NORMAL PUERPERIU

M

WHAT IS PUERPERIUM?

Period following childbirth Pelvic organs & other body tissues Revert to pre-pregnant state Anatomically & physiologically

Begins as soon as placenta is expelled

lasts for appx 6 weeks(42 days)

3 stagesI. Immediate-within 24hrsII. Early -upto 7 daysIII. Remote – upto 6wks

INVOLUTION OF THE UTERUS

Anatomical consideration● At delivery-20 x 12 x 7.5cm and appox. 1000g● After involution-reverted to non-preg size of

appox. 60g● 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

Muscles:

Endometrium:

regen starts on day 7 from uterine gland mouths and interglandular stromal cells completed by day 16 except @ placental site

Steroid hormones withdrawn

Inc Collagenase & Proteolytic enzymes

Autolysis

Myometrial cell size reduced

Endophlebitis Thrombosis

Fibrinoid end arteritis Hyalinisation

Blood Vessels

Clinical assessment of Involution of uterus• Fundus lies 13.5cm above sypmphysis pubis for the 1st 24hrs following delivery

• Steady decrease by 0.5'' in nxt 24 hrs• Day 14- not palpable- pelvic organ• Completed by 6 wks

Vagin

a

4-8 weeks;Does not revert to original state

Bro

ad/r

ound

ligam

ents

Long time d/t stretching during parturition

Pelv

ic fl

oor

& F

asc

ia

Long time d/t stretching during parturition

Involution of other Pelvic structures

LOCHIA

• Vaginal discharge for the 1st fortnight during puerperium● Odour: offensive fishy smell● Colour and composition

Lochia Rubra

Lochi Serosa

Lochia Alba

• 1-4 days• Blood,fetal memb & decidua shreds,lanugo,meconium

• 5-6 days• Leucocytes,Cx mucus,wound exudates,microorganisms

• 10-15 days• Decicual cells,leucocytes,mucus,cholestrin crystals,fatty epithelial cells,microorganisms

• Puerperal Sepsis d\t E. ColiMalodorous

• Infection• LochiometraScanty/absent

• InfectionExcessive

• Subinvolution• Retained conceptus• Causes secondary PPH

Red color persist

• Local genital infectionL.Alba beyond 3 wks

Clinical importance

CHANGES IN BREAST & LACTATION

• Mammary duct-gland growth & developmentMamogenesis

• Initiation Of milk secretion in alveoliLactogenesis

• Maintenance of LactationGalactopoiesis

• Removal of Milk from GlandGalactokinesis

General Physiological Changes Pulse:

raises but settles down to normal on 2nd day

Temperature: Any rise above 0.5C suggestive of infection of genito-urinary tract

Urinary Tract: Pronounced Diuresis on 2nd - 3rd day over distension incomplete emptying presence of residual urine high risk of infection

GIT: increased thirst constipation

Weight Loss: 5-6kg expulsion of fetus placenta, liqour, blood 2kg- during puerperium d\t diuresis Continued upto 6 months of delivery

Blood Values: immediate-reduced blood volume; Normal in 2 weeks rise in cardiac output; Normal in 1 week leuycocyotsis d\t stress Hypercoagulable state for 48 hrs Fibrinolytic activity enhanced in 4 days

Menstruation: if not breast feeding- resumes in 6 to 8 wks

Ovulation: non-lactating mother- 4 wks lactating mother- 10 weeks Exclusive Breastfeeding- 98% contraception up 6 months

Management of normal Puerperium To restore health of Mother

Rest and Early ambulation Emotional support Diet of patients choice Sleep Immunization- anti-D- Gamma globulin Maternal-infant Bonding Postnatal exercise

To prevent infection Care of bladder & Vulva Care of episiotomy wound Maintenance of asepsis and proper hygiene Immunization- Rubella vaccine, TT

To take care of the Breasts & promote breast feedingTo motivate mother for contraception

• After pains• Uterus massage• Ibuprofen• Anti-spasmodic

• Pain at site of perineum• Sitz bath• analgesics

• Treatment of Anaemia• Supplementary Iron therapy

Treatment of minor ailments

Abnormal Puerperium

Puerperal fever/ pyrexia Puerperal Sepsis

• Pelvic pain• Fever• Foul smelling vaginal discharge• Subinvolution

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

Urinary Problems• Retention• Incontinence• Infection

Venous thrombosis Secondary Hemorrhage Puerperal psychosis Obstetric palsy

THANQ