Normal Puerperium

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Normal Puerperium

  1. 1. NORMALPUERPERIUM
  2. 2. WHAT IS PUERPERIUM? Period following childbirth Pelvic organs & other body tissues Revert to pre-pregnant state Anatomically & physiologically
  3. 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. 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. 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. 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. 7. Vagina4-8 weeks;Does not revertto original stateBroad/roundligamentsLong time d/tstretchingduringparturitionPelvicfloor&FasciaLong time d/tstretchingduringparturitionInvolution of other Pelvic structures
  8. 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. 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. 10. CHANGES IN BREAST & LACTATION
  11. 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. 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. 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. 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. 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. 16. Abnormal Puerperium Puerperal fever/ pyrexia Puerperal Sepsis• Pelvic pain• Fever• Foul smelling vaginal discharge• Subinvolution
  17. 17.  Breast Problems• Retracted/cracked nipples• Breast engorgement• Mastitis• Breast abscess• Failure of lactation
  18. 18.  Urinary Problems• Retention• Incontinence• Infection Venous thrombosis Secondary Hemorrhage Puerperal psychosis Obstetric palsy
  19. 19. THANQ

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