Complication of puerperium

1. Complication & minor ailments ofComplication & minor ailments of
puerperiumpuerperium
PRESENTED BY:-PRESENTED BY:-
Balkeej kaurBalkeej kaur
M.Sc (N) Ist yrM.Sc (N) Ist yr
Roll no- 08Roll no- 08

2. INTRODUCTION:
• Puerperium, the period of adjustment after
childbirth during which the mother’s reproductive
system returns to its normal prepregnant state.
triggered by a sharp drop in the levels of estrogen
and progesterone produced by the placenta during
pregnancy. The uterus shrinks back to its normal
size and resumes its prebirth position by the sixth
week.

3. DEFINITION
• It is the period following child birth during
which all the body tissue especially pelvic organs
revert back to their pre pregnant stage both
anatomically and physiologically.
• It has 3 types:
• Immediate- within 24 hrs
• Recent- within 7 days
• Remote- up to the end of 6 weeks

4. MINOR AILMENETS OF
PUERPERIUM
• AFTER PAIN:-
it is infrequent, spasmodic pain felt in
the lower abdomen after delivery for a
variable period of 2-4 days. presence of
blood clots or bits after birth leads to
hypertonic contraction of the uterus in an
attempt to expel them out.

5. NURSING MANAGEMENT
it includes in massaging the uterus with
expulsion of clots followed by
administration of analgesics &
antispasmodics.

6. cont..
• Effective relief from pain by emptying bladder.
• Provide a prone position with pillow under her
lower abdomen.( it provides a constant pressure
against her uterus ,which keeps it contracted
thus eliminates after birth pains)

7. • PAIN ON THE PERINEUM
Never forget to examine the perineum when
analgesic is given to relieve pain.
- Early detection of vulvo- vaginal heamtoma can
thus be made.

8. Signs and Symptoms.
• Severe, sharp perineal pain.
• (2) Appearance of a tense, sensitive mass
of varying size covered by discolored skin.
• (3) Swelling in the perineal wall.
• (4) Often seen on the opposite side of the
episiotomy.

9. • (5) Inability to void due to pressure/edema
on or around the urethra.
• (6) Complaint of fullness or pressure in the
vagina.
Medical Treatment. This is consists of
analgesics given for discomfort, opening
the hematoma so blood clots can be
evacuated and the bleeders can be ligated,
and packing for pressure

10. • Nursing Interventions.
• Apply ice to area of hematoma.
• Observe for evidence of enlarged hematoma.
• Flag the patient's chart if packing was inserted.
• Sitz baths (hot or cold ) can give additional
relief.

12. DEFINITION

13. PREDISPOSING FACTORS
ANTEPARTUM FACTORS:-
Malnutrition & anemia
Pre-eclampsia
Pre mature rupture of
membranes
Chronic debilitating illness
Sexual intercourse

14. INTRAPARTUM FACTORS
• Sepsis during internal
examination
• Dehydration & keto-acidosis
• Traumatic operative delivery
• Hemorrhage
• Placenta praevia

15. INVESTIGATIONS
Collect the history
Clinical examination
Investigations include-
Urine culture
Blood culture
Vaginal swabs for culture

16. MEDICAL TREATMENT:
•Ampicillin 500 mg,I/M
•Gentamycin 3-5 mg/kg body
weight,
•Cefuroxime 750 mg,I/V
•Metronidazole 0.5 gm,I/V

17. PROPHYLAXIS NURSING
MANAGEMENT
Certain measures are undertaken before,
during and postpartum period.
Antenatal period-
To detect and eradicate the septic focus.
To maintain or improve the health status
like hemoglobin level, prevent
preeclampsia.
Should take care about personal hygiene.

18. Contd…..
INTRANATAL PERIOD
The delivery should be conducted
taking full surgical asepsis.
The patient is instructed not to touch
the vulva during labour.
Excessive blood loss should be
replaced promptly.
Prophylactic antibiotics.

19. •Use caps, mask, gowns, and gloves when
working in delivery rooms.
• Use sterilized equipment within control dates.
•Wash hands meticulously (staff).
•Correct breaks in sterile techniques immediately.
•Limit unnecessary vaginal exams during
labor which increases the chances of introducing
organisms from the rectum and vagina into the uterus

20. POSTPARTUM PERIOD
• Aseptic precautions should be taken during
perineal care.
• Too many visitors should not be allowed.
• Sterilized pads should be used and changed.
• Instruct the patient on hand washing and cleansing
her perineum from front to back.
• Restrict personnel with respiratory infections from
working with patients.
• Early ambulation postpartum.
• Daily evaluation of fundal height to document
involution
•

21. Nursing Care of Puerperal Infection.
-Isolation, if possible, the removal of
the patient from the maternity ward.
-Meticulous hand washing.
-Patient placed in Fowler's position to
facilitate drainage.
-Reeducation of the patient on
-handwashing and peri-care.

22. Emotional support since the patient may be
prevented from rooming in with her infant
while her temperature is elevated.
-Check the vital signs.
-Maintain the fluid intake and output.
-Anemia should be corrected by blood
transfusion.
-Sufficient rest is enforced by analgesics and
sedatives.

23. PUERPERAL
PYREXIA

24. Definition
An elevation of temperature to 38˚c
(100.4˚f) or more occurring on two separate
occasions at 24 hours apart (excluding the
first 24 days ) following delivery is called
puerperal sepsis.

25. CAUSES
• Puerperal sepsis
• Urinary tract infection: cystitis, pyelonephritis.
• Breast infection
• Infection of laparotomy wound (caesarean
section)
• Intercurrent infection : acute bronchitis,
pneumonia, influenza, acute appendicitis &
enteric fever

26. NURSING MANAGEMENT
• Isolation,.
• -hand washing.
• - Patient placed in Fowler's position to
facilitate drainage.
• - education of the patient on handwashing
and peri-care.

27. • - Emotional support
• Check the vital signs.
• -Maintain the fluid intake and output.
• Sufficient rest is enforced by analgesics and
sedatives.

28. Sub involution ofSub involution of
uterusuterus

29. Definition
• Sub involution of uterus is impaired and
deficient involution of the uterus following
delivery
• when the uterus is not reverted back to the
pre-pregnant both anatomically & physiology.

30. Causes
• Predisposing factors
• Grand multiparity
• over-distention of uterus as in twins &
hydromnios
• Maternal ill health
• Cesarean section
• Prolapse of the uterus
• Uterine fibroids
• No sucking of the baby

31. Clinical features
• Excessive or prolonged discharge of lochia
• Irregular or excessive uterine bleeding
• Irregular cramp like pain
• Uterine height more than normal for the
particular day of post partum

32. Management
• Sub involution is managed by treating the
causes.
• Antibiotics for sepsis.
• Exploration of the uterus for retained
products.
• pessary in prolapse or retroversion.
• Early ambulation postpartum.
• Daily evaluation of fundal height to document
involution.

33. BREAST DISORDERSBREAST DISORDERS

34. CLASSIFICATION
BREAST DISORDERS
IN FEMALES
NIPPLE
DISORDERS
BREST
INFECTIONS

35. NIPPLE DISORDERS
CLASSIFICATION
INVERTED
NIPPLE
RETRACTED
NIPPLE
ACCESSORY
NIPPLES

36. INVERTED NIPPLES
DEFINITION-
It is a condition in
which nipple
instead of pointing
outwards get
retracted into the
breast.

37. METHODS-
• Use of breast pump.
• Hospital grade electric pump.
• Use of nipple shield.
• Frequent stimulation

38. Breast pump

39. Nipple shield

40. Cont..
OTHER METHODS-
• Plastic surgery
• Nipple piercing
• Regular stimulation
• Suction cups or clamps
• Homemade nipple protractor.

41. Suction cups

42. Clamp, piercing, shells…

43. CRACKED NIPPLES
DEFINITION- it is a condition in which there is loss
of surface epithelium with the formation of raw
area on the nipple along with fissure situated
either at the tip or of the base of nipple
CAUSE-improper hygiene resulting in crust
formation,
Retracted nipples,
Trauma
Due to incorrect breast feeding.

44. Cont…

45. Cont…
SYMPTOMS- painful breast feeding, it may
progress to mastitis.
PROPHYLAXIS-maintaining hygiene.
TREATMENT-correct attachment of infant,
purified lanonin application(3-4 times),
usage of breast pump and shields(if
severe), application of miconazole lotion,
biopsy.

46. BREAST INFECTIONS
CLASSIFICATION
MASTITIS
SUBAREOLAR
ABCESS

47. MASTITIS
DEFINITION- It is the inflammation of parenchyma
of the mammary gland
TYPES-
PATHOGENS-staphylococcus, streptococcus,
gram negative bacilli such as escherichia coli,
salmonella, mycobacterium, candida,
cryptococcus (rarely)
PUERPERAL MASTITIS
NON PUERPERAL MASTITIS

48. Mastitis

49. Cont…
CAUSES-
PUERPERAL MASTITIS
 Blocked milk ducts
 Milk excess
 Cracked nipples
 Tight clothing
 Microorganism
transference by
patient and infant.
CAUSES-
NON PUERPERAL
MASTITIS
 Hyperprolactinemia
 Thyroid disorders
 Breast trauma,
surgery
 Nipple piercing
 Medications .

50. Cont…
SYMPTOMS
PUERPERAL
MASTITIS
Tough, doughy
texture
Dull to severe pain
Flu-like symptoms
Abscess (rare)
SYMPTOMS
NON PUERPERAL
MASTITIS
Redness, swelling
Diffused
tenderness, pain
Hot sports
Abscess
Nipple discharge.

51. TREATMENT
PUERPERAL
MASTITIS
 Breast feeding.
 Use of suction
devices
 Heat application (prior
to feeding)
 Cold compresses
(severe)
 Antibiotics
TREATMENT
NON PUERPERAL
MASTITIS
Symptomatic
management
Broad spectrum
antibiotics.

52. BREAST ENGORGEMENT
DEFINITION-it is a condition which occurs
in mammary glands by expanding viens
and the pressure of new breast milk
contained with in them.
CAUSE-It is due to exaggerated normal
venous and lymphatic engorgement of
breasts which precedes lactation.it
involves primiparous women and women
with inelastic breast.

53. Breast engorgement

54. Cont….
SYMPTOMS-Pain, feeling of heaviness,
generalized malaise, transient rise of
temperature, painful breast feeding.
PREVENTION-to avoid prelacteal feeds, to
initiate early and unrestricted breast
feeding, exclusive breast feeding on
demand, feeding in correct position.

55. Cont…
MANAGEMENT
-To support the breast with brassiere
-Mannual expression of any remainaing milk
after each feed
-To administer analgesics for pain
-Put baby on breast feed regularly and at
frequent intervals
-Gentle use of breast pump (if severe)

56. Failing lactation
CAUSES:-
• Debilitating state of the mother
• Early primigravidae
• Failure to suckle the baby regularly
• Depression or anxiety state in the
puerperium
• Apprehension to nursing
• Premature baby, who is too weak to suck
• Painful breast lesions

57. MANAGEMENT
ANTENATAL
• Education regarding the advantages of
breast feeding
• Correction of abnormalities like retracted
nipples
• Breast hygiene
• Improving the general health status of
mother

58. Cont…
POSTNATAL
• Encourage adequate fluid intake
• Nurse the baby regularly
• Treat painful lesions promptly
• Express residual milk after each feeding
• Drugs like thyroid extract or prolactin are
useful.

59. Summarization

60. ANY QUERY

61. THANK YOU