Post natal care complaints during post natal period

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Post natal care & complaints during post natal period Vijay Zutshi MAMC & Lok

Post natal care & complaints during post natal period Vijay Zutshi MAMC & Lok Nayak Hospital, New Delhi

Normal puerperium and Postnatal Care

Normal puerperium and Postnatal Care

Objectives Definition of normal puerperium n Various physiological changes during normal puerperium n Various

Objectives Definition of normal puerperium n Various physiological changes during normal puerperium n Various aspects of lactation n Care of a woman during puerperium n Explain the postnatal exercises to be practiced during puerperium. n

Definition of Normal Puerperium Child birth – 6 weeks(42 days) § First 24 hours

Definition of Normal Puerperium Child birth – 6 weeks(42 days) § First 24 hours § Early- up to 7 days § Remote- up to 6 weeks

Points to remember for puerperium: • Prevention of sepsis at placental site • Newborn

Points to remember for puerperium: • Prevention of sepsis at placental site • Newborn care • Initiation of breast feeding • Role of post-natal exercises

Physiological changes in Normal Puerperium Changes in Genital Tract n Changes in breast and

Physiological changes in Normal Puerperium Changes in Genital Tract n Changes in breast and Lactation n Changes in other systems n

Changes in Genital Tract Involution of the Uterus n Lochia n Involution of Other

Changes in Genital Tract Involution of the Uterus n Lochia n Involution of Other Pelvic Organs n Menstruation n

Changes in Breast and Lactation Mamogenesis n Lactogenesis n Galactopoiesis n Galactokinesis n (Mammary

Changes in Breast and Lactation Mamogenesis n Lactogenesis n Galactopoiesis n Galactokinesis n (Mammary (Initiation duct-gland growth & dev. ) Of milk secretion in alveoli) (Maintenance of Lactation) (Removal of Milk from Gland)

Changes in other system n n n n Fatigue Pulse slow Temp. subnormal Shivering

Changes in other system n n n n Fatigue Pulse slow Temp. subnormal Shivering Fever up to first 24 hours Hb. Rises TLC increases Diuresis- 2 nd to 5 th day post delivery

Postnatal Care n n n n Postnatal Check Up Detection of risk at earlier

Postnatal Care n n n n Postnatal Check Up Detection of risk at earlier stage & its management Management of Normal puerperium Treatment of Minor Ailments Treatment of anaemia Health & nutrition education Postnatal Exercise

Postnatal Check Up General health check up n Monitoring of involution process n For

Postnatal Check Up General health check up n Monitoring of involution process n For satisfactory establishment of lactation n For examination of newborn n

Management of Normal Puerperium First hour– important for PPH n Early ambulation n Avoid

Management of Normal Puerperium First hour– important for PPH n Early ambulation n Avoid strenuous activities for 6 weeks n 8 -10 hours sleep n Needs 300 calories more n Care of MLE stitches if any n Care of nipples and areola. n

Treatment of Minor Ailments After pains n Retention of urine n Pain at site

Treatment of Minor Ailments After pains n Retention of urine n Pain at site of perineum n Engorgement of breast n Treatment of Anaemia n

Health & nutrition education Family planning advise n Sexual intercourse can be resumed after

Health & nutrition education Family planning advise n Sexual intercourse can be resumed after 6 weeks after delivery n Breast feeding is best n Immunization of child n Calorie need per day-2200+700 =2900 n Role of post natal exercises n

Postnatal Exercise Pelvic floor exercise n Abdominal tightening n Pelvic tilting or rocking n

Postnatal Exercise Pelvic floor exercise n Abdominal tightening n Pelvic tilting or rocking n Rectus gap n Hip hitching n Foot and Leg Exercise n

ABNORMAL PUERPERIUM

ABNORMAL PUERPERIUM

OBJECTIVES n n n Importance of puerperal infections to maternal morbidity and mortality Definition

OBJECTIVES n n n Importance of puerperal infections to maternal morbidity and mortality Definition of puerperal fever and puerperal sepsis Various puerperal abnormalities Causes of puerperal fever Aseptic and antiseptic measures to be adopted for the prevention of puerperal sepsis Management of the various abnormalities.

Abnormal puerperium Sepsis is the commonest complication during puerperium but largely preventable.

Abnormal puerperium Sepsis is the commonest complication during puerperium but largely preventable.

Puerperal Fever/Pyrexia Oral temp. 38 degree C or more recorded twice in the first

Puerperal Fever/Pyrexia Oral temp. 38 degree C or more recorded twice in the first 10 days after delivery.

Causes of Puerperal fever Uterine infection n Breast infection n Urinary infection n Thrombophlebitis

Causes of Puerperal fever Uterine infection n Breast infection n Urinary infection n Thrombophlebitis n Other incidental infections n

Puerperal Sepsis Definition n Risk Factors for Puerperal Sepsis n Diagnosis n Management n

Puerperal Sepsis Definition n Risk Factors for Puerperal Sepsis n Diagnosis n Management n Complication n

Definition Infection of genital tract : Delivery-42 days after delivery n Two or >

Definition Infection of genital tract : Delivery-42 days after delivery n Two or > features to be present n pelvic pain, fever 38. 50 C, vaginal D/S, smell of D/S, sub-involution

Risk Factors for Puerperal Sepsis Anaemia n Malnutrition n DM n Prolonged labor n

Risk Factors for Puerperal Sepsis Anaemia n Malnutrition n DM n Prolonged labor n Obstructed labor n Prolonged PPROM n Frequent vaginal examinations n

Contd…. n n n n Operative delivery Un-repaired tears PPH Poor hygiene Poor aseptic

Contd…. n n n n Operative delivery Un-repaired tears PPH Poor hygiene Poor aseptic technique for delivery Manipulations high in the birth canal Retained bits of placenta or membranes Pre-existing STDs

Diagnosis Endometritis n Subinvolution n Pelvic cellulites n Salpingitis & peritonitis n Pelvic thrombophlebitis

Diagnosis Endometritis n Subinvolution n Pelvic cellulites n Salpingitis & peritonitis n Pelvic thrombophlebitis n Septicaemia n

Management Preventive n Good antenatal care n Proper intra-natal care n Post natal care

Management Preventive n Good antenatal care n Proper intra-natal care n Post natal care Curative n General care n Antibiotics for infection n Local care of various wounds

Complication Septicaemia n Septic shock n DIC n Pulmonary embolization n Distant spread of

Complication Septicaemia n Septic shock n DIC n Pulmonary embolization n Distant spread of infection n Kidney failure n Death n

Contd…. Late complications: n Menstrual problems n Chronic pelvic pain n Chronic PID n

Contd…. Late complications: n Menstrual problems n Chronic pelvic pain n Chronic PID n Secondary infertility

Infections Associated with Childbirth Process other than Puerperal Sepsis Breast Problems n Urinary Problems

Infections Associated with Childbirth Process other than Puerperal Sepsis Breast Problems n Urinary Problems n Venous Thrombosis n

Breast Problems Retracted / cracked nipples n Breast engorgement n Mastitis n Breast abscess

Breast Problems Retracted / cracked nipples n Breast engorgement n Mastitis n Breast abscess n Failure of lactation n

Urinary Problems Retention n Incontinence n Infection n

Urinary Problems Retention n Incontinence n Infection n

Venous Thrombosis n n Due to hypercoagulable state of pregnancy Predisposing factors: Increasing maternal

Venous Thrombosis n n Due to hypercoagulable state of pregnancy Predisposing factors: Increasing maternal age Obesity Anaemia Dehydration Trauma Infection Smoking Reduced mobility

Puerperal Morbidity other than infection Secondary Hemorrhage n Puerperal Psychosis n Obstetric Palsy n

Puerperal Morbidity other than infection Secondary Hemorrhage n Puerperal Psychosis n Obstetric Palsy n

Secondary Hemorrhage n Due to: Infection Retained bits of placenta & membranes Subinvolution

Secondary Hemorrhage n Due to: Infection Retained bits of placenta & membranes Subinvolution

Puerperal Psychosis Transient n Self limiting n Antidepressants & psychological counseling n

Puerperal Psychosis Transient n Self limiting n Antidepressants & psychological counseling n

Obstetric Palsy Severe neuralgia due to pressure on lumbo -sacral nerve plexus n Foot

Obstetric Palsy Severe neuralgia due to pressure on lumbo -sacral nerve plexus n Foot drop n Rarely femoral, obturator or sciatic nerves may be involved n Spontaneous recovery usually n Physiotherapy is helpful n

Conclusions Importance of history n Systematic evaluation n Proper advise & motivation regarding contraception

Conclusions Importance of history n Systematic evaluation n Proper advise & motivation regarding contraception n Importance of immunization for new born n Stress upon post natal exercises. n