importatant topic

1. LACTATION
MAMMOGENESIS
LACTOGENESIS
GALACTOKINESIS
GALACTOPOIESIS

2. PHYSIOLOGY OF LACTATION

5. TYPE OF HUMAN MILK
A. Colostrum
B. Transitional milk
C. Mature milk.

6. COMPOSITION OF COLOSTRUM AND
BREAST MILK
PROTEIN FAT CARBOHYDRATE WATER
COLOSTRUM 8.6 2.3 3.2 86
BREAST MILK 1.2 3.2 7.5 87

7. Postnatal care & counselling
 Postnatal care includes systematic examination of the mother and baby and
appropriate advice given to the mother during postpartum period. • First
postnatal examination done and advice is given on discharge of the patient
from the hospital. • Second routine postnatal care is conducted at the end of 6th
week postpartum

8. Aims and objectives
 To assess the health status of the mother. Medical disorders- diabetes,
hypertension, thyroid disorders.
 • To detect and treat any gynaecological condition arising out of obstetric
legacy.
 • To note the progress of the baby including immunisation schedule for the
infant.
 • To impart family planning guidance.

9. Examination of mother
 Routine examination: weight, pallor, blood pressure and tone of abdominal
muscles, progress of normal involution of uterus and examination of breasts.
 • Pelvic examination: cervical smear for exfoliative cytology and insertion of
IUD when desired.
 • Laboratory investigation depending on clinical need (Hb).

10. Advice given to mothers- first visit
• Measures to improve her general health.
Continue iron supplementation.
• Procedures for gradual return to day to day activities.
• Breastfeeding and care of the newborn.
• Avoidance of intercourse for a period of 4-6 weeks until lacerations or
episiotomy wound are healed.
• Postnatal checkup after 6 weeks.

11. Postnatal exercises
 Objectives: - to improve the muscle tone - to educate about correct posture to
be attained when the patient is getting up from her bed.
 • Advantages: - minimize risk of puerperal venous thrombosis
 - to prevent backache,
 to prevent genital prolapse and stress incontinence of urine.
 • Procedure: - breathing exercise and leg movements lying in bed. - instructed
to tone up the abdominal and perineal muscles and to correct postural defects.
- Continued for 3 months.

12.  To tone up the pelvic floor muscles: patient asked to contract the pelvic muscles
in a manner to withhold the act of defecation or urination, then to relax.
 • To tone up abdominal muscles: patient lies in dorsal position with the knees
bent and the feet flat on the bed. Abdominal muscles contracted and relaxed
alternately, the process is to be repeated several times a day.
 • To tone up back muscles: patient lies on her face with the arms by her side.
Shoulders slowly moved up and down. Repeated 3-4 times a day, gradually
increased each day.

14. To impart family planning guidance
• Family planning counselling and guidance:
Method of contraception depends upon: -
Breastfeeding status - State of health - Number
of children

15. Natural methods:
 Exclusive breastfeeding provides 98% contraceptive protection. Cannot be
used until menstrual cycles are regular. Barrier methods may be used.
 • In non lactating mothers: steroidal contraception can be used. Should be
started 3 weeks after delivery
 . • In lactating women: progestin only pill can be used. Other progestins- DMPA,
Levonorgestrel implants.
 • IUDs can be used irrespective of breastfeeding status. Inserted immediately
after delivery.
 • Sterilisation: for those who have completed their families.

16. Advice given to mother- second visit
 • If the patient is in sound health she is allowed to
do her usual duties.
 • Postpartum exercises may be continued for
another 4-6 weeks.
 • Evaluate the progress of the baby periodically
and to continue breastfeeding for 6 months
 . • Family planning counselling and guidance.

17. To detect and treat any gynaecological condition arising out
of obstetric legacy.
• Complications of postpartal period: - Puerperal sepsis:
infection of genital tract within 3 weeks after delivery.
Treated with gentamicin. Adequate fluid and calorie intake.
- Thrombophlebitis: inflammation of veins of the legs.
Analgesics, antibiotics, anticoagulants like heparin. -
Secondary haemorrhage: bleeding from vagina between 6
hours after delivery to the end of puerperium. May be due
to retained placenta or membranes. - Others: UTI and
mastitis (dicloxacillin 500mg every 6hrs orally)

18. • Gynaecological problems: - Irregular vaginal bleeding:
usually the first period especially in non lactating
women. Persistence of bleeding dating back from
childbirth likely due to retained bits of conceptus.
Requires ultrasound followed by D&C. - Leukorrhea:
profuse white discharge may be due to ill health,
vaginitis, cervicitis or subinvolution. Improve general
health and specific therapy. - Cervical ectopy: without
any symptom should not be treated surgically. Thus
examined again after 6 weeks and if still persists,
cauterization.

19. • Backache: due to sacroiliac or lumbosacral strain.
Backache over the sacrum - pelvic pathology.
• Slight degree of uterine descent with cystocele,
stress incontinence and relaxed perineum- effective
pelvic floor exercise. If prolapse marked- effective
surgery should be done after 3 months.
• Urinary and anal incontinence- any sphincter injury.
Perineal exercises.
• Retroversion: produces backache. If associated
with subinvolution with symptoms, a pessary is
inserted after correcting position, to be kept about 2
months.

21. To note progress of the baby
 • Examination of the baby- - Done by
a paediatrician.
 Progress of the baby evaluated
 Immunization of baby started.