The word puerperium is originated from the Latin words ‘puer’ – child and ‘pams’ – bringing forth. Also known as the post-partum, post-natal, or post-delivery period. The mother during puerperium is termed as puerpera.

1. NORMAL
PUERPERIUM

2. INTRODUCTION
• The word puerperium is originated from Latin words ‘puer’ –
child and ‘pams’ – bringing forth.
• Also known as post-partum, post-natal or post-delivery
period.
• The mother during puerperium is termed as puerpera.

3. DEFINITION
1. Puerperium is the period following childbirth during which the body tissues, especially the pelvic
organs revert back approximately to the pre-pregnant state both anatomically and physiologically.
2. Puerperium is the period following child birth when the endocrine influences of the placenta
removed the physiological changes of pregnancy is reversed. This is characterized by the following
features:
 The reproductive organs return back approximately to their pre gravid state both anatomically
and physiologically
 Lactation is initiated
 Recuperation from the physical, hormonal and emotional experiences of parturition

4. DURATION
Puerperium begins as soon as placenta is expelled and last for
approximately 6 weeks when the uterus becomes regressed almost
to the non pregnant size. The period is divided into;
1. Immediate – within 24hrs
2. Early – upto 7 days
3. Remote – after 7 days upto 6 weeks

5. PHYSIOLOGICAL
CHANGES
DURING
PUERPERIUM

6. A) INVOLUTION OF UTERUS
• Uterine Involution
- Return of the uterus to its pre-pregnancy size and
condition, which begins immediately after expulsion of
the placenta with contraction of the uterine smooth
muscle.
• Uterine Fundal Descent
- After labour, fundus is 5cm below umbilicus or 12 cm
above the symphysis pubis. During the first 24 hrs, the
level remains constant, the consistency of uterus will be
firm and retracted. There after there is a steady decrease
in height by 1.25 cm in 24 hrs, so that by the end of
second week the uterus becomes a pelvic organ. The
rate of involution thereafter slows down until by 6
weeks, the uterus becomes almost normal in size.

7. B) INVOLUTION OF OTHER PELVIC
STRUCTURES
 Vagina: The distensible vagina, noticed soon after birth takes a long
time (6-10 weeks) to involute. It begins its tone but never to the
virginal state.
 Broad ligaments and round ligaments require considerable time to
recover from the stretching and relaxation.
 Pelvic floor and pelvic fascia take a long time to involute from the
stretching effect during parturition.

8. C) LOCHIA

9. GENERAL PHYSIOLOGICAL CHANGES
• Pulse
• Temperature
• Urinary tract
• GIT
• Weight loss
• Fluid loss
• Blood values
• Ovulation

10. PSYCHOLOGICAL CHANGES

11. POST
PARTUM
ASSESSMENT

13. MANAGEMENT
OF
NORMAL
PUERPERIUM

15. POSTPARTUM
COMPLICATIONS

16. • Pulmonary Embolism

17. POSTNATAL
CARE

18. POSTNATAL CARE
Postnatal care includes systematic examination of the mother and the baby and appropriate advice
given to the mother during postpartum period. The first postnatal examination is done on discharge
of the patient from the hospital. The second routine postnatal care is conducted at the end of 6th
week postpartum.
Aims and objectives
 To assess the health status of the mother.
 To detect and treat at the earliest any gynaecological condition arising out of obstetric legacy.
 To note the progress of the baby including the immunization schedule for the infant.
 To impart family planning guidance.

19. POSTNATAL CARE
Examination of the mother
 Routine examination
 Pelvic examination should be done only when indicated
 Laboratory investigations (e.g. haemoglobin) depending on the clinical need may be advised.
Examination of the baby
Conducted by a paediatrician, the progress of the baby is evaluated. Immunization to the baby is started.
Advice given
(1) If the patient is in sound health she is allowed to do her usual duties.
(2) Postpartum exercises may be continued for another 4-6 weeks.
(3) To evaluate the progress of the baby periodically and to continue breastfeeding for 6 months.
(4) Family planning counselling and guidance

20. POSTNATAL CARE
MANAGEMENT OF AILMENTS
Irregular vaginal bleeding
Leukorrhea
Backache
Urinary and anal incontinence

21. POSTNATAL
EXERCISES

22. Objectives
 To improve the muscle tone which are stretched during pregnancy and labor,
specially the abdominal and perineal muscles
 To educate about correct posture to be attained when the patient is getting up
from the bed
POSTNATAL EXERCISES

23. POSTNATAL EXERCISES
Deep Breathing Head & Shoulder Raising
Head Raising
Leg Raising Knee & Leg Rolling
Pelvic Tilting

24. Sit Ups Kegel Exercise
POSTNATAL EXERCISES

25. MANAGEMENT OF
MINOR AILMENTS
DURING
PUERPERIUM

26. MANAGEMENT OF MINOR AILMENTS DURING
PUERPERIUM
1. After pain: It is the infrequent spasmodic pain felt in the lower abdomen after delivery for a variable period of 2-4
days, commonly met in primipara & may be due to vigorous uterine contractions, especially in multipara. The pain is
similar to cardiac anginal pain. It can be managed by massaging the uterus with expulsion of the clots, administration
of antibiotics and antispasmodics.
2. Pain on the perineum: Perineum has to be examined for vulval haematoma and provide analgesics and sitz bath
(cold/hot)
3. Hypertension: Increased BP during puerperium period. Urine analysis also should be done for proteinuria.
4. Breast engorgement: Encourage breast feeding, warm sock, analgesics etc gives better result.
5. Anaemia: Supplementary iron therapy (Iron sulphate 200 mg) is to be given daily, for 4-6 weeks
6. Constipation: Mild laxatives or stool softeners can be advised to the mothers

27. LACTATION

28. LACTATION
• It is the process of breast feeding
results from interplay of hormones,
instinctive reflexes and learned
behaviour of mother and newborn.
• Colostrum is the first milk secretion

30. MANAGEMENT OF LACTATION
- Initiate breast feeding within half an hour after birth and exclusively breast feed till 6 months
- Encourage mother to take nutritive diet with plenty of fluids and milk intake. Food containing calcium should be given.
- Promote 2 hourly feeding
- Support and educate the mother about the benefits of breast feeding in antenatal period itself
- Discourage bottle feeding and encourage regular feeding
- Follow proper hygienic measures
- Prevent the mother from any diseases such as infections and dehydration
- Use drugs to improve milk production in case of inadequacy
Suppression of lactation may be needed in case of still birth, HIV infected mother etc . So
- Stop feeding
- Avoid pumping or milk expression
- Apply ice packs to prevent engorgement
- Give analgesics to relieve pain
- Apply tight compression bandage for 2-3 days
- Use drugs such as bromocriptine 2.5 mg orally bd for 14 days, which inhibit prolactin and suppress lactation.

31. EMOTIONAL NEEDS
DURING
POSTNATAL PERIOD

32. EMOTIONAL NEEDS DURING POSTNATAL
PERIOD
Mother experiences many hopes and fears at the beginning of new human life and family
relationship. Mother need to be supported as she adjusts to her experiences.
1. Mother need support because she is taking a major responsibility
2. Rest and relaxation
3. No comparisons
4. Praise and encouragement
5. Consistent advice
6. Mother’s self esteem

33. ROLE
OF NURSE

34. NURSE’S RESPONSIBILITY
The role of nurse midwife during postnatal period is to provide care and support to the mother and baby
based on the following principles :
1) Promoting physical and psychological well-being of the mother, her baby and the family unit.
2) Identification of deviation from normal physiological or psychological progress
3) Encourage sound methods of infant care and prompt development of effective parent-infant
relationship.
4) Support and strengthen woman, her husband and family's confidence.
5) Monitor progress of mother and child.
6) Promotion of a relaxed environment
7) Provide non-judgemental approach, offer guidance, advise whenever necessary.
8) Promote breast feeding whenever possible.

35. SUMMARY
• This lesson deals with Puerperium -its definition, duration, anatomical,
physiological and psychological changes during puerperium, management of
normal puerperium. It also discusses about postnatal assessment, postnatal
exercise, and care. Further management of minor ailments, lactation and role of
nurse is also explained.

36. CONCLUSION
• Puerperium is the period following childbirth during which the body tissues,
especially the pelvic organs, revert approximately to the pre-pregnant state both
anatomically and physiologically. During the postpartum period, assessment of
maternal condition must be done on a regular basis and a progress record to be
maintained.

37. RESEARCH
ABSTRACT

38. RESEARCH ABSTRACT
Ji Yeon Lee et. al (2015) conducted a study to identify the physical and mental state of Korean women after
delivery, to investigate the factors that influence those, and to examine the effects of postpartum care performance.
The study targeted 148 women who visited hospital for postpartum check-up on the 2nd week or 6th week after
delivery. Questionnaire method was used and the women were asked to self-evaluate their postpartum symptoms.
The findings were 72 women had depression. Factors related to postpartum symptoms and depression were
smoking before pregnancy, low marital satisfaction, bad mood during and after pregnancy, lack of support from
husbands, and bad quality of sleep during puerperium. Treating the joints of hands carefully when milking breasts,
and avoiding squatting down, demonstrated a negative correlation with the average points of postpartum
symptoms. Multivariate linear regression analysis showed that the degree of support from husbands and mood
during pregnancy were statistically related with depression. Many women complained of postpartum discomfort.
Although, while some postpartum care methods which are traditionally believed to be appropriate care in Korea
can be helpful to women's recovery, most of them are not. It was confirmed that physical symptoms and
depression are closely related to each other.