The normal puerperium period lasts 6 weeks after delivery as the body returns to its non-pregnant state. It involves 3 stages: immediate (first 24 hours), early (first week), and remote (until 6 weeks). During this time, the uterus involutes, lochia is discharged, and anatomical and physiological changes reverse, including changes to the cervix, vagina, breasts, cardiovascular and hematological systems. Complications can include postpartum hemorrhage, sepsis, retained placenta, and painful perineum. Management focuses on rest, nutrition, perineal care, breastfeeding support, and exercise.
Please find the power point on Puerperal sepsis. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Please find the power point on Puerperal sepsis. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
A serious pregnancy complication in which the placenta detaches from the womb (uterus).
Placental abruption occurs when the placenta detaches from the inner wall of the womb before delivery. The condition can deprive the baby of oxygen and nutrients.
Symptoms include vaginal bleeding, stomach pain and back pain in the last 12 weeks of pregnancy.
Depending on the degree of placental separation and how close the baby is to full-term, treatment may include bed rest or a Caesarean (C-section).
INTRODUCTION
DEFINITION
TYPES
CAUSES
MANAGEMENT-Management of 3rd stage bleeding
Actual management
MANAGEMENT OF 3RD STAGE BLEEDING
Steps of management
1. Placental site bleeding-
To palpate the fundus and massage the uterus to make it hard. The massage is to be done by placing four fingers behind the uterus and thumb in front.
To start crystalloid solution (NS or RL) with oxytocin (1L with 20 units) at 60 drops per minute and to arrange for blood transfusion if necessary.
Oxytocin 10 unit IM or methergine 0.2 mg is given intravenously.
To catheterize the bladder.
To give antibiotics (Ampicillin 2gm and Metronidazole 500mg IV)
2. Management of traumatic bleed
The uterovaginal canal is to be explored under general anesthesia after the placenta is expelled and haemostatic sutures are placed on the offending sites.
STEPS OF MANUAL REMOVAL OF PLACENTA
The patient is placed in lithotomy position. With all aseptic measures, the bladder is catheterized.
One hand is introduced into the uterus in cone shaped manner following the cord. While introducing the hand, the labia are separated by the fingers at the other hand.
Counter pressure on the uterine fundus is applied by the hand placed over the abdomens. The abdominal hand should steady the fundus and guide the movement of the fingers inside the uterine cavity till the placenta is completely separated.
what is the Puerperium and Postpartum Period
what's the normal?
what's the abnormal Puerperium?
and what are the most common complications and how to manage it?
A serious pregnancy complication in which the placenta detaches from the womb (uterus).
Placental abruption occurs when the placenta detaches from the inner wall of the womb before delivery. The condition can deprive the baby of oxygen and nutrients.
Symptoms include vaginal bleeding, stomach pain and back pain in the last 12 weeks of pregnancy.
Depending on the degree of placental separation and how close the baby is to full-term, treatment may include bed rest or a Caesarean (C-section).
INTRODUCTION
DEFINITION
TYPES
CAUSES
MANAGEMENT-Management of 3rd stage bleeding
Actual management
MANAGEMENT OF 3RD STAGE BLEEDING
Steps of management
1. Placental site bleeding-
To palpate the fundus and massage the uterus to make it hard. The massage is to be done by placing four fingers behind the uterus and thumb in front.
To start crystalloid solution (NS or RL) with oxytocin (1L with 20 units) at 60 drops per minute and to arrange for blood transfusion if necessary.
Oxytocin 10 unit IM or methergine 0.2 mg is given intravenously.
To catheterize the bladder.
To give antibiotics (Ampicillin 2gm and Metronidazole 500mg IV)
2. Management of traumatic bleed
The uterovaginal canal is to be explored under general anesthesia after the placenta is expelled and haemostatic sutures are placed on the offending sites.
STEPS OF MANUAL REMOVAL OF PLACENTA
The patient is placed in lithotomy position. With all aseptic measures, the bladder is catheterized.
One hand is introduced into the uterus in cone shaped manner following the cord. While introducing the hand, the labia are separated by the fingers at the other hand.
Counter pressure on the uterine fundus is applied by the hand placed over the abdomens. The abdominal hand should steady the fundus and guide the movement of the fingers inside the uterine cavity till the placenta is completely separated.
what is the Puerperium and Postpartum Period
what's the normal?
what's the abnormal Puerperium?
and what are the most common complications and how to manage it?
The presentation contain:
Normal puerperium ; Physiology, Duration
Postnatal assessment and management
Promoting physical and emotional well-being
Lactation management
Immunization
Family dynamics after child-birth.
Family welfare services; methods, counseling
Follow-up
Records and reports
The puerperium is the period of time following childbirth, during which a woman's body returns to its pre-pregnancy state. This period typically lasts around 6-8 weeks, and during this time, the woman may experience physical and emotional changes. Lactation is the process of producing and secreting milk from the mammary glands, and it typically begins during the puerperium. The hormones released during pregnancy, specifically, prolactin and oxytocin, help to stimulate lactation and the production of milk. While lactation is a natural process, it can be challenging for some women and may require support and guidance.
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. puerperium begins as soon as the placenta is expelled and lasts for approximately 6 weeks when the uterus becomes regressed almost to the non-pregnant size.
what is labor and what is the normal?
what are the signs of labor?
what are the stages of labor?
what are the mechanism of labor?
what are the factors that affect the labor?
Mariadelmar Grajales
Compu-med Vocational Careers
Blue-Print Unit exam 2
Exam 2 Blue Print COMPLETE
Bladder Hypotonia
Abdominal diastasis
After pains
Vaginal recovery:
· normal/abnormal findings
Cesarean recovery
· Risks, interventions, medications, education
Early maternal assessment (ALL body changes)
· Vital signs
· Body systems and adaptations/physiological changes
· BUBBLE-HE(B)
· Assessment of Lochia Flow
Phases associated with the Mothering Role
Deep Vein Thrombosis/thrombosis
·
Medications/labs for meds
· Treatments
· Interventions
Postpartum Psychosocial (PPD/psychosis, blues)
·
Medications/contraindications/interactions, interventions, etc
Postpartum hemorrhage
· Labs
· Medications to treat PPH
· Education
Hematomas
· signs & symptoms/ interventions, patient education,
Storing breastmilk/ breast pumping
Uterine Involution and how to document
REEDA Acronym: scoring
IPV: Economic, Isolation, emotional, threats
IPV: priority interventions for each type of abuse
Phases of IPV (honeymoon, tension, etc.)
Documenting IPV
Sexual assault treatments/ therapeutic communication
PMS vs. PMDD: signs and symptoms
PMD/PMDD patient education
Women at risk for PMS
Diseases that mimic PMS, how to rule it out
Menopause: effects/body changes/ treatment of symptoms
Fibrocystic changes
Benign breast tumor
Breast drainage
Breast self-examination
Breast screenings
Fine needle biopsy vs. core needle biopsy.
Breast cancer: cancer stage prognosis/ cancer survivorship plans/ diagnostics
REVIEW UNIT 2 EXAM
Bladder Hypotonia:
Occurs when your bladder muscles lose their ability to hold your urine.
You are not longer able to sense when your bladder is full or empty it completely, so it over fills and urine leaks out.
Is also called flaccid or hypotonic bladder.
Urinary retention can also result from bladder hypotonia after childbirth because the weight of the gravid uterus no longer limits bladder capacity.
Assess the maternal bladder (extremely important)
N.I: Kegel exercises.
Abdominal Diastasis:
Diastasis recti abdominal (abdominal separation) the separation between the two rectus abdominis muscles that can occur from pregnancy.
N.I: Nurses should teach them to maintain correct posture when performing activities such as lifting, carrying, and bathing the baby for at least 12 weeks after birth.
Performing modified sit-ups during this time is beneficial in helping to strengthen the abdominal muscles.
Afterpains:
Afterpains are intermittent
uterine contractions that occur during the process of involution. Patients often describe the sensation as discomfort
similar to menstrual cramps.
Also defined as
belly cramps that a postpartum mother feels as her uterus shrinks back to its regular size after pregnancy.
Multiparas and patients with uterine overdistention (e.g., .
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We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
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Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
3. Normal Puerperium
Definition
1. It is the period of adjustment after pregnancy and delivery when
anatomical and physiological changes of pregnancy are reversed and
the body returns to the normal non pregnant state.. (reproductive tract
returns to its normal, non-pregnancy state)
1. 6 weeks in duration. (periods after birth )
4. Stages of Puerperium
• The post partum period has been divide into:
• The immediate puerperium, the first 24 hours after
parturition; when acute post anesthetic or post delivery
complications may occur.
• The early puerperium, which extends until the first
week post partum.
• The remote puererium, which includes the period of
time required for involution of the genital organs through
the sixth weeks postpartum.
5. Anatomical and Physiological
changes
• Immediately after labor, the woman is in a
state of physical fatigue in many cases,
slight shivering, muscular tremors and
chattering of teeth occur for about 10 – 15
minutes.
6. Temperature:
Fever It is normal but usually there is a slight rise
during the first day which is known as (reactionary
rise), not exceed 38oC and drops within 24 hours
and not accompanied by increased pulse rate, if it
is more than 38oc or for more than 24 hours, it is
called puerperal pyrexia).
7. Involution of the uterus
return to the pelvis by about 2 weeks
be at normal size by 6 weeks
the weight changes of uterus
1000g immediately after birth (excluding the fetus,
placenta, membrane and amniotic fluid.
500g 1 weeks after birth
300g 2 weeks after birth
50g 6 weeks after birth
The endometrial lining rapidly regenerates (16 days)
The placental site undergoes a series of changes in the
postpartum period
Its fundus level approximates that of a 20 week pregnancy at the
level of umbilicus, at the end first post partum week it is
palpable at the symphysis pubic
8. Decidua
discharge comes from the placental site and
maintains for 4-6 weeks
• Lochia rubra
Red in color for the first 3-4 days
• Lochia serosa
Pink in color, maintains for 2 weeks
• Lochia alba
White in color, maintains for 2-3 weeks
9. After Pain
After expulsion of fetus and placenta the uterus contracts to
regain its normal size, weight and site, this called involution of
uterus. Oxytocin is released from posterior lobe of the pituitary
gland in response to the sucking, which facilitate uterine
contraction.
Characteristic of after pain:
Occur during the 1st
2-3 days of puerperium
Abdominal pains (like cramps) and back pain.
Strong, regular, and coordinated.
The intensity, frequency and regularity of contraction decrease
after the 1st
postpartum day.
10. Constipation
• It is common in the first few days of
puerperium and is due to many factors.
The woman‘s food intake is interrupted,
there may be dehydration during labor, the
abdominal muscles are lax and perineal
lacerations make defecation painful.
11. Cervix
it never returns to the nulli-parous state.
the external os is closed to the extent that a
finger could not be easily introduced.
It return to its normal state at 4 weeks
after birth
Vagina
shrinks to a non-pregnant state
resolution of the increased vascularity and
edema occurs by 3 weeks
the vaginal epithelium appears atrophic.
This is restored by weeks 6-10.
12. Perineum
Swelling completely gone within 1-2
weeks
The muscle tone may or may not
return to normal, depending on the
extent of injury.
13. Preparation for lactation
Lactation can occur by 16 weeks' gestation.
Lacto genesis is initially triggered by the delivery
of the placenta (E↓P↓and prolactin).
the prolactin levels decrease and return to normal
within 2-3 weeks (not breastfeeding)
The colostrums (the first 2-4 days)
The milk continues to change throughout the
period of breastfeeding to meet the changing
demands of the baby.
14. Psychological changes.
• Mild degree of depression and emotional
liability. (normal)
• Puerperal psychosis, confusion with
disorientation in time, space and a
complete loss of interest in the child
(abnormal)
15. Systemic change
Cardiovascular system
Blood volume returns to non-pregnant levels by the
tenth days of puerperium
Cardiac output ↑(immediately after delivery) →
slowly declines→ reach late pregnancy levels 2 days
postpartum→ normal 2-6 weeks.
Hematologic changes
Hemoglobin concentration↑on the first postpartum
days
Several clotting factors (fibrinogen) ↑on the first days
16. Micturation;
There is diuresis in the first two days of puerperium.
Retention of urine may occur either due to the sphincter
or reflexly from perineal trauma.
Skin;
There is a tendency to sweating.
Body weight:
Is slightly lost during the first 10 days.
17.
18. Post natal problems:
Post partum hemorrhage.
Puerperal Sepsis
Retained placenta (the placenta still in the uterus for
more than one hour after birth of the baby)
Painful perineum. (laceration of the perineum)
Circulatory problems: (Varicose veins, Deep venous
thrombosis (DVT) or superficial venous thrombosis
(SVT)).
• After pain:
19. Management of painful perineum
Cold baths
Electrotherapy (TENS)
Pelvic floor exercises (contract relax
technique
Teach the mother the correct defecation
technique
Use of an appropriate cushion when
sitting.
20. Deep venous thrombosis
• Venous thrombosis occurs most commonly in the
superficial and deep veins of the lower extremities.
• Deep thrombi are most likely to develop in soleos muscle
of the calf muscle.
21. Management of Varicose veins
Avoid prolonged standing and prolonged sitting.
Apply well-fitted below knee support stocking
before ambulating in the morning.
Ask mother to elevate her leg on pillow while
taking supine lying position.
Intermittent compression.
Bandaging.
Burgers Exercises.
Not to sit with leg crossed or knee flexed.
22. Management of DVT or SVT
Prophylactic treatment:
Early ambulation.
Avoidance of pressure on the thighs and
calves.
Sitting position with knee flexed.
Encouragement of:
Circulatory ex., leg and deep breathing ex.
23. Management of After Pain
1) Analgesics.
2) TENS.
3) Frequent urination every 2 hours.
4) Heat application.
5) Relaxation on face.
Prone lying position with tow pillows under the pelvis (to keep the back
from hollowing and to stretch the abdominal muscles, small pillow
under feet, the upper limbs extended beside the trunk, head
turned to one side, or the upper limbs crossed with the forehead
rested on the crossed upper limbs
24. Values of relaxation on face:
It is a relaxed position.
Help involution of uterus.
Help discharge of blood colts and lochia.
Guard against retroversion flexion
Relief after pain
25. Diastasis of recti abdominal muscles
• It means separation of the rectus abdominal muscles from med-line
at linea alba. It is not hernia.
• It is a gap between the recti muscles 25mm(2.5 fingers)
• Palpated just superior to the umbilicus.
• It may occur during pregnancy after 20 weeks of pregnancy
or expulsive stage of labour due to weakness and increases tension
of abdominal muscles.
26. Management of diastases
of recti abdominal muscles
Static abdominal exercises.
Graduated dynamic abdominal exercises.
Neuromuscular electrical stimulation:
Using:
asymmetrical square current,
frequency 80 pulse/second,
Pulse duration 0.1→0.5 ms for ½ hour daily.