NORMAL PUERPERIU M WHAT IS PUERPERIUM Period following
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NORMAL PUERPERIU M
WHAT IS PUERPERIUM? Period following childbirth Ø Pelvic organs & other body tissues Ø Revert to pre-pregnant state Ø Anatomically & physiologically Ø
Ø Ø Ø I. III. Begins as soon as placenta is expelled lasts for appx 6 weeks(42 days) 3 stages Immediate-within 24 hrs Early -upto 7 days Remote – upto 6 wks
INVOLUTION OF THE UTERUS Anatomical consideration ● At delivery-20 x 12 x 7. 5 cm and appox. 1000 g ● After involution-reverted to non-preg size of appox. 60 g ● Lower uterine segment isthmus in a few weeks ● Contour of cervix regained in 6 wks ● External os never reverts back to nulliparous state
Physiological Consideration Autolysis Ø Muscles: Steroid hormones withdrawn Myometrial cell size reduced Inc Collagenase & Proteolytic enzymes Endophlebitis Thrombosis Blood Vessels Fibrinoid end arteritis Ø Hyalinisation Endometrium: q q regen starts on day 7 from uterine gland mouths and interglandular stromal cells completed by day 16 except @ placental site
Clinical assessment of Involution of uterus • Fundus lies 13. 5 cm above sypmphysis pubis for the 1 st 24 hrs following delivery • Steady decrease by 0. 5'' in nxt 24 hrs • Day 14 - not palpable- pelvic organ • Completed by 6 wks
Long time d/t stretching during parturition Pelvic floor & Fascia 4 -8 weeks; Does not revert to original state Broad/round ligaments Vagina Involution of other Pelvic structures Long time d/t stretching during parturition
LOCHIA • Vaginal discharge for the 1 st fortnight during puerperium ● Odour: offensive fishy smell ● Colour and composition Lochia Rubra • 1 -4 days • Blood, fetal memb & decidua shreds, lanugo, meconium Lochi Serosa • 5 -6 days • Leucocytes, Cx mucus, wound exudates, microorganisms Lochia Alba • 10 -15 days • Decicual cells, leucocytes, mucus, cholestrin crystals, fatty epithelial cells, microorganisms
Clinical importance Malodorous Scanty/absent Excessive Red color persist L. Alba beyond 3 wks • Puerperal Sepsis dt E. Coli • Infection • Lochiometra • Infection • Subinvolution • Retained conceptus • Causes secondary PPH • Local genital infection
CHANGES IN BREAST & LACTATION Mamogenesis • Mammary duct-gland growth development Lactogenesis • Initiation Of milk secretion in Galactopoiesis Galactokinesis • Maintenance of Lactation • Removal of Milk from Gland
General Physiological Changes Ø Pulse: Ø Ø Temperature: Ø Ø Ø Pronounced Diuresis on 2 nd - 3 rd day over distension incomplete emptying presence of residual urine high risk of infection GIT: Ø Ø Ø Any rise above 0. 5 C suggestive of infection of genito-urinary tract Urinary Tract: Ø Ø raises but settles down to normal on 2 nd day increased thirst constipation Weight Loss: Ø Ø Ø 5 -6 kg expulsion of fetus placenta, liqour, blood 2 kg- during puerperium dt diuresis Continued upto 6 months of delivery
Ø Blood Values: Ø Ø Ø Menstruation: Ø Ø immediate-reduced blood volume; Normal in 2 weeks rise in cardiac output; Normal in 1 week leuycocyotsis dt stress Hypercoagulable state for 48 hrs Fibrinolytic activity enhanced in 4 days if not breast feeding- resumes in 6 to 8 wks Ovulation: Ø Ø Ø non-lactating mother- 4 wks lactating mother- 10 weeks Exclusive Breastfeeding- 98% contraception up 6 months
Management of normal Puerperium Ø To restore health of Mother Ø Ø Ø Ø Rest and Early ambulation Emotional support Diet of patients choice Sleep Immunization- anti-D- Gamma globulin Maternal-infant Bonding Postnatal exercise
Ø To prevent infection Care of bladder & Vulva ØCare of episiotomy wound ØMaintenance of asepsis and proper hygiene ØImmunization- Rubella vaccine, TT Ø To take care of the Breasts & promote breast feeding ØTo motivate mother for contraception Ø
Treatment of minor ailments • After pains • Uterus massage • Ibuprofen • Anti-spasmodic • Pain at site of perineum • Sitz bath • analgesics • Treatment of Anaemia • Supplementary Iron therapy
Abnormal Puerperium Ø Puerperal fever/ pyrexia Ø Puerperal Sepsis • Pelvic pain • Fever • Foul smelling vaginal discharge • Subinvolution
Ø Breast Problems • Retracted/cracked nipples • Breast engorgement • Mastitis • Breast abscess • Failure of lactation
Ø Urinary Problems • Retention • Incontinence • Infection Ø Venous thrombosis Ø Secondary Hemorrhage Ø Puerperal psychosis Ø Obstetric palsy
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