Table of contents
- 1. Breast Feeding
- 1.1. Why Breast Feed
- 1.2. Drugs
- 2. Postpartum Hemorrhage
Breast Feeding
Why Breast Feed
- Cheap, easy, no preparation/sterilization.
- Colostrum - secretion immediately after delivery. Yellow color contains carotenoids, minerals, protein.
- Presence of antibodies IgA protects against enteric coated pathogens.
- Immune complexes, macrophages, lactoferrin.
- Contains all vitamins except vitamin K.
- Contains Fe, but supplementation requred >6mo.
- Stable if mother's diet is poor.
- Breastfeeding is contraception - suppresses gonadotrophins and LH, and suppresses ovulation.
Drugs
- Domperidone - 30mg 3x/day increases milk production (blocks dopamine, upregulates prolactin)
- Safe drugs:
- Analgesics: acetaminophen, NSAIDS, sumatriptan
- Anticoagulants: acenocoumarol, heparin
- Antidepressants: Sertraline, Fluoxetine, TCA
- Antiepileptics: Phenytoin, carbamazepine, valproic acid
- Antihistamines
- Antimicrobials
- B-agonists: propranolol, labetalol
- Insulin, Steroids
- Contraindicated:
- Bromocripine - suppresses milk production (Dopamine agonist used in Parkinsons Disease, hyperprolactinemia, putuitary tumors, TIIDM)
- Cyclophosphamide - Immune suppressant
- Cocaine - intoxication
- Lithium, phenindione, radioactive idone, methotrexate, cyclosporin
- Other contraindications:
- Drug and EtOH abuse.
- Infant with galactosemia
- HIV
- Untreated TB
- HepC (HepB is ok if baby is vaccinated)
- CMV - transmitted through breast milk, but maternal transmitted antibodies just before labour prevent infection
Postpartum Hemorrhage
<24hrs = immediate
>24hrs = delayed
4 T's of PPH
- Tone (atony, most common....typically uterine contraction causes hemostasis)
- Overdistended Uterus (polyhydraminos, multiple gestation, macrosomia)
- Uterine Muscle Exhaustion (rapid/prolonged labour/oxytosin use)
- Intra-amnionic infection (Prolonged ROM, fever)
- Trauma
- Uterine, cervical, vaginal injury
- Uterine inversion/rupture
- Tissue
- Retained products of conception or retained blood clots
- Abnormal placentation
- Retained cotyledon or succenturiate lobe???
- Thrombin
- Acquired (ITP, DIC, thrombocytopenia with pre-eclampsia)
- Pre-existing (Von willebrand's disease, hemophilia A)
- Anticoagulation Medication
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