Postpartum

    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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