Puerperium

1. NORMAL
PUERPERIUM

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(42days)
 3 stages
I. Immediate-within 24hrs
II. Early -upto 7 days
III. Remote – upto 6wks

4. INVOLUTION OF THEUTERUS
Anatomical consideration
● At delivery-20 x12 x7.5cm and appox. 1000g
● After involution-reverted to non-pregsize of
appox. 60g
● Lower uterine segment isthmus in a fewweeks
● Contour of cervix regained in 6 wks
● External os never reverts back to nulliparous state

6. Physiological Consideration
 Muscles:
 Endometrium:
 regen starts on day 7
 from uterine glandmouths 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withdrawn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 ofuterus
• Fundus lies 13.5cm above sypmphysis pubis
for the 1st24hrs following delivery
• Steady decrease by0.5'' in nxt 24 hrs
• Day 14- not palpable- pelvic organ
• Completed by 6wks

8. Vagina
4-8 weeks;
Does not revert
to original state
Broad/roun
d
ligament
s
Long timed/t
stretching
during
parturition
Pelvic
floor
&
Fascia
Long timed/t
stretching
during
parturition
Involution of other Pelvicstructures

9. LOCHIA
• Vaginal discharge for the 1st fortnight duringpuerperium
● Odour: offensive fishysmell
● Colour and 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 Sepsis dt E. Coli
Malodorous
• Infection
• Lochiometra
Scanty/absent
• Infection
Excessive
• Subinvolution
• Retained conceptus
• Causes secondary PPH
Red color persist
• Local genital infection
L.Alba beyond 3wks
Clinical importance

11. THANK YOU