Informative presentation for BHMS students for Therapeutics in Abnormal Puerperium.

1. DR. D. Y. PATIL
HOMOEOPATHIC MEDCIAL COLLEGE
AND RESEARCH CENTRE

2. ABNORMALITIES OF PUERPERIUM
PUERPERAL PYREXIA
PUERPERAL SEPSIS
URINARY COMPLICATIONS IN PUERPERIUM
BREAST COMPLICATION
PUERPERAL VENOUS THRPMBOSIS & PULMONARY EMBOLISM
PUERPERAL EMERGENCIES
OBSTETRIC PALSIES
PSYCHIATRIC DISORDERS DURING PUERPERIUM

3. PUERPERAL PYREXIA
DEFINITION –
A rise of temperature reaching 100.4°F
(38°C) or more (measured orally) on
two separate occasions at 24 hours
apart (excluding first 24 hours) with in
first 10 days following delivery is
puerperal pyrexia.
CAUSES –
 Puerperal sepsis
 UTI
 Mastitis
 Infection of caesarean section wound
 Pulmonary infection

4. PUERPERAL SEPSIS
DEFINITION –
An infection of the genital tract which
occurs a complication of delivery is
termed as puerperal sepsis.
CAUSES –
 Endometritis
 Endomyometritis
 Endoparametritis or a combination of
all three.

5. PUERPERAL SEPSIS
PREDISPOSING FACTORS -
ANTEPARTUM FACTORS
• Malnutrition and anaemia
• Preterm labour
• PROM
• Chronic debiliting illness
• Prolonged rupture of membranes
PREDISPOSING FACTORS –
INTRAPARTUM FACTORS
• Repeated vaginal examinations
• Prolonged rupture of membranes
• Dehydration & keto-acidosis
• Traumatic operative delivery
• APH/PPH
•Retained placenta/membranes
•Placenta praevia
•Caesarean delivery

6. PUERPERAL SEPSIS
CLINICAL FEATURES
 LOCAL/WOUND INFECTION
• Slight rise of temperature
• Generalized malase/headache
• Wound red swollen
• Pus formation
 SPREADING INFECTION
• Pelvic peritonitis
• Parametritis
• General peritonitis
• Thrombophlebitis
• Septicemia
 UTERINE INFECTION
• MILD – Rise in temperature,
raised pulse rate, lochial
discharge offensive &
copious, Uterus sub-involuted
& tender.
• SEVERE – Acute onset with
high fever, with chills & rigor;
rapid pulse; lochia scanty &
odorless; tender uterus;
associated wound infection.

7. URINARY COMPLICATIONS IN
PUERPERIUM
URINARY TRACT
INFECTION
• Recurrence of
previous cystitis
or pyelitis
• Asymptomatic
bacteriuria
becomes overt
• Effect of
frequent
catherisation
• Stasis of urine
due to lack of
bladder tone
and less desire
to pass urine.
RETENTION OF
URINE
• Bruising &
edema of
bladder neck
• Reflex from
perineal injury
• Unaccustomed
position
INCONTINENCE
OF URINE
• Overflow
incontinence
• Stress
incontinence
• True
incontinence
SUPPRESSION OF
URINE
• If 24 hours urine
excretion is less
than 400ml or
less, suppression
of urine is
diagnosed.

8. BREAST COMPLICATIONS
BREAST
COMPLICATIONS
BREAST
ENGORGEMENT
CRACKED OR
RETRACTED
NIPPLE
MASTITIS
LACTATION
FAILURE
Its is due to exaggerated
normal venous and
lymphatic engorgement
of the breasts which
precedes lactation.
Its is due to unclean
hygiene; retracted nipple;
trauma from baby’s
mouth
CAUSES –
•Infrequent suckling
•Depression or anxiety
state
•Reluctance or
apprehension to
nursing
•Ill development of the
nipples
•Painful breast lesion
CAUSES –
•Poor nursing
•Maternal fatigue
•Cracked nipple

9. PUERPERAL VENOUS
THROMBOSIS/PULMONARY EMBOLISM
PREDISPOSING FACTORS –
• Vascular stasis
• Hypercoagulability of blood
• Vascular endothelial trauma
• Advanced age and parity
• Operative delivery
• Obesity
• Anaemia PREDISPOSING FACTORS –
• Heart disease
• Infection-pelvic cellulitis
• Trauma to the venous wall
• Immobility
• Smoking
• Prior DVT or PE

10. PUERPERAL EMERGENCIES
•Postpartum hemorrhage
•Shock
•Postpartum eclampsia
•Pulmonary embolism
•Inversion
IMMEDIATE
•Acute retention of urine
•Urinary tract infection
•Puerperal sepsis
•Breast engorgement
•Mastitis & breast abscess
•Pulmonary infection
EARLY
•Secondary PPH
•Pulmonary embolism, thrombophlebitis
•Psychosis
•Postpartum cardiomyopathy
DELAYED

11. PSYCHIATRIC DISORDERS DURING
PUERPERIUM
HIGH RISK FACTORS –
• Past history – psychiatric illness, puerperal
psychiatric illness.
• Family history – major psychiatric illness,
martial conflict, poor social situation.
• Present pregnancy – young age, caesarean
delivery, difficult labour, neonatal
complications.
•Others – unmet expectations.
DISORDERS ARE –
• Puerperal blues
• Post partum depression
•Post partum psychosis

12. HOMOEOPATHIC APPROACH
SCOPE
• PUERPERAL PYREXIA
• PUERPERAL SEPSIS
• URINARY
COMPLICATIONS IN
PUERPERIUM
• BREAST
COMPLICATION
• PSYCHIATRIC
DISORDERS DURING
PUERPERIUM
LIMITATIONS
• PUERPERAL VENOUS
THRPMBOSIS &
PULMONARY
EMBOLISM
• PUERPERAL
EMERGENCIES
• OBSTETRIC PALSIES
• RETAINED UTERINE
PRODUCTS
• PELVIC ABSCESS

13. HOMOEOPATHIC APPROACH
CASE TAKING –
o Date of delivery
o Obstetric & gynecological history in detail
o Chief complaints – in detail with exact ODP of symptoms
o Physical examination – Abdomen, stitches, breast examination
o Investigations – Urine routine & culture; Haemogram; Blood culture;
Pelvic sonography.
SUSCEPTIBILITY – High
INDIVIDUALISATION –
o The clinical picture will be seen, but the sensations, modalities will
make the case individualized.

14. HOMOEOPATHIC THERAPEUTICS
o Aconitum napellus
o Arnica montana
o Bryonia alba
o Lachesis
o Pyrogen
o Rhus toxicodendron
o Secale cor
o Baptisia
o Belladonna
o Cicuta virosa
o Causticum
o Hyocyamus niger
o Trillium pendulum
o Cyclamen
o Viburnum prunifolium
o Chinium sulphuricum

15. ACONITUM
NAPELLUS
MENTALS
MODALITIES
GENERALS
PARTICULARS
•Physical & mental restlessness, & fright are most
characteristic feature of aconitum.
•Acute, sudden & violent invasion, with fever, calls for it.
•First remedy in inflammation & inflammatory fevers.
•Action is brief & shows no periodicity.
•Aconite causes only functional disturbance, there is no
evidence that is can produce tissue changes.
•Great fear, anxiety & worry accompany every ailment,
however trivial.
•Fears death, but believes that he will soon die, predicts
the day.
•Fears future.
•Restlessness, tossing about.
•Cold stage is marked; cold sweat & icy coldness of the
face.
•Coldness & heat alternates.
•Cold waves pass through the body.
•Thirst & restlessness always present.
•Most valuable medicine for fever with mental anxiety,
restlessness.
•WORSE – warm room,
evening, at night, lying
on affected side, from
music, from tobacco,
smoke, dry, cold wines.
•BETTER – open air.

16. ARNICA
MONTANA
MENTALS
MODALITIES
GENERALS
PARTICULARS
•It is especially suited to cases when any injury, however
remote, seems to have caused the present problem.
•After traumatic injuries, overuse of any organ strains.
•Tendency to tissue degeneration, septic conditions,
abscesses that do not mature.
•Sore, lame, bruised feeling.
•Fear touch, or approach of anyone.
•Inability to perform continuous active work.
•Agrophobia (Fear of space).
•Want to be left alone.
•Bruised parts after labour. Violent after pains.
•Sore nipples. Mastitis after injury.
•Febrile symptoms closely related to typhoid.
•Shivering all over the body.
•Heat & redness of head, while rest of the body is cold.
•Internal heat; hands & feet cold.
•Sour sweat at night.
•WORSE – least, touch,
motion, rest, wine,
damp, cold.
•BETTER – lying down,
lying with head low.

17. LACHESIS
MUTUS
MENTALS
MODALITIES
GENERALS
PARTICULARS
•Lachesis decomposes blood, rendering it more fluid;
hence haemorrhagic tendency.
•Purpura, septic states, diphtheria & other forms of
disease, when the systems is thoroughly poisoned &
prostration is profound.
•Great loquacity.
•Sad in the morning; no desire to mix with the world.
•Suspicious; nocturnal delusion of fire.
•Derangement of time sense.
•Left ovary very painful & swollen, indurated.
•Mammae inflamed, bluish (mastitis).
•Chills in back; feet icy cold; hot flushes & hot
perspiration.
•WORSE – after sleep,
left side, in spring,
warm bath, pressure or
constriction, hot drinks,
closing eyes.
•BETTER – appearance
of discharges, warm
applications.

18. PYROGENIUM
MENTALS
MODALITIES
GENERALS
PARTICULARS
•Great remedy for septic states, with intense
restlessness.
•In septic fevers, especially puerperal, pyrogenium has
demonstrated its great value as a homoeopathic
dynamic antiseptic.
•Typhus, dissecting wounds, after affects of miscarriage.
•All discharges are horribly offensive – menstrual,
lochial, diarrhoea, vomit, sweat, breath, etc.
•Full of anxiety & insane notions.
•Restlessness.
•Cannot tell whether dreaming while awake or asleep.
•Feels as if crowded with arms & legs.
•Puerperal peritonitis.
•Septicemia following abortion.
•Septic puerperal infection.
•PID, inflammatory exudate.
•Post-operative cases with over-whelming sepsis.
•Septic fevers, temperature rises rapidly.
•Great heat with profuse hot sweat, but sweating does
not cause a fall in temperature.
•BETTER – by motion.

19. BAPTISIA
TINCTORIA
MENTALS
MODALITIES
GENERALS
PARTICULARS
•Simulating low fevers, septic conditions of the blood.
•Great muscular soreness & putrid phenomena are
always present.
•Thinks he is broken or double & tosses about in bed
trying to get pieces together.
•Delirium, wandering, muttering.
•Falls asleep while being spoken to.
•Mental confusion, ideas confused.
•Threatened miscarriages from mental depression,
shock, night watching, low fevers.
•Puerperal fever.
•Chills with rheumatic pains & soreness all over the
body.
•Chills around 11 am.
•Adynamic fever.
•WORSE – humid heat,
fog, indoors.

20. BELLADONNA
MENTALS
MODALITIES
GENERALS
PARTICULARS
•It has marked action on vascular system, skin & glands.
•Neuralgic pains that come & go suddenly.
•Heat, redness, throbbing & burning.
•No thirst, anxiety or fear.
•Belladonna stands for violence of attack & suddenness
of onset.
•Patient lives in a world of his own.
•Hallucinations; sees monsters, hideous faces.
•Delirium; frightful images; furious; rages, bites, strikes;
desire to escape.
•Acuteness of all senses.
•Retention of urine.
•Acute urinary infections.
•Sensation of motion in bladder, as if a worm.
•Urine scanty, with tenesmus; dark & turbid, loaded with
phophates.
•Vesical region sensitive – cystitis.
•Incontinence, continuous dripping.
•WORSE – touch, jar,
noise, draught,
afternoon, lying down.
•BETTER – semi-erect
position.

21. CICUTA
VIROSA
MENTALS
MODALITIES
GENERALS
PARTICULARS
•Affection of nervous system.
•Strange and vivid dreams.
•Touch & little noise bring on convulsions.
•Difficult hearing.
•Everything seems to be strange and terrible.
•Unable to recognise family members.
•Fails to recollect what has occurred just few minutes
before.
•Melancholic and indifferent.
•Iirelevant talk confused state of mind.
•Irritability due to pressure on the genital tract during
labour.
•Pressure and progress of labour causes convulsion,
which goes from centre to circumference.
•Vertigo with gastralgia.
•WORSE – touch, jar,
noise, draught,
afternoon, lying down.
•BETTER – semi-erect
position.