Puerperium (masa nifas)

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Puerperium (masa nifas)

  1. 1. Puerperium
  2. 2. • Puerperium : Is period during which the reproductive organs and all the system of the body returns to their normal condition following the delivery of the placenta and o Ends approximately 6 weeks later. The Principal Changes 1. Uterine Involution : 2. Blood and Fluid Changes 3. Lactation
  3. 3. Involution of uterine corpus Fundus of contracted uterus : slightly below umbilicus immediately after placental expulsion - within 2 wks : descend into a cavity of true pelvis - within about 4 wks : regain previous nonpregnant size
  4. 4. Endometrial regeneration the remain decidua becomes differentiated into 2 layers within 2 or 3 days after delivery superficial layer : become necrotic, sloughed in the lochia basal layer : remains intact, source of new endometrium
  5. 5. cervix • Cervix is very flaccid and curtain –like after delivery but within a few days is returning to the original form and consistency . The cervical channel become closed to a finger during the second week of Puerperium .
  6. 6. 2. Blood and Fluid Changes leukocytosis and thrombocytosis occur during and after labor : by 1 week after delivery, blood volume return nearly to nonpregnant level Cardiac output remains elevated for at least 48 hours postpartum (due to increased stroke volume from venous return)
  7. 7. Lactation • Two similar independent mechanisms for successful lactation : 1. Prolactin release from A .p mammary glandular tissue stimulation of milk secretion .  Prolactin is long chain of polypeptide it has only physiological role that its action on lactating breast .
  8. 8. 2 ) milk ejection reflex ( milk lead down ) mediated by release of oxytocin from hypothalamus and ( p.p ):  causing contraction of myoepithelial cells around the milk –secretary .  dilatation of main ducts . So , Expelling milk from glands .  oxytocin released in response to : suckling , and sensory input like mother seeing or hearing their baby crying .
  9. 9. Management of normal puerperium 1.Vital signs + contraction of the uterus (uterin involution) + Lochia (amount; colure ,and odder) =Every 5 min. for ½ hours , then every ½ hourly for 2 hours, then transfer the mother to the postnatal ward and observation every 2 hours for 6 hourly; then 6 hourly till discharge.
  10. 10. 2.Breast examination+lawer limb examination for the detection of signs of DVT every day. 3.The mother should be encouraged to pass urine. 4. Early mobilization. 5. Management of episiotomy ;and perennial tears.
  11. 11. 6. In normal delivery the mother can go home 48 hours after delivery ;and 10 days in C.S. 7. Diet regime. 8 .postnatal visit. 9. Advising for contraception and spacing of pregnancy.

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