3. Content Overview
⢠Puerperium : Definition
⢠Duration
⢠Anatomical Changes
⢠Physiological changes
⢠Lactation
⢠Nursing Management
⢠Management Of Minor Ailments
⢠Records
⢠Check up And Advice On Discharge.
4. Introduction
ď Postpartum period is the period beginning
immediately after the birth of a child and
extending for about six weeks
ď The WHO describes the Postnatal period as the
most critical and yet the most neglected phase in
the lives of mothers and babies; most death occurs
during the Postnatal period.
5. Definition â Puerperium
⢠Puerperium is the period following the childbirth
during which the body tissues, specially the pelvic
organs revert back approximately to the pre
pregnant state both Anatomically and
Physiologically
⢠Involution is the process whereby the genital
organs revert back approximately to the state as
they were before pregnancy.
The women is termed as Puerpera.
6. Duration
⢠Puerperium begins as soon as the placenta
expelled and last for approximately 6 weeks when
Maternal system return to pregnant state.
Immediate : within 24 hours
Early : up to 7days
Remote : up to 6weeks.
7. Anatomical changes during Puerperium
1. Involution of uterus :
Uterus :
⢠Becomes firm and retracted with hardening and
softening.
⢠Measures about 20x12x7.5cm(Length x Breadth x
Thickness) and weighs about 1000gm
⢠At the end of 6 weeks become non pregnant state
weight about 60gm.
8. Cont..
Lower uterine segment :
â Immediately following delivery, the
Lower segment becomes a Thin, Flabby,
Collapsed structure.
â It takes few weeks to get revert back to pre-
pregnant state.
10. ContâŚ
Clinical assessmentof Involutionofuterus
⢠Funduslies13.5cm forthe 1st24hrs following delivery
⢠Steady decrease by1.25cminnext24hrs
⢠At Day14(2ndweek)-notpalpable-pelvicorgan
Cervix contracts slowly,
⢠External os : for few days can admit 2 fingers.by
the end of 1st week narrow down can admit tip of
finger only.
⢠Cervix never return back to nulliparous state.
⢠Internal os : closes as before
12. ContâŚ
ď Endometrium
ďą Regenerationstartson day 10
ďą Endometrium arises from proliferation of
endometrial glandular and stroma of the inter
glandular
⢠By the 10th day : regeneration of epithelium
completed.
⢠By the 16th day : the endometrium is restored.
⢠At about 6 weeks : the endometrium of placental
site is restored
14. Other pelvic structure
4-8weeks;
It regain its tone. but
Does not revert to
originalstate.
Hymen is lacerated and it
is like a nodular tag.
Vagina
Long time
d/t
stretching
during
parturition
Pelvicfloor&Fascia
15. Lochia
⢠Vaginal discharge for the 1stfortnight during
puerperium
â Odor: Offensive fishysmell
â Reaction :Alkaline reaction
17. Measurement of discharge
⢠If it is excessive the number of pad changes can be
measured in every 15mins
⢠Weighing measures : 1 gram = 1 ml of blood
⢠By inch tape :
⢠Scanty = <1 inch stain
⢠Small = <4 inch
⢠Moderate = < 6 inch
⢠Heavy = > 6 inch
⢠Excessive : pad saturation with in 15mins
19. General physiological changes
ďś Pulse:
ď Raises following delivery but settles down to
normal on 2nd day
ďś Temperature:
ď It should not exceed 99 degree Fahrenheit.
Any raise above suggestive of infection of
Genito-urinarytract
ďś GIT:
ď Increased thirstduetoexcessivebloodloss
ď Constipation due to intestinal paresis
ď Reduced abdominal muscle tone.
20. contâŚ
ď UrinaryTract:
ď Pronounced Diuresison 2nd -3rdday
ď Overdistension
ď Presence of residualurine
ď High riskofinfection
ď Weight Loss:
ď 5-6kgexpulsionof fetusplacenta, liqour,
blood
ď 2kg-during puerperium dt diuresis
ď Continued up to 6monthsof delivery
21. Cont..
ďś BloodValues:
ď Immediate-reduced blood volume;Normalin
2weeks
ď Riseincardiacoutput; Normal in1week
ď Leukocytosis dt stress
ď Plateletcountreduced;normalstatewithin2wks.
ďś Menstruation:
ď Ifnot breastfeeding- resumesin6wks in
40% cases and by 12th week in 80%
cases.
ď If breast fed her baby then, the
menstruation occur until the baby stops
breast fed.
25. Changes in Breast and Lactation
⢠Mammary duct-
gland growth and
development
⢠Initiation of milk
secretion in alveoli
⢠Maintenance of
lactation
⢠Removal of milk
from gland
27. ContâŚ
ďśComposition of colostrum
ď Deep yellow serous fluid
ď High specific gravity
ď High protein
ď High vitamin A and chloride content
ď Low carbohydrate fat and sodium content
ďśAdvantages :
ď The Ab( IgA, IgG and IgM) and humoral factors
(lactoferrin) provide immunological defense to the
newborn
ď It has laxative action on the baby because of large
fat globules
28. Nursing care of mother during
puerperium (immediate care)
Principles :
⢠To give all out attention to restore the health status
of the mother
⢠To prevent infection
⢠To take care of the breast, to promote lactation and
to take care of the child
⢠To motivate the mother for contraception
29. 1.Rest and ambulance
⢠Good rest to feel fresh and can breast feed the
baby.
⢠Good sleep is in need for both physical and mental
health
Early ambulation :
⢠To provide sense of wellbeing.
⢠Bladder complications and constipation are
reduced
⢠Facilitates uterine drainage and hastens involution
of the uterus
⢠Lessens puerperal venous thrombosis and
30. 2.Diet
Normal diet :
⢠High calories, adequate protein, fat, plenty of
fluids, minerals and vitamins
31. 3.Care of bowel and bladder
⢠The mother is encouraged to pass urine following
delivery as soon as convenient
⢠A diet containing sufficient roughage and fluids is
enough to move the bowel
32. 4. Care of vulva and episiotomy wound
⢠After delivery vulva and buttocks are washed with
soap and water down over the anus and a sterile
pad is applied.
⢠Personal cleanliness of the vulval region.
⢠The perineal wound should be dressed with spirit
and antiseptic powder after micturition and
defecation.
⢠Change sanitary pads atleast every 2-4hours
⢠Encourage sitz bath 20mnts thrice a day.
⢠Educate mother to take well balanced diet(rich
protein and vitamin)
33. Cont..
⢠Avoid from scratching or touching the wound site
unnecessarily.
⢠Educate the mother regarding signs of
infection(swelling, redness etc.)
⢠Early ambulation to help healing process of
episiotomy wound.
⢠Kegel exercise to strengthen the pelvis and lessen
perineal pain.
34. 5.Call doctor or health care provider if
mother has
⢠Repeated clots the size of a quarter or larger passing
from the vagina.
⢠Heavy or gushing bleeding from the vagina.
⢠Discharge that has a bad odor.
⢠Severe pain in the abdomen or increased pain near
your stitches.
⢠Fever or chill.
⢠No bowel movement within one week after the birth
of your baby.
⢠Pain or urgency with urination or inability to urinate.
35. 6.Care of breast
⢠The Nipple should be washed with water before
each feeding.
⢠It should be kept dry after the feeding is over
⢠Support he breast with brassiere.
⢠Avoid Nipple soreness.
36. 7.Maternal infant bonding-rooming in
⢠It starts from first few moments after birth.
⢠The baby should be kept in her bed or in a cot
besides her bed.
⢠Rooming in promotes parent infant bonding.
⢠Initiate breast feeding.
38. 8.Asepsis and antiseptics
⢠Maintain asepsis during perineal wound dressing
⢠Use clean bed linen and clothing
⢠Clean surroundings
⢠Limited number of visitors to prevent infection
39. 9.Management of ailments
After pain :
⢠Abdominal pain due to presence of placental bits
or blood clots
Nursing care:
⢠Massaging the uterus
⢠Check for expulsion of the clots
⢠Administer analgesics and antispasmodics
⢠If there is a pain in the perineum check for vulval
hematoma
Nursing care :
⢠Sitz bath with hot or cold water
40. Records
⢠Vital signs : record twice a day
⢠Measurement of height of the uterus above the
symphysis pubis once a day same time(check for
involution of the uterus)
⢠Character of lochia
⢠Bowel and bladder movement
For new born:
⢠Vital signs
⢠Weight
⢠Nutrition(sucking well)
⢠Bowel and bladder
41. Check up and advice on discharge
⢠Continuance of supplementary iron therapy
⢠Postnatal exercise
⢠Return back to routine physical activity
⢠Breast feeding and care of the New born
⢠Avoidance of intercourse 4-6weeks until
lacerations or episiotomy wound healing
⢠Family planning advice and guidance
⢠Postnatal check up after 6weeks.