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puerperium Presentation Transcript

  • 1. Normal & abnormal www.doctor.sd
  • 2.
    • DEFINITION ; (puer-infant+parous-to bring forth) – a period of time “6 – 8/52”after the birth,during which the following events take place; [1] Anatomical changes,
    • [2] Physiological changes,
    • [3] Psychological readjustments
  • 3.
    • Expulsion of placenta – removes major source of peptide and steroid hormones.
    • Body water – diuresis 3L/day in first 3-4d.
    • Hb falls at first 2-3d.then rises thereafter.
    • Increased coagulability –during first 2/52 despite the reduction in clotting factors. FDP are also increased.
    • Leucocytosis + raised temperature.
  • 4.
    • 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.
  • 5. www.doctor.sd
  • 6.
    • 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.
  • 7.
    • 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.
  • 8.
    • 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.
  • 9.
    • 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 :[1]Direct – parametritis, pelvic cellulitis and peritonitis – localized with abscess formation or generalized . [2]Lymphatic – pelvic cellulitis .[3]Vascular – by anaerobic streptococcus – thrombophlebitis.
    • Causal organisms : Endogenous– (enterobacteria) E.Coli, Bacteroides, β -hemolytic & anaerobic streptococci(fecalis). Exogenous – Staphylococci & streptococci. Other ; Neisseria gonorrhoea and Closteridium perfringens.
    • Treatment :cleaning wound from debris,draining abscesses,antibiotics. Supportive ttt– rehydration,electrolyte homeostasis,ttt anaemia.
  • 10.
    • Common during puerperium due to bruising trauma,stasis and cathetrization.
    • Organisms :E.coli or streptococcus faecalis.
    • Symptoms :frequency of micturition,dysuria, fever and pains.
    • Consequences :cystits,uretrits,pyelonephritis
    • Treatment: Antibiotics,fluids,analgesics -- paracetamol and even pethidine.
  • 11.
    • Main reason is stasis due to duct obstruction and congestion.
    • Organism :Staphylococci from baby’s mouth and the ingress through a crack.
    • Clinically :insidious then acute pyrexia = 39t headaches, rigors.Results;abscess formation
    • Treatment :Isolation.ttt cracks,stop lactation, cold packs. Antibiotics.Absecess drainage.
  • 12.
    • Superficial vein thrombosis : in varicose veins is common. Ttt local heat and support.
    • DVT: In complicated delivery. Warnings : rise of temp.& pulse, deep tenderness, edema and varicosities.Other investigations request
    • Pulmonary Embolism: preceded by DVT. Raised temp.,severe chest pain, dyspnoea, cough and hemoptosis.X-ray—wedge shaped shadow and pleural effusion. ECG – right heart strain. Treat-t : Oxygen, sedation and analgesia + anticoagulants.