On October 23rd, 2014, we updated our
By continuing to use LinkedIn’s SlideShare service, you agree to the revised terms, so please take a few minutes to review them.
1) Genital tract : Involution – is the process of regression in the genital tract.
2) Withdrawal of E2 stimulus to protein synthesis and autolysis of myometrial cells +contractions & retractions lead to ;
a} Reduction in uterine size ;from 8x4x3 in. to 3x2x1in.
b} Weight; from 1000 gm. to 60 gm.
3) Enzymes ; proteolytic enz.break down the cytoplasm of muscle tissues (actomyosin),blood vessels and thrombi.
4) Placental site(7-8cm in d-r) contracts rapidly and endo- metrial lining is completed at the end of the 3/52.
7)The urinary tract: a) oedema, hyperaemia. a) loss of sensation – risk of overdistension. c) diuresis-nocturia.d) proteinuria+increased creatinine excretion.e) physiol. dilatation of the up u.t. return to normal within 6-12/52.
8)Skeletal system& skin : hormonal/ stretch- ing effects in pregnancy leaves flabby abdominal wall.Varicosities improve.
Unlike other genital tract structures, which involute during puerperium, the breasts become active.
Anatomy: They lie on the anterior thoracic wall between the 2 – 6 ribs.Tissues consist of glands and connective tissue and fat.Each breast comprises 15-20 lobes – then lobules with alveoli & i/lobular ducts.They are surrounded by myoepithelial cells.Each lobe has lactiferous sinus.
Lactation :Preparation during pregnancy through placental hormones ( Es-for duct growth, P-for alveolar devel-nt). Other hormones involved; placental lactogen, prolactin, thyroid, adrenocorticosteroids and insulin. Sudden fall of Es release prolactin inhibition which initiates lactation.
Colostrum : is reach in protein, sodium & chlorides but low fat. It is replaced on the 3- 4 d. by mature milk.Suckling is important for the release of prolactin.
Suppresssion of lactation : 1) Stopping suckling,2) Reduce fluid intake,3) Es –
may cause DVT,(4) Bromocriptine-inhibits prolactin production.
Prevention: requires cooperation of the obstetric team, including the mother and relatives. During pgy; breast care,perineal toilet and sterilization of baby feeding eq-t. During labour ; colonization takes place,esp. after membranes rupture.Reduce prolongation of labour.Avoid trauma and remember the following three cleans:
(I ) Clean hands ( gloves )
(II) Clean vulva & vagina
(III) Clean instruments.
Primary sites; perineal, vaginal or cervical lacerations. Placental raw area.Organisms present in g.t.: 1}endogenous (autogenous) or 2}exogenous – introduced by a vector. Extension of infection depends on nature & virulence of organism and tissue resistance. Spread of infection :Direct – parametritis, pelvic cellulitis and peritonitis – localized with abscess formation or generalized . Lymphatic – pelvic cellulitis .Vascular – by anaerobic streptococcus – thrombophlebitis.