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- 1. P R E S E N T E D B Y S R I S H T I M A S S E Y M S C ( N ) I S T Y E A R E R A C O L L E G E O F N U R S I N G Minor Discomforts And Complication Of Pueperium
- 2. Introduction Following the birth of the baby and expulsion of the placenta, the mother enters a period of physical and psychological recuperation, and this period is called pueperium , starts immediately after the delivery of the placenta and membranes and continues for 6 weeks.
- 3. Definition Pueperium 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 -D C Dutta
- 4. Minor Discomforts Of Pueperium And Its Relief After pains Pain on the perineum Breast engorgement Postnatal diuresis Constipation Lactation suppression
- 5. After pains It is the spasmodic, intermittent pain felt in the back and lower abdomen after delivery for a variable period of 2-4 days. Presence of blood clots or bits after the birth leads to spasmodic hypertonic contraction contraction of the uterus in an attempt to expel them out.
- 6. Management Massage the uterus with expulsion of the clot Administer analgesics and antispasmodics
- 7. Pain in peineum Some degree of the pain is felt in the stiches. Abnormal pain should be investigated to diagnose vulvo-vaginal hematoma or infection id developing
- 8. Management • After using the bathrrom, spray or pour warm water over the entire vaginal area. • Encourage mother to pat the area dry, making sure to start at the front and end at the back to avoid spreading germs from the rectum to vagina
- 9. Apply ice packs Sitz bath Care of perineal stiches
- 10. Breast Engorgement May occur about the third day postpartum and is often regarded by mothers as the result of the milk coming in. The mother approaches with pain and tense feeling of the breasts, generalised malaise and painful breastfeeding
- 11. Management Encourage the mother to consume lots of fluids. Support the breast with binder or brassiere. Express the milk manually. The baby should be put to breast regularly after the expression of milk. Analgesics may also be prescribed to relieve pain.
- 12. Postnatal diuresis Within 12 hours of the birth the women begins to loose excess tissue fluid accumulated during pregnancy. The profuse diaphoresis occurs especially at night for the first 2-3 days after childbirth.
- 13. Management Keep the mother clean and dry Change the dress frequently Change the bed sheet Keep the mother well hydrated
- 14. Constipation The problem is much less because of early ambulation and liberalisation of dietary intake. Encourage the mother to take a diet containing sufficient amount of roughage and fluids is enough to move the bowel. If necessary mild laxative such as Igol 2 tea spoons may be advised at bed time.
- 15. Complication of the pueperium Heamorrhage Post partum heamorrgae is defined as excessive blood loss during or after the third stage of labour. The average blood loss is 500 ml at vaginal delivery and 1000 ml at cesarean delivery.
- 16. Early postpartum hemorrhage Is described as that occuring within the first 24 hours. Late postpartum hemorrahage Most frequently occurs 1-2 weeks after delivery but may occur upto 6 weeks of postpartum.
- 17. Etiology Uterine atony Retained products of conception Uterine rupture Uterine inversion Placenta accreta Infection Subinvolution .
- 18. Diagnosis History collection Physical examination Cbc count Prothrombin test Activated partial thromboplastin time (PT/aPTT).
- 19. Treatment O2 administration Bimanual massage Removal of blood clots from the utreus Empty the bladder Carboprost , IM , 0.25mg, every 15 minutes, not exceeds 3 doses. Misoprostol for the treatment of post partum hemorrahge.
- 20. Surgical Management When the conservative therapy fails, surgery is done either bilateral uterine artery ligation or hypogastric artery ligation. Uterine artery ligation is thought to be successful in 80-95% of patients. It this fails , hypogastric artery ligation is an option.
- 21. Pueperal Pyrexia Definition A rise of temperature reaching 100 degree measured orally within first 10 days following delivery is called pueperal pyrexia
- 22. Causes Pueperal sepsis Urinary tract infection Mastitis Infection of caesarean section wound. Pulomary infection Septic pelvic thrombophlebitis Unknown origin.
- 23. Pueperal Sepsis An infection of the genital tract which occurs as a complication of delivery is termed as pueperal sepsis.
- 24. Risk factors Chronic debilitating disease. Poor standards of hygiene Pre- term labour. Poor aseptic techniques. Presence of dead tissue Retained fragements. Frequent vaginal examination. Prolonged or obstructed labour.
- 25. Mode of infection Essentially a wound infection. Placental site, lacerations of the genital tract or caesarean section wounds may be infected in the following ways
- 26. Sources Of Infection Endogenous Exogenous Autogenous
- 28. Investigation History collection Physical examination Assess the severity of the disease High vaginal $ Endocervical swabs for culture and senstivity. “CLEAN CATCH” mid stream specimen of urine for analysis for culture and senstivity. Cbc count, BUN , Serum creatinine.
- 31. Subinvolution Subinvolution is a medical condition in which after childbirth , the uterus does not returnto its normal size. The uterus is the most common organ affected by subinvolution, as it is the most accessible organ to be measured per abdomen.
- 32. Causes Grand multiparity Overdistention in case of twins Maternal ill health Prolapse of the uterus Caesarean section Uterine fibroids. Long labour Retained placenta
- 35. Management Adminster antibiotics Exploration of the uterus in retained products Ergometrine so often prescribed to enhance the involution process by reducing the blood flow of the uterus is of no value in prophylaxis.
- 39. Bibliography D C Dutta(2004) “ textbook of obstetrics”, 6th edition , India, New Central book agency, Page No 433- 444. Myles(2003) “ textbook for midwives”, 14th edition, Philadelphia, Churchill Livingstone publishers, Page No 625- 653. www.healthline.com.