abnormal puerperium

1. 1
S.NO. TIME SPECIFIC
OBJECTIVE
CONTENT TEACHING
ACTIVITIES
LEARNING
ACTIVITIES
AV
AIDS
EVALUATION
1
2
3
2min
2min
7min
To define
minor
disorder&
complication
To
enumerate
the minor
disorder &its
feature and
management.
INTRODUCTION
Puerperiumisthe periodfollowingchildbirthduringwhich
bodytissue revertbackto the pre pregnanatstate both
anatomicallyandphysiologically,durationapproximately 6- 8
week,there is involutionof the organoccur mainly
reproductive organ,butsome factor affectnormal involution
process.anddevelopcomplication.
DEFINTION OF DISORDER
“a puerperal disorderisa disorderwhichpresentprimarily
duringthe Puerperium
and specificpathologymaybe presentduringthisperiod’’
if the conditionisminorcalledminordisorder.
and the conditionhasfatal that alteredthe physiological
processcalledcomplication
there are numberof minordiscomfortof the Puerperium.
1. Afterbirthpain = it calledafterpains,canbe quite
painfull,theyare continuingsequentialcontractionand
relaxationof the uterus.There are muchcommon with
increase parityandinwomenwhobreastfeed,due to
the sucklingreflex the oxytocinissecrete,itstimulate
uterine contraction.
Management= 1 emptythe bladder
2 the womenlie prone positionwith
a pillow
underherlowerabdomen
Student
teacher
define minor
disorder &
complication.
Student
teacher
enumerate
minor
disorder& its
c/f,and
management.
Listening and
writing
notes.
Listening and
writing
notes.
Black
board
&
chalk
Chart,
black
board
&
chalk
Define minor
disorder and
complication.
Describe the
various types
of minor
disorder

2. 2
3 analgesiacan be effective
2. Excessive perspiration=excessisdue tothe bodyusing
thisroute as well asdiuresstorid itself of the excess
interstitial
Fluidthatresultedfromthe hormonal effectduring
prgnancy
Management1 keepingthe mothercleananddrywill
provide comfort
2 the womenhave change the gown frequently
3 bedsheetshouldbe change
4 hydrate the women
3. Breast engorgement= itis isdue to combinationof
milk accumulationandstasisandincrease vascularity
and congestion.itoccurmainlythirdpostpartumdayin
breasrfeedingornonbreastfeedingmotherandlast
approximately24 – 48 hrs
Sign /symptom
Sense of increase heaviness
Enlargementof breastdue to descent
Skinbecome tightshiningreddened
Breastare feel firmandfull tender
Management
Reliefmeasure fornon breast feeding
1 give the breastgoodsupport
2 applyice bags or packsto the breast
3 take analgesictorelive pain
4 do not applythe heatheatdilate the bloodvessels
Reliefmeasure for breastfeeding mothers
1 carrry outbreast massage ,manual expressionand
nipple rolling

3. 3
2 feedthe babyevery2-3hrs withoutmissingnay
feeding.
3 use bothbreasteach feed.
4 maintaingoodsupport.
5 ice bag may be used.
6 analgesicmaybe usedif neede.
4. Perineal (stitchpain) before anyinstituteditis
essential toexamine the perineumtoascertainif the
womenhavingnormal painorif a complication
Management
1 Ice bagsor ice packsapply
2 Topical anestheticspray
3 Sitzbath 2 -3 timesa day
5. Constipation
Management
Hydrationmaintain
stool softenerormildlaxative are usallyorderedfor
womenwiththirdorfourthdegree repairof perineum
6. hemorrhoids
management
1 ice bag bag or ice packs apply
2 medicatedcompression
3 analgesicointment
4 stool softener
5 rectal suppositories
6 replacementof external hemorrhoidinside the
rectum
7. anemia

4. 4
4
5
2min
5min
To enlist the
complication
of
puerperium
To describe
the signs and
management
supplementaryirontherapy(ferroussulphate200
mg) is to be given4-6 week&bloodtransfusion
8. hypertension
management
give antihypertensionmedication
educationregarding the minorailmentsis a must . the
midwivesshouldsuggestpromoting healtheducation that
encourage women to seekappropriate and timelycare during
the puerperial period.
COMPLICATIONOF PUERPERIUM
PUERPERIAL PYREXIA
PUERPERIA SEPSIS
SUBINVOLUTION
URINARY COMPLICATIONIN PUERPERIUM
BREAST COMPLICATION
PUERPERIAL VENOUS THROMBOSIS AND PULMONARY
EMBOLISM
PUERPERI OBSTETRIC PALSIES(syn:postpartum traumatic
neuritit
PUERPERIAL EMERGENCIES
PSYCHIATRIC DISORDER DURING PUERPERIUM
Puerperal blue
Post partum depression
Postpartum psychosis
PUERPERIAL PYREXIA
DEFINTION=‘’AN ELEVATION OFTEMPERATURETO 38 DEGREE
Student
teacher
enlists the.
complication
of
puerperium
Student
teacher
Listening and
writing
notes.
Listening and
Black
board
&
chalk
Black
board
Enlist the
complication
of Puerperium

5. 5
6
15
min
symptoms of
Puerperal se
To explain
the
puerperial
sepsis
OR MOREOCCURINGON TWO SEPRATE OCCASIONSAT24 hrs
APART( excludingthefirst 24 hours) WITHIN THE FIRST 10
DAYS FOLLOWINGDELIVERY ISCALLED PUERPERIALSEPSIS”
CAUSES=
Puerperalsepsis
Urinary tract infection
Breastinfection
Infectionof laprotomy
Intercurrentinfectionlike bronchitis
Thrombophlebitis
Deep vein thrombosis
Flaringup of tuberculosis
PUERPERIA SEPSIS
Introduction= puerperal sepsisisthe aninfective
conditioninthe motherfollowingchildbirthandone of
the leadingcause causesof maternal deathasa result
of childbirth.after hemorrhage andabortion. infection
occur Puerperiumleadingtosecondaryhemorrhage
and infertility.
DEFINITION =”IT IS AN INFECTION OFTHE GENITAL
TRACT ,WHICHOCCURAS A COMPLICATION OFA
DELIVERY”
Epidemiologythe incidenceof puperial sepsisis
between0.1-10 %all overdelivery.
Conditionthat favor the developmentofsepsis
1 The vaginal floraeg. Doderlinbacillus
,sataphylococcus,streptococcus,thatpresentthe
normal flora
2 Damage to the cervical mucousmembrane
3 The openwoundcreate by the cleavage of the
deciduas,whichtake place whenplacentais
describes the
signs and
symptoms of
puerperal
pyrexia
Student
teacher
explain
pueperial
sepsis
writing
notes.
Listening and
writing notes
& ch
Black
board
&
chalk
Describe the
signs and
symptoms of
puerperal
sepsis

6. 6
separated
4 The bloodclot at the placental site are an excellent
mediaforthe growth of bacteria
Predisposingfactor ofpuerperial sepsis
Antepartumfactors=
1 Malnutritionandanemia
2 Pretermlabour
3 Premature rupture of the membrane
4 Sexual intercourse duringpregnancy
Intra partumfactor=
1. Introductionof organismsintouppergenital tract
duringvaginal examination,especiaalyrupture of the
membrane .
2. Dehydrationandketoacidosis
3. Traumatic operationdelivery
4. Hemorrhage
5. Retainedbitsof placental tissueormembrane
6. Placental site lyingclosetothe vagina
Organism responsilble
Aerobic: staphylococcuspyogen,E-coli,klebseilla,
pseudomonas,staphylococcusauerus,nonhemolytic
streptococcus
Anaerobic:anaerobicstreptococcus,clostridium
welchii,clostridiumtetani, bacteroides
mode of infection
Endogenous:organismpresentinthe genital tract
before deliverybecome pathologic.
Autogenous:organismpresentelsewhere inthe body
migrate to the genital organeitherthroughblood
streamor by otherdirectroute
Exogenous:infectionistransmittedbythe client,the
Student
teacher
enlists the
various
predisposing
factor.
Discussing
and writing
notes
Black
board
&
chalk

7. 7
organismtransmittedthroughattendants,doctor
nurse
Pathology
Puerperial infectionisawoundinfection.the primary
site of infectionare perineum,vaginacervix,uterus
 Perineum=lacerationof the perineumare likelytobe
infected,the woundedge become redand swallowen.
There may be collectionof purulentdischarge orpus
resultingcomplete disruptionof the wound.
 Vagina=the vaginal lacerationisdirectlyinfectedorby
extensionfromthe perinealinfection,the mucosais
swollenandhyperaemic.
 Cervix =the cervical lacerationsbecomethe site of
infection
 Uterus =the uterusismost commonsite of infection.
the deciduasoverthe placental site isthe commonsite
to be infectedfirst.The infectionmainlymanifestfirst
b/t the 3-6day of delivery.ittermendometritis.the
infectionispreventbya zone of lecocyticbarrier
 Othersite
pelviccellulites=infectionof the pelvicperitoneum
,andlevatorani muscle ,
salpingitis
peritonitis
Thrombophlebitis
Septicemiaandpyremia
SepticpelvicThrombophlebitis
Septicemiaandshock
Clinical feature =
Local infection
 Slightraise of temp.generalizedmalaiseorheadache .
 Rednessandswellingof the local wound.

8. 8
 Pusformationanddisruptionof wound.
Uterine infection
 Pyrexiaof variable degree andtachycardia
 Red, copiousand offensive lochia.
 Subinvolution,tenderandsoftuterus
Extra uterine spread
Parametritis- the onsetof 7-10 dayof peritoneum
c/f = constantpelvicpain,tendernessoneithersite on
the hypogastrium,sustainedraise temp.,unilateral tendermass
feltonthe vaginal examination.,lecucytosis.
Pelvicperitonitis –sustainedraise of temp.,lowerabdominal
painand tenderness,collectionof the pusinpouchof douglas.
General peritonitis highfeverwithrapidpulse,vomiting,
generalizedabdominal pain,tenderanddistendedabdomen
Thrombophebitis –swingingtempwithchillsandrigor,
pyemiaaccordingtoorgan .
Septicemia–hightemp.associatedwithrigor,rapidpulse
,headache ,insomniamental confusion,positivebloodculture,
symptomandsignof metastaticinfectioninthe lungs,joints
and meninges
Endotoxicshock
invesigation
 Historycollection=antenatal historyof anemia
,APH,andanyotherinfectiousdisease.
Intranatal historyof pre term labour
,durationof rupture of membrane,no.of internal
examinationdoneoutsideandinsideof the institution
., nature of intra uterine manipulation
Postnatal historyof the nature of feverand

9. 9
otherassociatedsymptomrelatedtothe site of lesion
 Bacteriological study=smear,culture andantibiotic
sensitivitytest,of purulentmaterial,
,highvaginal andcervical swab,peritoneal fluidblood
culture
 Urine –routine andmicroscopicexamination
 Complete bloodcount
 Ultra sonography
 Otherspecificinvestigationasperclinical condition
such as X-ray,CT AndMRI needed.
Prophylaxis
Antenatal –improvementof nutritionalstatusand
general condition.,treatmentof septicfoci,abstinence
fromsexual intercourse inthe lasttwo month, care
aboutpersonal hygiene ,avoidunnecessaryvaginal
examination,avoidcontactwith infectiousperson.
Intrapartum– staff attendthe laborclientfree from
infection&full surgical asepsis tobe taken,
Membrane shouldbe keptintactas longas possible
and vaginal examinationshouldbe restricted ,traumatic
deliveryavoided. bloodloss shouldbe avoided,
prophylacticantibioticshouldbe use.
Postpartum=aseptictechnique shouldbe use during
,while perinealdressing
Treatment
General care
1. 1 Isolationof the ptis preferredspeciallywhen
hemolyticinfection
2. Adequate fluidandcalorie
3. Anemiaiscorrectedoral ironand blood
transfusion
4. An indwellingcathetertorelieve anyretention.
5. A chart is maintainbyrecordingpulse ,
Explain the
other
complcation

10. 10
7
12
min
To explain
other
complication
respiration,temp,
Antibiotics–gentamycin2mg /kgIV every8
hrs
Ampicillin1gm IV every6 hrs
Clindamycin900 mg IV every8 hrs
Cefotaxime1gm IV 8 hrs
Metronidazole 0.5gm IV is given8 hrs
Surgical treatment–
1. perineal woundif there isstitchshouldbe
remove tofacilitate the drainage.
2. Retaineduterineproductisevacuate drain
by D&E
3. Pelvicabscessdrainbycoloptomyunder
ultrasoundguidance
4. Laprotomy
Infectioncontrol measure relevantto puerperial sepsis
Hand hygiene.
Equipment&cleandeliverykit.
Trainingandeducationof traditional birthattendants.
Vaginal antisepsis( use chlorohexidineduringvaginal
examination)
Surgical asepsis
Micro nutrientsupply
Antibiotics
SUBINVOLUTION
URINARY COMPLICATION IN PUERPERIUM
Retention&incontinence of urine ,UTI
Student
teacher
explains the
complication
Listening and
writing
notes.
Black
board
&
chalk
Explain briefly
puerperial
sepsis?

11. 11
BREAST COMPLICATION
 BREAST ENGORGEMENT
 CRACKED AND RETRACTED NIPPLE
 ACUTE MASTITIS
 BREAST ABSCESS
 LACTATION FAILURE
PUERPERIAL VENOUS THROMBOSIS AND PULMONARY
EMBOLISM
PUERPERIALVENOUSTHROMBOSIS
Deep vein thrombosis
Thrombophlebitis
Septic vein Thrombophlebitis
Pulmonaryembolism
Pulmonary embolism
OBSTETRIC PALSIES(syn:postpartum traumatic neuritit
.it is usually unilateral and appear shortly after delivery . it is
due to stretching of the lumbosacral trunk by the prolapsed
intervertebrial disc between L5and S1.
PUERPERIAL EMERGENCIES
There are manycomplicationthatmayoccur during
the Puerperium the complicationare:
IMMEDIATE – postpartumhemorrhage
Shock
Postpartumeclampsia
Pulmonaryembolism
Inversion
EARLY –acute retentionof urine

12. 12
8
5 Min
UTI
Puerperal sepsis
Breast engorgement&breastother
complication
DELAYED –secondarypostpartum hemorrhage
PSYCHIATRIC DISORDER DURING PUERPERIUM
Puerperal blue
postpartum depression
Postpartum psychosis
SUMMARY
we discussabout minordisorderincludeafterbirthpain,
perineumpain,excessiveperspiration,breastengorgement
,constipationhemorrhoids anditsmanagement
Andcomplicationinclude puerperal pyrexia
,puerperal sepsis,subinvolution,urinarycomplication,breast
complication,pPuerperal venousthrombosisandpulmonary
thrombosis,obstetricpalsy,puerperal emergencyand
psychiatricdisorder andmanagementduringPuerperium.
Beinga nurse we are not takingpropercare that affectclient
healthandcreate many complication.so acceptaseptic
technique andpropercounselingof the clientbefore discharge.
Assignment Briefly describe a complicationof
Puerperiumand its management

13. 13
Evaluation
A class test of 30 marks will be conducted after 1 week at
10 am. The test will be of 1 hour.
REFERENCE
 VG Padubidri & SN Daftary , ‘’Howkins & Bourne
Shaw’s Textbook of Gynecology’’, Fifteenth Edition,
Elsevier India Private Limited, 2011, Pp 200-209
 D.C.Dutta, ‘’Textbook of Gynecology’’, Fifth Edition,
New centralbook agency (P) Ltd, Kolkata, 2006, Pp
145-154and 433-444
 Jacob annamma “A comprehensive text book of
midwifery and gynecological nsg”3 rd edition jaypee
brother medical publication (p)ltd207-227 and 432-440
 www.wikipedia.com
 www.freedictionary.com
 www.Currentnursing.co