physiological changes during puerperium is very important to bsc nursing students to understand that what are exactly changes occure in mother during post natal periods.

1. PRESENTED BY:- Preeti shukla
Lecturer, RCN, Kanpur

2. SPECIFIC OBJECTIVES
Define the normal Puerperium.
Discuss the features of normal
Puerperium.
Explain the physiological changes during
Puerperium.
Discuss the management of normal
Puerperium.

3. DEFINITION
 Puerperium is the
period following
childbirth during which
the body tissues
,specially the pelvic
organs revert back
approximately to the
pre-pregnant state both
anatomically and
physiologically.

4. DURATION :- Puerperium begins as
soon as placenta is expelled .
Lasts for approximately 6 weeks.
The period is divided into –
 Immediate within 24 hrs
 Early upto 7 days
 Remote upto 6 weeks

6. ANATOMICAL AND PHYSIOLOGICAL
CHANGES OF THE PUERPERIUM
ANATOMICAL CONSIDERATION
 Uterus:-Immediately after delivery uterus is
hard , reduced in size and fundus is generally
felt about 10-12cm above the symphysis pubis.
 Uterus weigh 500gm by the end of the first
post –partal week,300-350 by the end of
second post- partal week and 100gm by the
sixth partal week.

7.  INVOLUTION OF UTERUS :-It is process whereby
the genital organs revert back approximately to the
state as they were before pregnancy.
 An arrest or retardation or delay of involution is called
subinvolution.
 The causes of subinvolution include retained placental
fragments and pelvic infection.

8. CLINICAL FEATURE OF
SUBINVOLUTION
Prolongation of lochial discharge and
irregular and excessive uterine bleeding.
On examination uterus is larger and softer
for the period of Puerperium.

9. UTERINE ATONY :-
Failure of the uterus to remain firmly
contracted ,can lead to postpartum
haemorrhage.
A full bladder is a major cause of uterine
atony.

10. CERVIX:-
Lower Uterine segment and cervix
remains loose ,thin and stretched.
Immediately after birth ,the cervix is
extremely soft ,flabby.

11. It looks congested and rarely admit 2-3
fingers.
The cervix contracts slowly ,the external
OS admits 2 fingers for a few days and by
the end of the first week narrows down to
admit the tip of finger.
External OS never revert to nulli parous
state.

12. PHYSIOLOGICAL CONSIDERATION
 The physiological process of involution is most
marked in the body of the uterus .Changes
occur in the following components :
oMuscles
oBlood Vessels
oEndometrium

13. INVOLUTION OF OTHER PELVIC
STRUCTURE
VAGINA
 Takes a long time (4-8 weeks ) to involute .
 It regains its tone but never to the virginal state .
 The mucosa remains delicate for the first few weeks
and sub mucous venous congestion persists even
longer .
 Rugae partially re appear at third week .
 The introitus remains permanently larger than the
virginal state.

14. LOCHIA
 It is the vaginal discharge for the first fortnight during
Puerperium.
 The discharge originates from the uterine body,cervix
and vagina.
 Odour and reaction :-It has got a peculiar offensive
fishy smell.
 Colour :- Depending upon colour
 lochia rubra
 lochia serosa
 lochia alba

15. LOCHIA RUBRA:
It is red in color as it contains blood
shreds of fetal membrane ,decidua,vernix
caseosa,lanugo and meconium. It starts
immediately after the delivery and
continues for the 3-4 days.

16. LOCHIA SEROSA:
Lochia serosa:-it is pale than rubra and is
serous and pink. It contain less RBC’s
but more leukocytes, wound exudates,
decidual tissues and mucus from the
cervix. It last for 5-9 days.

17. LOCHIA ALBA:
It starts about the 10th post partum day
till week. It is pale creamy white and
contains leukocytes, decidual cells &
mucus.

18.  URINARY TRACT :-the bladder may be over
distended without any desire to pass urine..
 Dilated ureters and renal pelvis return to
normal size within 8 weeks.

19. BOWEL :- Soon after delivery ,there is
some degree of intestinal paresis which
predisposes to constipation.
Early ambulation , a high residual diet
and increase in intake of fluids generally
help to overcome this problem.

20. BREAST :- The secretion from the breast is
thick ,sticky and yellowish in colour for the
initial 2-3 days ,is called colostrums.

21. SOME OF THE OTHER PHYSIOLOGICAL
CHANGES
 PULSE :- For a few hours after normal delivery
,the pulse rate is likely to be raised, which settle
down to normal during the second day.
 TEMPERATURE :- The temperature should not
be above 37.2 ˚ with the first 24 hrs.
 On the 3rd day ,there may be slight rise if
temperature due to breast engorgement which
should not last for more than 24 hrs.

22. GASTROINTESTINAL TRACT :-
Increased thirst in early Puerperium is
due to loss of fluid during labour.
Constipation is a common problem for
the following reasons : delayed GI
motility ,together with perineal
discomfort.

23. WEIGHT LOSS:- In addition to the
weight loss (5-6 kg) as a consequence of the
expulsion of the foetus ,placenta, liquor and
blood loss .The weight loss may continue upto
6 months of delivery.
FLUID LOSS :- There is a net fluid loss of
about 2 litres during the 1st week and an
additional 1.5 litres during the next 5weeks.

24. ABDOMINAL WALL :-The
abdominal striae are never eradicated
completely but they do change to fine,
silvery white lines.
Women who take exercise regain their
abdominal muscle tone. however
regaining complete muscle tone becomes
difficult with increasing parity.

25.  HAEMATOLOGICAL CHANGES:-
Immediately following delivery ,there is slight
decreases of blood volume due to dehydration
and blood loss .
 Cardiac output rises soon after delivery to
about 60% above the pre labour value but
gradually returns to normal within 1 week.

26. MENSTRUATION AND OVULATION:-
If the woman does not breast fed her baby
,the menstruation returns by 6th week
following delivery in about 40% and by
12th week in 80% of cases.

27. In non lactating mothers ,ovulation may
occur as early as 4 weeks and in lactating
mothers about 10 weeks after delivery .

28. POSTNATAL CARE
 Postnatal Check Up
 Detection of risk at earlier stage & its
management
 Management of Normal Puerperium
 Treatment of Minor Ailments
 Treatment of anemia
 Health & nutrition education
 Postnatal Exercise

29. POSTNATAL CHECK-UP
General health check up
Monitoring of involution process
For satisfactory establishment of lactation
For examination of newborn

30. MANAGEMENT OF NORMAL
PUERPERIUM

31. 1)Immediate care- After about 2 hrs of
observation following delivery, the patient is
examined thoroughly before shifting her to room
or ward.
2)Hospital stay- All patient’s with perineal
stitches should preferably be hospitalized for 2 -
4 days to ensure satisfactory healing &to
safeguard her against infection.

32. 3)Diet- encourage the patient to drink lots of
fluids &to take simple easy to digest diet. Fatty
foods should be restricted.
4)Sleep- it is important to ensure adequate
rest and sleep .it is good restrict visiting hours
and to prescribe mild hypnotics to ensure
sound restful sleep.

33. 5)Care of the bladder- The patient is
encouraged to pass urine following delivery,if
fails than catheterization should be done.
6)Care of perineum - Perineal wound
should receive proper surgical attention to
promote healing & prevent infection. Perineal
wound should be kept clean & dry.

34. 7)Well baby care- care of the baby should be
explained and direct her to the pediatrician.
8)Contraception- couples should be provided
with necessary information & counseled to adopt
the method of their choice.

35. 9) Medication-
All medication prescribed to the mother must
be consulted as many of these drugs may pass
through breast milk to new born baby & can
be harmful..

36. 10)Advice on discharge- Thorough examination
of the mother and child is to be taken before
discharge
 Gradual return to normal activity at home.
 Care of the newborn & breast feeding .
 Iron and vitamin supplements to improve
mother’s health.
 Contraception.
 For regular follow up.

37. MANAGEMENT OF AILMENTS
 After pains
 Pain at site of perineum
 Engorgement of breast
 Treatment of Anemia
 Hypertension

38. Health and nutrition education
 Family planning advise
 Sexual intercourse can be resumed till to 6
weeks after delivery
 Breast feeding is best
 Immunization of child
 Calorie need per day-2200+700 =2900
 Role of post natal exercises

39. POSTNATAL EXERCISE
 Deep breathing Exercise
 Foot and ankle exercise
 Pelvic floor Exercise
 Pelvic Tilting Exercise
 Abdominal Breathing
 Head and shoulder raising
 Leg raising
 Knee rolling
 Hip hitching or leg
shortening.

40. SUMMARY
 So today we have discussed about:-
 Definition of Puerperium
 Duration of Puerperium
 Anatomical and physiological changes during
puerperium
 General physiological changes
 Management of normal Puerperium
 Management of ailments
 Postnatal Exercise

41. 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.

42. BIBLIOGRAPHY
• Jacob annamma” text book of
obstetric nursing”, 3rd edition,
published by Jaypee brothers,
page no. 438-441.
• Dr.B.T Basavanthapa, “Child
health nursing , First edition,
published Ahuja Publishing
house no., Pageno.222-225.
• D.C Dutta :Obstetric Nursing 7th
edition ,Published by Jaypee
Brothers ,Pg no.144-153.