:
🔷
🔸
physiological reversal of pregnancy-induced increase in extracellular water : regularly occurs between 2nd and 5th day 4-THROMBIN ((COAGULATION DEFECT))
Puerperal bladder create optimal condition for development of UTI: 1-Hypofibrinogenemia
increased capacity & relative insensitivity to intravesical fluid pressure -->overdistention, incomplete emptying, excessive 2-Thrombocytopenia
residual urine 3-disseminated intravascular coagulation.
4- Transfusion of more than 8 U of blood in itself may induce a dilutional coagulopathy.
puerperium
5-Von Willebrand's disease, autoimmune thrombocytopenia, and leukemia may occur in pregnant
women.
▪️ Vagina and vaginal outlet gradually diminishes in size
🔸Rugae : reappear by the 3rd week
but rarely returns to nulliparous dimensions
🔸 hymen: represented by several small tags of tissue, which
🔸
are converted into the myrtiform caruncles
Relaxation of the Relaxation of vaginal outlet:
extensive laceration or overstretching of perineum during
vaginal outlet and
🔸
delivery
prolapse Changes in pelvic supports during parturition :
predispose to uterine prolapse & urinary stress incontinence --> operative correction is usually postponed until childbearing is
🔸
end
Abdominal wall:
return to normal -->requires several weeks (aided by exercise): usually resumes its prepregnancy state except for silvery
striae
🔸byleukocytosis and thrombocytosis occur during and after labor:
blood and Fluid Changes
🔸Cardiac output remains elevated for atleast 48 hours postpartum (due to increased stroke volume from venous return)
1-2 week after delivery, blood volume return nearly to nonpregnant level
🔸 Management
🔸
1 Vital signs (P,BP,Temp,R.R) + contraction of the uterus(uterine involution) + Lochia (amount; colour,and odour)
🔸
=Every 5 min. for 1% hours , then every 1% hourly for 2 hours, then transfer the mother to the postnatal ward and observation Prevention by identify pt. at risk of PPH
🔸
every 2 hours for 6 hourly; then 6 hourly till discharge BLOOD FOR GROUPING AND CROSS MATCHING LARGE PORE CANULA INSERTED 18 g OR 16g
🔸🔸🔸 🔸 Following delivery of the infant, the uterus is massaged in a circular or back-and-forth motion
2 Breast examination+lawer limb examination for the detection of signs of DVT every day. Prior to placental separation, gentle steady traction on the cord combined with upward
3 The mother should be encouraged to pass urine. pressure on the lower uterine segment (Brandt-Andrews maneuver)
🔸
4 Early mobilization.
🔹
5 Management of episiotomy; and perennial tears. ACTIVE MANAGEMENT OF THIRD STAGE
Management of normal Care of the Vulva Should be instructed to cleanse vulva from anterior to posterior (vulva- anus) ice bag applied to perineum Uterotonic agents can be administered as soon as the infant's anterior shoulder is delivered. 10
🔸🔸 🔹
Warm sitz bath :beginning about 24 hours after delivery Tab bathing after uncomplicated delivery is allowed oxytocin UNITS GIVEN IM
puerperium 6 In normal delivery the mother can go home 48 hours after delivery ;and 10 days in C.S. (ERGOMETRINE)Ergot alkaloids should not be used in hypertensive women or in women with
🔹
7 Diet regime: cardiac disease.
No dietary restrictions for women who have been delivered vaginally 2 hours after normal vaginal delivery, (if, no Cx) 10 units oxytocine can be injected into the umbilical cord to placental side
•lactating women : should be increased in calories and protein Manual Removal of the Placenta IF NOT SEPARATED WITHIN 30 MINUTES AFTER DELIVERY OF
🔸🔸
•not breast feeding: dietary requirement as for a nonpregnant woman
🔹
FETUS
📍
8 postnatal visit. prophylactic antibiotics can be given at the timeof manual removal of the placenta
9
🔸 Advising for contraception and spacing of pregnancy
10 Coitus Median interval between delivery and intercourse :5 weeks (1~12 weeks)
If there is retained products we advice to do currttage by bango currette
🔶 Preparation for lactation
-Lactation can occur by 16 weeks' gestation.
-Lacto genesis is initially triggered by the delivery of the placenta (E & P decrease and prolactin).
-the prolactin levels decrease and return to normal within 2-3 weeks (not breast feeding)
-The colostrums (the first 2-4 days)
-The milk continues to change throughout the period of breastfeeding to meet the changing demands of the baby.
🔶 Pituitary ovarian relationship
🔸
the plasma levels of placental hormones declined rapidly following delivery.
📍 The onset of the first mensrual period following delivery:
📍Ifnotlactating: Menstruate afterthe baby stop lactation or even before
lactating mensrruate in 6-12 weeks
🔶
🔸 Milk production
1 .MAMOGENESIS:
Uterine atonia
If uterotonic agents failed to control atonia we do bimanual compression for 30 minutes Folyes
during puberty the Duct system was formed under the influence of Estrogen, Adrenal gland and Growth hormones, while in catheter must be inserted first
pregnancy the Lobuloalveolar system of the breasts was formed under the influence of Estrogen, Progesterone, Prolactin,
🔸
Adrenal gland and Growth hormones.
2.LACTOGENESIS:
Repair of Lacerations`
IN prescence of firm uterus check with good ligth the cervix and vagina and vulva for laceration
BREAST FEEDING
With delivery due to withdrawal of inhibitory effect of both Estrogen and Progesterone in addition to the effect of Prolactin,
Glucocorticoides, Thyroid, Insulin and Growth hormones the well developed mammary glands stimulate lactose syntheses and 📍
or tear Epsiotomy must be repaired Pack of gauze inside vagina keep the field dry for stitch.
If hematoma extend to broad ligament laparatomy is neededd
🔸
ultimately increased milk lactose.
3.GALACTOKINESIS:
when the baby suck, afferent signals from the breast ascended to the Supraoptic nucleus, and via the pituitary hypothalamic
Operative management
Internal Iliac Artery Ligation
pathway to the Posterior pituitary gland to secrete Oxytocin which causing contraction of myoepithelial cells in the alveoli and Pressure Occlusion of the Aorta
small milk ducts leading to Milk ejection, or "letting down B-Lynch Brace Suture
🔶 colostrum :
Colostrum, the premilk secretion, is a yellowish alkaline secretion that may be present in the last months of pregnancy and for
Uterine Artery Ligation
finally hysterictomy
the first 2-3 days after delivery. It has a higher specific gravity (1.040-1.060); a higher protein, vitamin A, immunoglobulin, and
sodium and chloride content; and a lower carbohydrate, potassium, and fat content than mature breast milk. Colostrum has a
normal laxative action and is an ideal natural starter food.
🔶
🔸 Advantages of Breastfeeding
🔸 1-Breastfeeding is convenient, economical, and emotionally satisfying to most women.
2- It helps to contract the uterus and accelerates the process
🔸
of uterine involution in the postpartum period, including decreased maternal blood loss.
🔸 3-lt promotes mother-infant bonding and self-confidence
🔸 4- Maternal gastrointestinal motility and absorption are enhanced.
🔸5-Ovulatory cycles are delayed with non supplemented breastfeeding.
6-According to epidemiologic studies, breastfeeding may help to protect against premenopausal cancer and ovarian cancer.
by fatema okoff
