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Normal Puerperium

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  • 1. NORMALPUERPERIUM
  • 2. WHAT IS PUERPERIUM? Period following childbirth Pelvic organs & other body tissues Revert to pre-pregnant state Anatomically & physiologically
  • 3.  Begins as soon as placenta isexpelled lasts for appx 6 weeks(42 days) 3 stagesI. Immediate-within 24hrsII. Early -upto 7 daysIII. Remote – upto 6wks
  • 4. INVOLUTION OF THE UTERUSAnatomical consideration● At delivery-20 x 12 x 7.5cm and appox. 1000g● After involution-reverted to non-preg size ofappox. 60g● Lower uterine segment isthmus in a few weeks● Contour of cervix regained in 6 wks● External os never reverts back to nulliparous state
  • 5. Physiological Consideration Muscles: Endometrium: regen starts on day 7 from uterine gland mouths and interglandular stromal cells completed by day 16 except @ placental siteSteroidhormoneswithdrawnIncCollagenase& ProteolyticenzymesAutolysisMyometrialcell sizereducedEndophlebitis ThrombosisFibrinoid end arteritis HyalinisationBlood Vessels
  • 6. Clinical assessment of Involution of uterus• Fundus lies 13.5cm above sypmphysis pubisfor the 1st 24hrs following delivery• Steady decrease by 0.5 in nxt 24 hrs• Day 14- not palpable- pelvic organ• Completed by 6 wks
  • 7. Vagina4-8 weeks;Does not revertto original stateBroad/roundligamentsLong time d/tstretchingduringparturitionPelvicfloor&FasciaLong time d/tstretchingduringparturitionInvolution of other Pelvic structures
  • 8. LOCHIA• Vaginal discharge for the 1st fortnight during puerperium● Odour: offensive fishy smell● Colour and compositionLochia RubraLochi SerosaLochia Alba•1-4 days•Blood,fetal memb & deciduashreds,lanugo,meconium•5-6 days•Leucocytes,Cx mucus,woundexudates,microorganisms•10-15 days•Decicualcells,leucocytes,mucus,cholestrincrystals,fatty epithelialcells,microorganisms
  • 9. •Puerperal Sepsis dt E. ColiMalodorous•Infection•LochiometraScanty/absent•InfectionExcessive•Subinvolution•Retained conceptus•Causes secondary PPHRed color persist•Local genital infectionL.Alba beyond 3 wksClinical importance
  • 10. CHANGES IN BREAST & LACTATION
  • 11. 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 dt diuresis Continued upto 6 months of delivery
  • 12.  Blood Values: 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 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
  • 13. 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
  • 14. 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 breastfeedingTo motivate mother for contraception
  • 15. • After pains• Uterus massage• Ibuprofen• Anti-spasmodic• Pain at site of perineum• Sitz bath• analgesics• Treatment of Anaemia• Supplementary Iron therapyTreatment of minor ailments
  • 16. Abnormal Puerperium Puerperal fever/ pyrexia Puerperal Sepsis• Pelvic pain• Fever• Foul smelling vaginal discharge• Subinvolution
  • 17.  Breast Problems• Retracted/cracked nipples• Breast engorgement• Mastitis• Breast abscess• Failure of lactation
  • 18.  Urinary Problems• Retention• Incontinence• Infection Venous thrombosis Secondary Hemorrhage Puerperal psychosis Obstetric palsy
  • 19. THANQ