2. WHAT ISPUERPERIUM?
Period following childbirth
Pelvic organs & other body tissues
Revert to pre-pregnant state
Anatomically & physiologically
3. Begins as soon as placenta is
expelled
lasts for appx 6 weeks(42 days)
3 stages
I. Immediate-within 24hrs
II. Early -upto 7 days
III. Remote – upto 6wks
4. 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
5.
6. 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withdrawn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 T
hrombosis
Fibrinoid end arteritis Hyalinisation
Blood Vessels
7. Clinical assessment of Involution of uterus
•Fundus lies 13.5cm above sypmphysis pubis
for the 1st 24hrsfollowing delivery
•Steady decrease by 0.5'' in nxt 24 hrs
•Day 14- not palpable-pelvic organ
•Completed by 6 wks
8. Vagina
4-8 weeks;
Does not revert
to original state
Broad/roun
d
ligament
s
Long time d/t
stretching
during
parturition
Pelvic
floor
&
Fascia
Long time d/t
stretching
during
parturition
Involution of other Pelvic structures
9. LOCHIA
• Vaginal discharge for the 1st fortnight during puerperium
● Odour:offensive fishy smell
● Colourand composition
Lochia Rubra
•1-4 days
•Blood,fetal memb & decidua
shreds,lanugo,meconium
Lochi Serosa •Leucocytes,Cx mucus,wound
•5-6 days
exudates,microorganisms
•10-15 days
Lochia Alba •Decicual
cells,leucocytes,mucus,cholestrin
crystals,fatty
epithelial
cells,microorganisms
10. • Puerperal Sepsisd t E. Coli
Malodorous
• Infection
• Lochiometra
Scanty/absent
• Infection
Excessive
• Subinvolution
• Retained conceptus
• Causes secondary PPH
Red color persist
• Local genital infection
L.Alba beyond 3 wks
Clinical importance
12. General Physiological Changes
Pulse:
raisesbut settlesdown to normal on 2nd day
Temperature:
Any rise above 0.5C suggestive of infection of genito-urinary tract
Urinary Tract:
Pronounced Diuresison 2nd - 3rd day
over distension
incomplete emptying
presence of residual urine
high riskof 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
13. Blood Values:
immediate-reduced blood volume; Normal in 2 weeks
rise in cardiac output; Normal in 1 week
leuycocyotsisd t stress
Hypercoagulable state for 48 hrs
Fibrinolytic activity enhanced in 4 days
Menstruation:
if not breast feeding-resumesin 6 to 8 wks
Ovulation:
non-lactating mother-4 wks
lactating mother-10 weeks
Exclusive Breastfeeding- 98%contraception up 6 months
14. 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
15. To prevent infection
Care of bladder & Vulva
Care of episiotomy wound
Maintenance of asepsis and proper hygiene
Immunization- Rubella vaccine, T
T
To take care of the Breasts & promote breast
feeding
To motivate mother for contraception
16. • After pains
• Uterus massage
• Ibuprofen
• Anti-spasmodic
• Pain at site of perineum
• Sitz bath
• analgesics
• T
reatment of Anaemia
• Supplementary Iron therapy
Treatment of minor ailments