uterus never comes back to its orginal preprgeancy weight of 80g . because of hyperplasia. the hypertrophy reduces. so with every pregacy will gain.
bladder over distension and stuff because of 1. neurpathy, stretching of nerves during labour 2. trauma to the bladder 3 infarction as bldder if sqased between fetal head and pelvic bone. Also because of pain n vulva.
Colostrum is produced over the nine months of pregnancy bt espeically from second trimester onwards...but mature milk production is later
matre milk is prduced after 3 to 4 days. ITs then that all the progesterone is washe out. Those coming from the placenta. Until then its mainly colustrum thats released.
very importatn concept in surgery and amnennorheas etc
dopamine inhibits prolactin release. so when dopamine drops will have gynecomastia.
infant sucking controls prolacin release and oxytocin release. so its all there.
so stress, anxiety and depression can increase doapmine and that can inhinit prolactin. also some drugs can do this as well.
pain around the nipple site can reduce prolactin release as well.
supression of milk prodction is for purposes like after infant death or introterine death or soemthing, to stop expressing it. The best way is to stiop milk expression,,,,ebm at al costs. Even if it leads to engogement of the breasts...then use cold compresses or breast tying etc
TB isnt transmitted by the reast milk. Its still respiratory route only. Its just that when feeding and being close, increased risk of tranmsision to the infact.
The iucd can be inserted within 24/48 hours after delivery, otherwise mst add after 4 weeks.
better to use progesterone only contraceotion = all types of this.
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Complications
within first 24 hours it can be physiological change from the stress or from misoprostol administeration. Important side effect.
can also be gauze left behind in vagina after delivery
if manual expression is still painful can se breast compresses that are available in the market
Sipport the breast = tight bras
So absoltely okay to breast feet with infected nipples because the source is the infants commensals = so no risk to the infant....just risk to the mother but doesnt matter Infants wellbeing is first.
Must look for nipple cracks and fissures and treat them to avoid this from happening. ⇒ stop breast feeding from that breast and manually express from that for some while.
Cracks should heal before it develops into mastitis/
MC following ascedning ower ginital tract if vaginal delivery , can be systemic as well
even in cs most common is from ascenending lower genital tract !!
Skin route is for superficial abdominal lesions
can also exacerbate into PID and pelvic peritonitis
No need to take high vaginal cultures = would take 3 days anyway so just start. Do basline investi and start empirical
take usg if yo're not sure about the delivery
Evlaluate condition looking for cause of feever from head to toe
How sick is she = to check for extent whether peirotnitis
puerperal sepsis (geneital tract infection after delivery) vs puerperal fever (fever after delivery)
Puerperal sepsis is a cause of puerperal fever!!
DVT is another important cause. So examine lower extremeties.
pelvic abcess is a much serious disease. so will have pain and fever and will look sick!
pregancy is a thrombotic state and so is puereral!!!
Spetic pelvic thrompophlebitis is not seen mch nowadays becase f good antibiotic treatment.
