- Puerperium refers to the 6-week period following delivery where the body returns to its pre-pregnant state. This involves involution of the uterus, breasts, and other organs as well as hormonal and physiological changes.
- Common issues during this period include uterine and breast involution, lochia, urinary changes, weight loss, endocrine changes, and psychological adjustment. Complications can include postpartum hemorrhage, infection, retained placenta, and painful perineum. Physical therapy modalities like cryotherapy, TENS, LLLT, and pelvic floor exercises can help manage pain.
This document discusses abnormal labour, defined as failure to meet defined milestones and time limits for normal labour. It can be caused by issues with uterine contractions (power), the birth canal (passages), or the fetus (passenger). Types of abnormal labour include slow progress/protraction disorders, arrest of progress/arrest disorders, and precipitate labour. Management involves assessing for causes, supporting labour through hydration and pain relief, and potentially augmenting contractions, assisting delivery, or performing a caesarean section if needed for fetal wellbeing. Complications of abnormal labour include increased risk of cesarean, fetal distress, and postpartum hemorrhage.
Uterine prolapse occurs when weakened or damaged muscles and connective tissues such as ligaments allow the uterus to drop into the vagina. Common causes include pregnancy, childbirth, hormonal changes after menopause, obesity, severe coughing and straining on the toilet.
This document discusses menstruation, menopause, and hormone replacement therapy (HRT). It provides details on the phases of the menstrual cycle and how it is regulated by hormones. Symptoms of menopause like hot flashes and night sweats are explained. Treatment options for post-menopausal syndrome include HRT, lifestyle changes, supplements like black cohosh, and a new product called Meno-HRT which contains phytoestrogens and other ingredients as a natural alternative to HRT. The benefits and formulation of Meno-HRT are outlined.
Premenstrual syndrome (PMS) and menopause are conditions that affect women. PMS involves cyclic symptoms like mood changes that occur in the week before a woman's period. It is caused by changes in estrogen and progesterone levels. Treatment may include lifestyle changes, antidepressants, or hormonal birth control. Menopause is when periods stop permanently due to low estrogen levels. It causes symptoms like hot flashes and vaginal dryness. Hormone replacement therapy can relieve symptoms but also has risks, so non-hormonal options are also used.
The document discusses the process of puerperium, which is the period following childbirth where the body returns to its pre-pregnant state over approximately 6 weeks. Key changes include the uterus involuting from 1000g to 100g over this time, the return of ovarian function and menstruation between 8-12 weeks (or longer while breastfeeding), and the production and composition of colostrum and breastmilk. Proper breastfeeding and lactation is encouraged for infant health and development during this postpartum period of maternal physiological changes.
1) The document describes the position of the fetus in the uterus, including lie, presentation, attitude, and position.
2) It then explains the mechanism of labor, including the steps of labor for an occiput lateral position: engagement, descent, flexion, internal rotation, crowning, extension, restitution, and expulsion of the shoulders and trunk.
3) Key points are that the fetus is usually in a longitudinal lie with cephalic presentation, and the mechanism of labor involves a series of movements that adapt the fetal head to navigate the birth canal.
This document discusses common gynaecological problems including menstrual problems, vaginal discharge, pruritus vulvae, and vulval swellings. It provides details on the typical presentation, causes, diagnostic workup, and treatment approaches for each condition. Key conditions covered include dysmenorrhoea, abnormal vaginal bleeding, endometriosis, adenomyosis, uterine polyps, vaginal infections like bacterial vaginosis and candidiasis, and pruritus. It emphasizes taking a thorough history and performing examinations to arrive at the correct diagnosis and treat underlying causes.
Disorders of menstruation include amenorrhea, cryptomenorrhea, primary amenorrhea, secondary amenorrhea, and dysmenorrhea. Amenorrhea is the absence of menstruation, cryptomenorrhea is menstruation that occurs internally with no external bleeding, primary amenorrhea is the failure of menstruation to start by age 16, and secondary amenorrhea is the absence of menstruation for 6 months after previous regular cycles. Dysmenorrhea refers to painful menstruation and can be primary (without pelvic pathology) or secondary (associated with an underlying condition). Various causes, clinical features, investigations, and management approaches are discussed for each condition.
This document discusses abnormal labour, defined as failure to meet defined milestones and time limits for normal labour. It can be caused by issues with uterine contractions (power), the birth canal (passages), or the fetus (passenger). Types of abnormal labour include slow progress/protraction disorders, arrest of progress/arrest disorders, and precipitate labour. Management involves assessing for causes, supporting labour through hydration and pain relief, and potentially augmenting contractions, assisting delivery, or performing a caesarean section if needed for fetal wellbeing. Complications of abnormal labour include increased risk of cesarean, fetal distress, and postpartum hemorrhage.
Uterine prolapse occurs when weakened or damaged muscles and connective tissues such as ligaments allow the uterus to drop into the vagina. Common causes include pregnancy, childbirth, hormonal changes after menopause, obesity, severe coughing and straining on the toilet.
This document discusses menstruation, menopause, and hormone replacement therapy (HRT). It provides details on the phases of the menstrual cycle and how it is regulated by hormones. Symptoms of menopause like hot flashes and night sweats are explained. Treatment options for post-menopausal syndrome include HRT, lifestyle changes, supplements like black cohosh, and a new product called Meno-HRT which contains phytoestrogens and other ingredients as a natural alternative to HRT. The benefits and formulation of Meno-HRT are outlined.
Premenstrual syndrome (PMS) and menopause are conditions that affect women. PMS involves cyclic symptoms like mood changes that occur in the week before a woman's period. It is caused by changes in estrogen and progesterone levels. Treatment may include lifestyle changes, antidepressants, or hormonal birth control. Menopause is when periods stop permanently due to low estrogen levels. It causes symptoms like hot flashes and vaginal dryness. Hormone replacement therapy can relieve symptoms but also has risks, so non-hormonal options are also used.
The document discusses the process of puerperium, which is the period following childbirth where the body returns to its pre-pregnant state over approximately 6 weeks. Key changes include the uterus involuting from 1000g to 100g over this time, the return of ovarian function and menstruation between 8-12 weeks (or longer while breastfeeding), and the production and composition of colostrum and breastmilk. Proper breastfeeding and lactation is encouraged for infant health and development during this postpartum period of maternal physiological changes.
1) The document describes the position of the fetus in the uterus, including lie, presentation, attitude, and position.
2) It then explains the mechanism of labor, including the steps of labor for an occiput lateral position: engagement, descent, flexion, internal rotation, crowning, extension, restitution, and expulsion of the shoulders and trunk.
3) Key points are that the fetus is usually in a longitudinal lie with cephalic presentation, and the mechanism of labor involves a series of movements that adapt the fetal head to navigate the birth canal.
This document discusses common gynaecological problems including menstrual problems, vaginal discharge, pruritus vulvae, and vulval swellings. It provides details on the typical presentation, causes, diagnostic workup, and treatment approaches for each condition. Key conditions covered include dysmenorrhoea, abnormal vaginal bleeding, endometriosis, adenomyosis, uterine polyps, vaginal infections like bacterial vaginosis and candidiasis, and pruritus. It emphasizes taking a thorough history and performing examinations to arrive at the correct diagnosis and treat underlying causes.
Disorders of menstruation include amenorrhea, cryptomenorrhea, primary amenorrhea, secondary amenorrhea, and dysmenorrhea. Amenorrhea is the absence of menstruation, cryptomenorrhea is menstruation that occurs internally with no external bleeding, primary amenorrhea is the failure of menstruation to start by age 16, and secondary amenorrhea is the absence of menstruation for 6 months after previous regular cycles. Dysmenorrhea refers to painful menstruation and can be primary (without pelvic pathology) or secondary (associated with an underlying condition). Various causes, clinical features, investigations, and management approaches are discussed for each condition.
This document discusses the prevention and management of uterine prolapse. Key points include:
1. Prevention focuses on limiting pelvic floor injury during childbirth through measures like avoiding prolonged labor and encouraging postnatal exercises.
2. Treatment is usually only when prolapse causes symptoms that interfere with daily activity.
3. Management options include conservative measures like pelvic floor exercises and pessaries, as well as surgical procedures like vaginal hysterectomy with pelvic floor repair to correct defects.
4. Surgical repair aims to tighten the anterior, middle/apical, and posterior compartments using techniques such as anterior and posterior colporrhaphy.
common problems associated with pregnancy by Sailaja Reddy, M.Sc.(N), PGDHM, ...9000965812
The document discusses common problems experienced during pregnancy such as heartburn, morning sickness, fatigue, frequent urination, constipation, back pain, stretch marks, gestational diabetes, high blood pressure, dental issues, headaches, severe vomiting, pelvic pain, piles, swollen ankles and fingers, tiredness, vaginal bleeding, discharge and cramping. It provides information on causes and treatments for these issues. Specific conditions covered in more detail include indigestion, morning sickness, hyperemesis gravidarum (severe nausea and vomiting), frequent urination, constipation, back pain, stretch marks, gestational diabetes and high blood pressure.
This document discusses the first stage of labor and its management. The main events of the first stage are dilatation of the cervix and effacement of the cervix. It describes the processes involved like softening and thinning of the cervix. Management of the first stage focuses on monitoring the mother and fetus, providing comfort, and assessing progress. Complications that may arise include maternal distress, fetal distress, cephalopelvic disproportion, and prolonged labor.
Breast complications during lactation can include engorgement, cracked or retracted nipples, mastitis, breast abscesses, and lactation failure. Engorgement is caused by a buildup of milk, blood and fluids in the breast tissues due to an imbalance between milk supply and infant demand. It causes swollen, painful breasts. Mastitis is an inflammation of breast tissue that can be infectious or non-infectious. Infectious mastitis requires antibiotic treatment to prevent complications like abscesses. Breast abscesses form when mastitis is left untreated and require drainage procedures. Septic pelvic vein thrombophlebitis refers to infected blood clots in the pelvic veins that can lead to abs
3 malpresentations.warda (3)- FACE PRESENTATIONOsama Warda
Face presentations occur when the fetal chin is the presenting part instead of the vertex. They are classified into four positions based on the position of the chin. Mentoanterior positions are more common and favorable than mentoposterior positions. Labor is usually prolonged in face presentations due to delayed engagement and lack of molding of the facial bones. Management depends on the position, with mentoanterior positions usually allowing vaginal delivery while mentoposterior positions often requiring assistance. Brow presentations are the rarest type and usually do not have a defined mechanism of labor.
Dysfunctional uterine bleeding is abnormal uterine bleeding that has no identifiable cause. It affects around 40 in 1000 women and is common in adolescents and women approaching menopause. It occurs due to disruptions in the normal hormonal cycle. Diagnosis involves examinations and tests to rule out other causes. Treatment may include medication, endometrial ablation, or hysterectomy in severe cases. Recent research is exploring the safety and effectiveness of thermal balloon endometrial ablation compared to other procedures.
This document discusses various pharmacotherapeutic agents used in obstetrics, including oxytocics, antihypertensive medications, and diuretics. It provides details on the mechanisms of action, indications, contraindications, preparations, and administration of oxytocin, ergot alkaloids, prostaglandins, methyldopa, labetalol, prazocin, hydralazine, nifedipine, and furosemide. The roles of these drugs in induction of labor, postpartum hemorrhage, and treatment of pregnancy-induced hypertension are summarized. Adverse effects on both mother and fetus are also outlined for each class of medication.
The document discusses postpartum care and complications. It covers the anatomical changes that occur after delivery, routine postpartum care including monitoring for bleeding and infection, complications like postpartum hemorrhage, and patient education on caring for themselves and their newborn. Discharge instructions advise women on resuming normal activities and making follow-up appointments.
Lochia is the postpartum bleeding and discharge from the uterus after giving birth. It typically lasts 4 to 8 weeks and comes in three phases - lochia rubra (bright red bleeding), lochia serosa (pinkish discharge), and lochia alba (yellowish discharge). The causes of lochia include open blood vessels in the uterus where the placenta detached and the contractions that help the uterus return to its normal size. Breastfeeding can help reduce lochia by stimulating uterine contractions. Women should use heavy pads and avoid tampons for at least 6 weeks, and see a doctor if bleeding increases or has a foul smell, which could indicate infection.
The document summarizes the physiological changes that occur during the puerperium period, which is the first 6 weeks following delivery. Key changes include the reversal of pregnancy-related changes and the return of the reproductive organs to a non-pregnant state through involution. This involves a decrease in the size of the uterus as well as changes to the cervix, vagina, and perineum. Common complications during this period include postpartum hemorrhage, puerperal pyrexia or infection, urinary issues, and psychiatric problems such as postpartum depression. The woman's body undergoes a transition in this time as it returns to its pre-pregnancy condition.
amenorrhea is a condition when female do not have regular mensural cycles by puberty or due to any causes this ppt can help the patient and nurses to gain knowledge about this disease process and apply their knowledge into their clinical practices
The document describes the physiological changes that occur during the postpartum period. It discusses the involution of the uterus, which returns to its non-pregnant size within 6 weeks. It also covers changes in other systems like the endocrine, cardiovascular, respiratory and urinary systems. The postpartum period allows the body to recover from pregnancy and birth by returning the organs to their pre-pregnancy state through processes like autolysis and homeostasis over a period of 6 weeks.
Postpartum voiding dysfunction and urinary retention is common after delivery and can lead to complications if not properly managed. Risk factors include instrumental delivery, epidural analgesia, prolonged labor, and large birth weight. Pathophysiology may involve nerve damage during delivery and physiological changes causing a hypotonic bladder. Management includes encouraging voiding every 2-3 hours during labor, offering an indwelling catheter for 6 hours after an epidural, and measuring voided volumes and post-void residuals to identify retention. Treatment involves catheterization, pelvic floor exercises, analgesia, and clean intermittent self-catheterization if needed.
It is a composite graphical recording of cervical dilatation and descent of head against duration of labour in hours.
It also gives information about fetal and maternal condition that are all recorded on single sheet of paper.
Health Talk on ANC Diet vies in Lesson Plan Format use for OBG Assignment sub...sonal patel
This document provides information on a health talk on antenatal care given to mothers. It begins with the objectives of the talk which are to explain the meaning, importance and aspects of antenatal care. It then details the various aspects that should be covered including registration, checkups, immunizations, tests, nutrition and danger sign identification. Each aspect is described in detail with explanations of why they are important for maternal and fetal health. The talk aims to educate mothers on properly following antenatal care routines to have a healthy pregnancy and baby.
Postpartum hemorrhage (PPH) is the second leading cause of maternal mortality worldwide, accounting for over 30% of maternal deaths in Africa and Asia. In Tanzania, almost 7,900 mothers die each year from childbirth or pregnancy complications, with PPH being one of the direct causes in 14.9% of cases. This case study examines a 33-year old woman admitted to Mnazi Mmoja Hospital in Tanzania suffering from PPH, as evidenced by a hemoglobin level of 8.4 and excessive vaginal bleeding. She received IV fluids, oxytocin, uterine massage and monitoring to manage her fluid deficit, stabilize her vital signs and prevent infection at the placental attachment site.
Uterine prolapse is the downward displacement of the uterus into the vaginal canal. It is usually rated by degree depending on how far the uterus has descended. Risk factors include pregnancy, childbirth, obesity, chronic coughing, and menopause. Symptoms include pressure or heaviness in the pelvis, urinary problems, and painful sex. Treatment options include the use of a vaginal pessary or various surgical procedures to repair tissues. Nursing care focuses on preventive measures like Kegel exercises and helping patients before and after surgery.
Maternal physiological changes in pregnancy are the adaptations during pregnancy that a woman's body undergoes to accommodate the growing embryo or fetus. ... The pregnant woman and the placenta also produce many other hormones that have a broad range of effects during the pregnancy.
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.
The document summarizes the physiological changes that occur during the postpartum period. Key changes include the rapid involution of the uterus as it returns to its non-pregnant size within 2 weeks of birth. Hormone levels like estrogen and progesterone dramatically decrease after birth, triggering changes throughout the body. Many body systems like cardiovascular, urinary, gastrointestinal, and breasts undergo adaptations to allow the woman's body to recover from pregnancy and childbirth. The postpartum period typically lasts 6 weeks as the body fully reverts to its pre-pregnancy state.
This document discusses the prevention and management of uterine prolapse. Key points include:
1. Prevention focuses on limiting pelvic floor injury during childbirth through measures like avoiding prolonged labor and encouraging postnatal exercises.
2. Treatment is usually only when prolapse causes symptoms that interfere with daily activity.
3. Management options include conservative measures like pelvic floor exercises and pessaries, as well as surgical procedures like vaginal hysterectomy with pelvic floor repair to correct defects.
4. Surgical repair aims to tighten the anterior, middle/apical, and posterior compartments using techniques such as anterior and posterior colporrhaphy.
common problems associated with pregnancy by Sailaja Reddy, M.Sc.(N), PGDHM, ...9000965812
The document discusses common problems experienced during pregnancy such as heartburn, morning sickness, fatigue, frequent urination, constipation, back pain, stretch marks, gestational diabetes, high blood pressure, dental issues, headaches, severe vomiting, pelvic pain, piles, swollen ankles and fingers, tiredness, vaginal bleeding, discharge and cramping. It provides information on causes and treatments for these issues. Specific conditions covered in more detail include indigestion, morning sickness, hyperemesis gravidarum (severe nausea and vomiting), frequent urination, constipation, back pain, stretch marks, gestational diabetes and high blood pressure.
This document discusses the first stage of labor and its management. The main events of the first stage are dilatation of the cervix and effacement of the cervix. It describes the processes involved like softening and thinning of the cervix. Management of the first stage focuses on monitoring the mother and fetus, providing comfort, and assessing progress. Complications that may arise include maternal distress, fetal distress, cephalopelvic disproportion, and prolonged labor.
Breast complications during lactation can include engorgement, cracked or retracted nipples, mastitis, breast abscesses, and lactation failure. Engorgement is caused by a buildup of milk, blood and fluids in the breast tissues due to an imbalance between milk supply and infant demand. It causes swollen, painful breasts. Mastitis is an inflammation of breast tissue that can be infectious or non-infectious. Infectious mastitis requires antibiotic treatment to prevent complications like abscesses. Breast abscesses form when mastitis is left untreated and require drainage procedures. Septic pelvic vein thrombophlebitis refers to infected blood clots in the pelvic veins that can lead to abs
3 malpresentations.warda (3)- FACE PRESENTATIONOsama Warda
Face presentations occur when the fetal chin is the presenting part instead of the vertex. They are classified into four positions based on the position of the chin. Mentoanterior positions are more common and favorable than mentoposterior positions. Labor is usually prolonged in face presentations due to delayed engagement and lack of molding of the facial bones. Management depends on the position, with mentoanterior positions usually allowing vaginal delivery while mentoposterior positions often requiring assistance. Brow presentations are the rarest type and usually do not have a defined mechanism of labor.
Dysfunctional uterine bleeding is abnormal uterine bleeding that has no identifiable cause. It affects around 40 in 1000 women and is common in adolescents and women approaching menopause. It occurs due to disruptions in the normal hormonal cycle. Diagnosis involves examinations and tests to rule out other causes. Treatment may include medication, endometrial ablation, or hysterectomy in severe cases. Recent research is exploring the safety and effectiveness of thermal balloon endometrial ablation compared to other procedures.
This document discusses various pharmacotherapeutic agents used in obstetrics, including oxytocics, antihypertensive medications, and diuretics. It provides details on the mechanisms of action, indications, contraindications, preparations, and administration of oxytocin, ergot alkaloids, prostaglandins, methyldopa, labetalol, prazocin, hydralazine, nifedipine, and furosemide. The roles of these drugs in induction of labor, postpartum hemorrhage, and treatment of pregnancy-induced hypertension are summarized. Adverse effects on both mother and fetus are also outlined for each class of medication.
The document discusses postpartum care and complications. It covers the anatomical changes that occur after delivery, routine postpartum care including monitoring for bleeding and infection, complications like postpartum hemorrhage, and patient education on caring for themselves and their newborn. Discharge instructions advise women on resuming normal activities and making follow-up appointments.
Lochia is the postpartum bleeding and discharge from the uterus after giving birth. It typically lasts 4 to 8 weeks and comes in three phases - lochia rubra (bright red bleeding), lochia serosa (pinkish discharge), and lochia alba (yellowish discharge). The causes of lochia include open blood vessels in the uterus where the placenta detached and the contractions that help the uterus return to its normal size. Breastfeeding can help reduce lochia by stimulating uterine contractions. Women should use heavy pads and avoid tampons for at least 6 weeks, and see a doctor if bleeding increases or has a foul smell, which could indicate infection.
The document summarizes the physiological changes that occur during the puerperium period, which is the first 6 weeks following delivery. Key changes include the reversal of pregnancy-related changes and the return of the reproductive organs to a non-pregnant state through involution. This involves a decrease in the size of the uterus as well as changes to the cervix, vagina, and perineum. Common complications during this period include postpartum hemorrhage, puerperal pyrexia or infection, urinary issues, and psychiatric problems such as postpartum depression. The woman's body undergoes a transition in this time as it returns to its pre-pregnancy condition.
amenorrhea is a condition when female do not have regular mensural cycles by puberty or due to any causes this ppt can help the patient and nurses to gain knowledge about this disease process and apply their knowledge into their clinical practices
The document describes the physiological changes that occur during the postpartum period. It discusses the involution of the uterus, which returns to its non-pregnant size within 6 weeks. It also covers changes in other systems like the endocrine, cardiovascular, respiratory and urinary systems. The postpartum period allows the body to recover from pregnancy and birth by returning the organs to their pre-pregnancy state through processes like autolysis and homeostasis over a period of 6 weeks.
Postpartum voiding dysfunction and urinary retention is common after delivery and can lead to complications if not properly managed. Risk factors include instrumental delivery, epidural analgesia, prolonged labor, and large birth weight. Pathophysiology may involve nerve damage during delivery and physiological changes causing a hypotonic bladder. Management includes encouraging voiding every 2-3 hours during labor, offering an indwelling catheter for 6 hours after an epidural, and measuring voided volumes and post-void residuals to identify retention. Treatment involves catheterization, pelvic floor exercises, analgesia, and clean intermittent self-catheterization if needed.
It is a composite graphical recording of cervical dilatation and descent of head against duration of labour in hours.
It also gives information about fetal and maternal condition that are all recorded on single sheet of paper.
Health Talk on ANC Diet vies in Lesson Plan Format use for OBG Assignment sub...sonal patel
This document provides information on a health talk on antenatal care given to mothers. It begins with the objectives of the talk which are to explain the meaning, importance and aspects of antenatal care. It then details the various aspects that should be covered including registration, checkups, immunizations, tests, nutrition and danger sign identification. Each aspect is described in detail with explanations of why they are important for maternal and fetal health. The talk aims to educate mothers on properly following antenatal care routines to have a healthy pregnancy and baby.
Postpartum hemorrhage (PPH) is the second leading cause of maternal mortality worldwide, accounting for over 30% of maternal deaths in Africa and Asia. In Tanzania, almost 7,900 mothers die each year from childbirth or pregnancy complications, with PPH being one of the direct causes in 14.9% of cases. This case study examines a 33-year old woman admitted to Mnazi Mmoja Hospital in Tanzania suffering from PPH, as evidenced by a hemoglobin level of 8.4 and excessive vaginal bleeding. She received IV fluids, oxytocin, uterine massage and monitoring to manage her fluid deficit, stabilize her vital signs and prevent infection at the placental attachment site.
Uterine prolapse is the downward displacement of the uterus into the vaginal canal. It is usually rated by degree depending on how far the uterus has descended. Risk factors include pregnancy, childbirth, obesity, chronic coughing, and menopause. Symptoms include pressure or heaviness in the pelvis, urinary problems, and painful sex. Treatment options include the use of a vaginal pessary or various surgical procedures to repair tissues. Nursing care focuses on preventive measures like Kegel exercises and helping patients before and after surgery.
Maternal physiological changes in pregnancy are the adaptations during pregnancy that a woman's body undergoes to accommodate the growing embryo or fetus. ... The pregnant woman and the placenta also produce many other hormones that have a broad range of effects during the pregnancy.
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.
The document summarizes the physiological changes that occur during the postpartum period. Key changes include the rapid involution of the uterus as it returns to its non-pregnant size within 2 weeks of birth. Hormone levels like estrogen and progesterone dramatically decrease after birth, triggering changes throughout the body. Many body systems like cardiovascular, urinary, gastrointestinal, and breasts undergo adaptations to allow the woman's body to recover from pregnancy and childbirth. The postpartum period typically lasts 6 weeks as the body fully reverts to its pre-pregnancy state.
The document discusses various anatomical and physiological changes that occur in the mother's body during the postpartum period known as the puerperium. It lasts between 4 to 6 weeks as the body returns to a non-pregnant state. This involves the involution of the uterus, cervix, breasts, ovaries, endometrium, and vagina. The uterus decreases in size, the cervix closes, lochia discharge occurs, and the breasts undergo mammogenesis, lactogenesis, galactopoiesis, and galactokinesis to allow for breastfeeding. Keeping the mother and newborn together for 24 hours has benefits like promoting breastfeeding and protecting the infant's health.
The postpartum period, also known as the puerperium, lasts around 6 weeks as the body returns to its pre-pregnant state. During this time, the uterus involutes from 1000g back to 60g, the cervix narrows, and the vagina regains tone. Lochia is discharged for 1-3 weeks as the endometrium regenerates. Physiological changes include temperature regulation returning to normal and increased risk of urinary tract issues as the bladder adapts. Nursing care focuses on monitoring involution and managing any complications.
The document discusses the physiology and management of the normal postpartum period, known as the puerperium. It begins immediately after delivery and lasts around 6 weeks. During this time, the body recovers from pregnancy and returns to a non-pregnant state. The uterus undergoes involution, decreasing in size over weeks. Other organs like the vagina, cervix, and breasts also undergo changes. The woman experiences vaginal bleeding called lochia that gradually decreases over weeks. Overall, the postpartum period involves a woman's body returning to its pre-pregnancy condition.
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
Management of puerperium.pptx, Gynecology and obstetrical Nursing, class pres...SOUMISOM
Mrs. Keya Midya, 30 Years, delivered normally. On the second postnatal day, she found that her abdomen was flabby, her breasts were full, and she had vaginal bleeding. She felt inadequate to take care of the baby and received conflicting suggestions, leaving her confused and wanting help.
NORMAL PUERPERIUM presentation notes for medical studentsIbrahimKargbo13
The document discusses the normal puerperium period following childbirth. It describes how over 6 weeks postpartum, a woman's body returns to its non-pregnant state as various physiological changes are reversed. Hormone levels fall, the uterus involutes to its pre-pregnant size, lactation is established, and the mother recovers from childbirth while bonding with her new infant. The management of a postnatal mother focuses on monitoring this recovery process and physiological changes.
The document describes the normal postpartum period following delivery, including the general physiological changes that occur as the maternal body returns to its pre-pregnant state over 6-8 weeks, the involution of the uterus, lochia discharge, changes in vital signs and body weight, as well as the psychological adaptations and nursing care needed in the postpartum period to support the physical and mental health of the new mother.
The puerperium period lasts approximately 6 weeks after childbirth. During this time, the body reverts back to a non-pregnant state through the involution of organs like the uterus, cervix, and vagina. The uterus undergoes the most dramatic changes, decreasing in size from 1000g immediately after birth to about 50g by 6 weeks postpartum. Other physiological changes include a decrease in temperature, pulse rate returning to normal, diuresis and weight loss from fluid loss. Lochia discharge gradually decreases in amount and changes color over a 2-3 week period as the reproductive system completes its postpartum transformation.
Assessment and management of woman during postnatal periodHARSH786249
The document summarizes the normal physiological changes that occur during the postnatal period. Key points include:
- The postnatal period, also called the puerperium, lasts 6 weeks as the body returns to its pre-pregnant state. Involution of the uterus and other organs occurs through this period.
- Vital signs like temperature and pulse are monitored to check for issues like hemorrhage and infection. The uterus normally decreases in size steadily in the first weeks after delivery. Lochia discharge indicates the progress of involution.
The puerperium is defined as the 6-week period following childbirth when the body recovers from pregnancy and returns to the non-pregnant state. This involves the involution of the uterus and other reproductive organs. The puerperium involves 3 stages - the immediate (first 24 hours), early (first week), and remote (weeks 2-6) periods. During this time the uterus decreases in size, the breasts produce milk, the vagina and perineum heal, and other systems such as the cardiovascular and respiratory systems return to normal. Proper care, rest, perineal exercises, and breastfeeding can help support the mother's recovery.
This topic contains detailed description regarding Normal puerperium, it's definition, duration, phases, involution of uterus and other pelvic organs, lochia, general physiological changes of puerperium, lactation, management of normal puerperium, management of ailments and postnatal care.
fundamental concept puerperium normal gynaecology.pdfschhataria
The document discusses the anatomical and physiological changes that occur during the postpartum period known as the puerperium. It begins immediately after delivery of the placenta and lasts approximately 6 weeks. During this time, the uterus and other reproductive organs revert back to their pre-pregnancy state through a process called involution. The document provides detailed information on the involution of the uterus, cervix, blood vessels, and endometrium as well as the characteristics, composition and clinical importance of lochia discharge during the puerperium.
The document summarizes physiological changes that occur during the postpartum period known as the puerperium. It lasts approximately 6 weeks as the body reverts back to its pre-pregnant state. This includes involution of the uterus, vagina, and other pelvic structures. Other changes include lochia discharge, temperature regulation returning to normal, changes in blood pressure and pulse, weight loss, fluid balance changes, and the return of menstruation being delayed in women who breastfeed.
The document discusses physiology and management of the normal postpartum period (puerperium). It defines puerperium as the 6-week period following childbirth when the body returns to a non-pregnant state. The puerperium involves involution of the uterus and other reproductive organs. It describes the stages of puerperium and changes that occur in the uterus, cervix, vagina, breasts and other organs during this period. Key signs like lochia, after pains, constipation and breast changes are also summarized.
NORMAL PUEPERIUM _(POST-PARTUM PERIOD) (1) (1).pptjagbo
The document summarizes key aspects of the postpartum (puerperium) period, which lasts approximately 6 weeks after childbirth. It is divided into immediate, early, and late phases. The uterus involutes from 1000g to 50g over this time. Lochia changes from red to white. Nursing focuses on assessment, perineal care, breastfeeding support, and ensuring the mother's physical and emotional recovery. Follow-up visits are conducted at 3-4 weeks and 6 weeks to assess involution and provide family planning education.
This document discusses the anatomical and physiological changes that occur during the postpartum period known as the puerperium. It defines puerperium as the period following childbirth when the body reverts back to the pre-pregnant state, which typically lasts around 6 weeks. The document outlines the involution process of the uterus, cervix, vagina, blood vessels, and endometrium during this time. It also discusses other aspects of the postpartum period including lochia, breastfeeding, weight loss, and the return of menstruation and fertility.
The document summarizes the normal postpartum period and changes that occur in the six weeks following childbirth. It discusses involution of the uterus and other organs, hormonal changes, wound healing, breastfeeding, weight loss, and potential complications like mastitis, urinary incontinence, and puerperal fever. Contraception options for breastfeeding mothers and contraindications to breastfeeding are also covered.
The document discusses the normal puerperium period following childbirth. It defines key terms like puerperium, involution, lochia, lactation, and others. It describes the physiological changes that occur in the reproductive system like the involution of the uterus returning to its pre-pregnancy size over 6 weeks and changes in the cervix, ovaries, and vaginal canal. It also discusses general physiological changes like changes in pulse, temperature, the urinary tract, and gastrointestinal tract. Blood values and the return of menstruation and ovulation are also summarized.
Similar to Normal and Abnormal Puerperium & Postnatal Physical Therapy Care (20)
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Hysterectomy is a surgical procedure to remove the uterus, and sometimes other female reproductive organs. It is one of the most common gynecological surgeries, with over 600,000 performed annually in the US. There are several types of hysterectomy that are performed depending on factors like the surgical approach and extent of organ removal. Physical therapy both before and after hysterectomy aims to improve patient strength, mobility, and recovery through exercises targeting the core, pelvic floor, breathing, and circulation. Complications can include infection, incontinence, and prolapse, so physical therapy also focuses on preventing and managing these issues.
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This document provides information about antenatal care (ANC). It defines ANC as care by health professionals during pregnancy to ensure the health of the mother and baby. ANC includes risk identification, preventing and managing pregnancy complications, health education, and screening. The goals of ANC are maintaining maternal health during pregnancy, identifying high-risk cases, detecting issues that could impact labor, decreasing mortality and morbidity, educating mothers, and providing family planning advice. The document outlines the components and frequency of ANC visits, as well as the roles of physiotherapists in addressing pregnancy-related issues.
Pregnancy causes many anatomical, physiological, and biomechanical changes in the body to support fetal development and birth. The uterus grows enormously over the course of pregnancy. Other systems like cardiovascular, respiratory, and renal systems also adapt to support increased demands on the mother. Hormonal changes induce physical changes in breasts, skin, ligaments and other tissues. Proper understanding of normal pregnancy changes helps healthcare providers manage common issues and risks.
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3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
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10. Define the mean QRS vector
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12. Comprehend the vectorial analysis of the normal ECG
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1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Normal and Abnormal Puerperium & Postnatal Physical Therapy Care
1.
2.
3.
4. -Puerperium is defined as the time from the delivery of the
placenta through the first few weeks after the delivery. This
period is usually considered to be 6 weeks in duration.
-By 6 weeks after delivery, most of the body tissue changes
of pregnancy, labor, and delivery, especially the pelvic organs
revert back approximately to the prepregnant state both
anatomically and physiologically.
-Similar changes occur following abortion but takes a shorter
period for the involution to complete.
-Fourth trimester is the time from delivery until complete physiological involution and
psychological adjustment.
5. Uterine involution:
Is the process by which the postpartum uterus, weighing about
1kg, returns to its pre pregnancy state of 50-100g.
1- Immediately after delivery: The uterine fundus is palpable
at or near the level of the maternal umbilicus. The measurement
should be taken after emptying the bladder.
2- 2 weeks after birth: the uterus becomes a pelvic organ in the
true pelvis.
3- By 6 weeks: it is usually normal size.
-Lower uterine segment: Immediately following delivery, the lower segment becomes a
thin, flabby and collapsed structure. It takes a few weeks to revert back to the normal
shape and size of the isthmus.
6. Endometrium:
-Following delivery, the major part of the decidua is cast off with the expulsion of the
placenta and the membranes, more at the placental site. The superficial part containing the
degenerated decidua, blood cells and bits of fetal membranes becomes necrotic and is cast off
in the lochia.
-Regeneration starts by 7th day. It occurs from the epithelium of the uterine glands and
stromal cells. Regeneration of the epithelium is completed by 10th day and the entire
endometrium is restored by the day 16, except at placental site where it takes about 6 weeks.
Placenta bed:
-The placental site contracts rapidly presenting a raised surface which measures
about 7.5 cm and remains elevated even at 6 weeks when it measures about 1.5 cm.
7. Myometrium:
-There is marked hypertrophy and hyperplasia of muscle fibers
during pregnancy and the individual muscle fiber enlarges to the
extent of 10 times in length and 5 times in breadth.
-During puerperium, the number of muscle fibers is not decreased,
but there is substantial reduction of the myometrial cell size.
Withdrawal of the steroid hormones, estrogen and progesterone, may
lead to increase in the activity of the uterine collagenase and release of proteolytic enzymes.
-The connective tissues also undergo the same type of degeneration.
The cervix:
-It involutes along with the uterine body but it contracts slowly, so
that by 2 to 3 weeks, the internal os is closed, while the external os
can remain open permanently, giving a characteristic appearance to the parous cervix.
8. The vagina:
-The Vagina gradually diminishes in size.
-In the 1st few days, the stretched vagina is smooth & edematous.
-By the 3rd week, vaginal rugae begin to reappear but never to the same
degree as in prepregnant state.
Broad ligaments and round ligaments:
-They require considerable time to recover from the stretching and laxation.
Pelvic floor and pelvic fascia:
-Take a long time may last to 6 months to involute from the stretching
effect during parturition.
9. Lochia:
-It Is the blood-stained uterine discharge that is consists of blood & necrotic decidua;
While persistence of red lochia means subinvolution, offensive lochia means infection.
Types of lochia:
1. Lochia rubra: for the first 4 days, lochia is red in
color. It contains blood as well as decidual debris.
2. Lochia serosa: from 5th to 9th day, lochia becomes
pale in color. It contains still some red cells, but
predominantly leucocytes and necrotic decidua.
3. Lochia Alba: after the 10th day, the lochia changes to yellowish
white color. It consists now principally of serous fluid and leucocytes.
10. Ovaries:
-The resumption of normal function by the ovaries is highly variable and is greatly
influenced by breastfeeding the infant. The woman who breastfeeds her infant has a longer
period of amenorrhea and anovulation than the mother who chooses to use formula.
-The onset of the first menstrual period following delivery is very variable and depends on
lactation. If woman does not breastfeed her baby, ovulation may occur as early as 4 weeks
postpartum while menstruation returns by 12th week following delivery in 80% of cases. The
meantime for onset of first menstruation is 6 – 9 weeks.
-Lactation provides a natural method of contraception whoever, in women who is
fully lactating, ovulation and menstruation may occur up to 6 -12 months.
-The physiological basis of anovulation and amenorrhea is due to elevated levels of prolactin
and oxytocin in response to baby’s suckling.
11.
12. Breast tissue changes:
-Although lactation starts following delivery, the
preparation for effective lactation starts during pregnancy.
-Prolactin and Oxytocin initiate milk secretion from
mammary glands previously primed by estrogen and
progesterone.
-For the first 2 days there is secretion of colostrum which
a deep yellow serous fluid rich in protein, Lactoferrin
and immunoglobulin while low in its fat and
carbohydrates content.
-Proper milk secretion commences at the 3rd day and
it may be associated with breast engorgement.
13. COMPOSITION OF THE COLOSTRUM:
-It is deep yellow serous fluid, alkaline in reaction. It has got a higher specific gravity; a
high protein, vitamin A, sodium and chloride content but has got low carbohydrate, fat
and potassium.
-Colostrum and milk contains immunologic components such as immunoglobulins
(IgA, IgG, IgM), complements, macrophages, lymphocytes, lactoferrin and other enzymes.
14. Abdominal wall:
-The abdominal wall remains soft and poorly toned for many weeks.
The return to a pre pregnant state depends greatly on maternal exercise.
Physiologic changes:
-General Changes:
*Temperature → normal but,
-A reactionary rise may occur after difficult labor. It does not exceed 38°C and
drops within 24 hours.
-A slight rise may occur at the 3rd day due to engorgement of the breast tissue.
*Pulse → normal but may rise if there is hemorrhage or infection.
*After pains → Painful uterine contractions occur in early puerperium
increasing with suckling due to oxytocin release.
15. Urine Changes:
*Diuresis by the 2nd - 4th day, as normal pregnancy is associated with an increase in
extracellular water and puerperal diuresis is a reversal of this process.
*Retention of urine may occur due to:
-Atony of the bladder. -Laxity of the abdomen.
-Recumbency. -Reflex inhibition if the perineum is sutured.
-Compression of the urethra by vaginal edema.
So, there is an increased incidence of urinary tract infection.
Bowel Changes:
*Tendency to constipation due to;
-Atony of the intestine. -Laxity of abdomen and perineum.
-Anorexia. -Loss of fluids.
16. Loss of weight:
May be due to:
*Evacuation of the uterine contents (5–6 kg).
*More fluid loss in urine and sweat (2 kg).
Blood Changes:
*Immediately following delivery, there is slight decrease of blood
volume due to blood loss and dehydration.
*Increased coagulability of the blood continues during the first two
weeks despite significant decrease in several coagulation factors.
*Fibrinogen level remains high up to the 2nd week of puerperium
which increases the risk for thrombosis.
*Hemoglobin concentration tends to fall in the first 2-3 days.
17. Endocrinal changes:
*Sharp decrease in both estrogen and progesterone with rise in prolactin is the main
initiative for lactation.
*Baby’s Suckling induced signals stimulate oxytocin release which is a milk letting factor.
*There is slight increase in Growth hormone level also, cortisol and thyroxine and they
play role in lactation.
*Prolactin inhibit GNRH which result in lactational amenorrhea.
Psychological changes:
*Postpartum depression (mild degree) is common.
18. Postpartum care
*The postpartum care (PPC) is an extension of both antenatal care (ANC)
Provided during pregnancy and intrapartum care (IPC) provided during
delivery.
1-General health care: as physical and mental relaxation & reassurance.
2-Observation: for fever, bleeding and lochia.
3-Balanced diet: Providing at least 2500 kcal and diet rich in fibers.
4-Breast feeding: encourage breast feeding every 2-3 hours and encourage
the mother to take additional amounts of water & fresh juices.
19. 6-Perineal care: regular cleaning with antiseptic solutions to prevent Genital tract infections
and Pelvic floor exercise is started in the 3rd day if there is no perineal wound.
7-Care of episiotomy: Regular cleaning with antiseptic solution every 4-6 hours with the use
of LLLT to assist in healing and provide bactericidal effect for the incision.
8-Bowel care: avoid constipation by drinking sufficient amounts of water, eating food rich in
fibers and walking.
9-Bladder care: frequent emptying of bladder until it regains its pre pregnant tone and capacity.
10-Postpartum visits: the patient is best seen 3-4 weeks after delivery.
5-Abdominal exercises: active exercises should start few days after
labor and only static after c-section until 6 weeks after c-section.
20. Abnormal puerperium
*Sub involution is a medical condition in which after childbirth,
the uterus does not return to its normal size.
*Predisposing factors
-Multiparity
-Bad maternal health
-Caesarean section
-Uterine prolapse
-Overdistension of uterus as in twins and hydramnios
-Retroversion after the uterus becomes pelvic organ
-Uterine fibroid
*Aggravating factors
-Retained products of conception
-Uterine sepsis, endometritis
21. Symptoms:
The condition of Sub involution may be asymptomatic. The predominant symptoms are:
*Abnormal lochial discharge either excessive or prolonged
*Irregular or at times excessive uterine bleeding
*Backache and irregular cramp like pain is cases of retained products
*rise of temperature in sepsis.
Signs:
*The uterine height is greater than the normal for the particular day of puerperium.
*Normal puerperal uterus may be displaced by a full bladder or a loaded rectum.
*It feels boggy and softer upon palpation.
-Semi sitting position encourage drainage of lochia with 2 hours in prone position (only in
normal labor ) daily to encourage anteversion of the uterus and assist in prevention of RVF.
22. 1-Postpartum hemorrhage (PPH):
*Primary postpartum hemorrhage is loss of blood estimated to be
more than 500 ml following vaginal delivery or 1000 ml
following caesarean section , from the genital tract, within 24 hours
of delivery (the most common obstetric hemorrhage) and bleeding
may be due to retrained placenta, birth canal trauma, uterine atony or
blood clotting disorders.
*Secondary PPH is defined as abnormal bleeding from the genital
tract, from 24 hours after delivery until 6 weeks postpartum and it
is caused by infection or sub involution of the uterus especially of the
placental site, Retrained placental tissues as in placenta accreta, increta
and percreta as well as in submucosal fibroid polyp.
23. 2-Postpartum infections:
*Any bacterial infections of the female reproductive tract following
childbirth or miscarriage.
*Signs and symptoms usually include a fever greater than 38 °C , chills,
lower abdominal pain, productive cough, delay in uterine involution and
possibly bad-smelling vaginal discharge.
*It usually occurs after the first 24 hours and within the
first postpartum 3 weeks.
*The most common sites of infection is that of the uterus and
surrounding tissues known as puerperal sepsis or
postpartum endometritis.
24. Causes of puerperal pyrexia:
*Puerperal sepsis
*Urinary tract infection.
*Mastitis or breast abscess.
*Thrombophlebitis (superficial vein thrombosis).
*Respiratory tract infection.
*Other infections.
Puerperal sepsis: is a type of wound infection of the female genital tract that
occurs during labor or the first postpartum 3 weeks.
-Any case of puerperal pyrexia is considered puerperal
sepsis until proved otherwise.
25. Risk factors for postpartum infections:
*Anemia
*Caesarean section
*Infections of an abdominal incision or an episiotomy
*Instrumental delivery with genital tract lacerations
*Presence of certain bacteria in the vagina such as group B streptococcus
*Premature rupture of membranes
*Multiple vaginal exams
*Manual removal of the placenta
*Prolonged labor
*Breast engorgement
*Urinary tract infections
*Diabetes mellitus
26. 3-Retrained placenta:
*Retained placenta is generally defined as a placenta that
has not undergone placental expulsion (all or part of
the placenta or membranes remain in the uterus) within
30 minutes of the baby’s birth, where the third stage of labor
has been managed actively.
*Retained placenta can be broadly divided into:
-failed separation of the placenta from the uterine lining.
-placenta separated from the uterine lining but retained within
the uterus.
*A retained placenta is commonly a cause of
postpartum hemorrhage, both primary and secondary.
27. 4-Painful perineum:
*Perineal pain after vaginal delivery affects women’s recovery
from childbirth. Genital tract trauma after birth is common.
*Both episiotomy and perineal laceration are strongly associated with the presence of
perineal pain during postpartum period. Also, strong
bearing down increase the incidence of perineal pain.
28.
29. Physical therapy for painful perineum
-Cryotherapy:
After 20 minutes of application, cryotherapy was effective in
relieving perineal pain in women in the immediate postpartum
period after vaginal birth with episiotomy (Beleza et al., 2017).
-TENS:
High frequency TENS is a safe and viable non-pharmacological analgesic resource to
be employed for pain relief post-episiotomy. The routine use of TENS
post-episiotomy is recommended (Pitangui et al., 2012).
-Low Level Laser Therapy:
LLLT can be used to enhance episiotomy wound healing, & to induce analgesic effects if
proper wavelength, energy density and exposure time are selected (Suhaila, 2011).
30. -Ultrasonic Therapy:
*US show a statistically significant result in reduction of pain and
improvement in subjects with persistent superficial dyspareunia after
episiotomy (Farzana et al., 2017).
*Therapeutic ultrasound can be used as a alternative noninvasive
treatment for relieving perineal pain and promote healing following
vaginal delivery with episiotomy to aid functional independence during
the postnatal period (Mahishale et al., 2013).
-Scar tissue mobilization:
*Scar tissue mobilization show a statistically significant result in
reduction of pain and improvement in subjects with persistent superficial
dyspareunia after episiotomy (Farzana et al., 2017).
31. -Pelvic floor exercises:
*The use of Kegel exercises after episiotomy is associated with less pain, analgesic
consumption and frequency of analgesic use (Mahmodi and Mobaraki, 2014).
*Practicing postnatal Kegel exercises had a significant effect on decreasing perineal pain
and accelerating healing of the perineal incision after episiotomy (Farrag et al., 2016).
32. A) Varicose veins:
Many women have varicose veins during pregnancy, but sometimes
this problem may stay after pregnancy. As the damage that veins
may have suffered remains irreversible.
Management:
* Avoid prolonged sitting or standing
* Bandaging
* Burger’s exercises
*Intermittent compression
-Sequential pneumatic compression therapy with the applied parameters was an
effective modality for increasing venous blood flow, reducing pain, and improving
quality of women life with varicose veins (Yamany and Hamdy, 2016).
5-Circulatory problems:
33. B) Hemorrhoids (Piles):
*Hemorrhoids are painful swelling of veins in the rectum.
After delivery - especially after a vaginal delivery and
Symptoms include pain, rectal itching, bleeding after
defecation or a swollen area around the anus.
*Many women experience them for the first-time during pregnancy
or the postpartum period for several reasons, including a rush of hormones,
internal pressure and constipation.
Management:
* Avoid constipation
* Ice gel packs application 10 min.
* Low Level Laser Therapy (LLLT)
* Pelvic floor exercises
34. 6-After pains:
*Women may experience cramping pain and discomfort following the
childbirth as the uterus contracts and returns to its pre-pregnancy size.
*These after pains are caused by involutionary contractions and usually last
for two to three days after childbirth. They are more evident for women who
are multiparous.
*Breastfeeding stimulates the uterus to contract and increases
the severity of after birth pains.
Management:
* Heat application 15-30min.
* TENS.
* Relaxation training with breathing.
35. 7-Feeding difficulties:
A) Breast engorgement:
Breast engorgement is uncomfortable swelling that results in
painful, tender breast, it is associated with an increase in blood
flow and milk supply and it occurs in the 3rd day after delivery.
Management:
* Regular feeding every 2-3 hours and 8-12 times throughout daily.
* Moist heat application for15-30min before lactation.
* Cold compresses for 10 min. to reduce swelling pain and vascularity after feeding.
* TENS: high frequency 60 HZ, for 30-60min.
* Ultrasonic therapy: Pulsed, 1MHz, 0.5W/cm2 and Duration 10:15 min.
-Ultrasound therapy helps in reduction of pain with non-tender breast which further helps the
post-partum mothers to recover better from discomforts of breast engorgement
(Priyanka et al., 2016).
36. B) Mastitis:
-Mastitis is an infection in the tissue of one or both mammary glands
inside the breast tissue.
-It is associated with pain, redness and axillary lymph nodes are enlarged
usually affects women who are breast-feeding in the 2nd week postpartum.
-Also, it has another peak in the 4-5th week postpartum.
-It is usually associated cracked nipples, allowing bacteria to enter the breast from nipples.
Management:
*Cold Application for 10 min. to reduce swelling and inflammation.
*Low level laser therapy: LLLT is a painless treatment, which appears to accelerate wound
healing of cracked nipples and ease pain (Buck et al., 2016). LLLT therapy is beneficial in
decreasing the somatic cell count and improving milk nutritional quality with an
intramammary infection (Wang et al., 2014).
*Bed rest & Continue breastfeeding.
37. C) Blocked ducts:
-Blocked or plugged ducts is a condition where a blockage in a
milk duct results in poor or insufficient drainage of the duct.
-When milk builds up behind the blockage, the concentration of
pressure in the duct may lead to local discomfort or lump
formation in the breast. It may be called non-infective mastitis.
Management:
* Moist heat application for15-30min.
* Continue breastfeeding.
* Feeding with the affected side firstly then the unaffected.
* Ultrasonic Therapy: US was a beneficial treatment for women presenting with
blocked ducts and difficulties breastfeeding. 100% (continuous) duty cycle, 1 MHz,
2 W/cm2, 10 min (Lavigne and Gleberzon, 2012).
38. 8-Diastasis recti:
*Diastasis recti is a fairly common condition of pregnancy and
Postpartum in which the right and left halves of Rectus abdominis
muscle spread apart at the body’s midline fascia (stretched linea alba)
which is a tendinous, fibrous raphe that runs vertically down the midline
of the abdomen. It extends between the inferior sternum and pubis; Linea
alba generally lacks blood supply and innervation. a gap about 2.7 cm
or greater between the two sides of the rectus abdominis muscle is considered positive sign.
*In pregnant or postpartum women, the condition is caused by
The stretching of the rectus abdominis by the growing
uterus. It is more common in multiparous women. Additional
causes can be attributed to excessive inappropriate abdominal
exercises after the first trimester of pregnancy.
39. Examination for Diastasis Recti:
*Instruct patients to perform a self-test on or
after the third postpartum day for optimal
accuracy. Until 3 days after delivery, the
abdominal musculature has inadequate tone for
valid test results.
*Patient position and procedure: Crock lying.
Have the patient slowly raise her head and shoulders off the floor or plinth, reaching her
hands toward the knees, until the spines of the scapulae leave the floor or plinth. Place the
fingers of one hand horizontally across midline of the abdomen at the umbilicus (Fig. 24.6).
If a separation exists, the fingers will sink into the gap between the rectus muscles, or a
visible bulge between the rectus bellies may be appreciated. The number of fingers that can
be placed between the muscle bellies is then documented. Because this condition can occur
above, below, or at the level of the umbilicus, test for it at all three areas.
40. *Rectus diastasis rehabilitation:
1) Kinesio tape
2) Core stability exercises:
- TA breathing
- Side plank
- Side lying leg lift
- Dead bug crunches
- Scissor kicks
- Heel slides
41. Exercises NOT suitable for Diastasis recti
1) All frontal planks
2) All crunches
3) Push ups
4) Sit ups
5) Twisting movements
6) Quadruped exercises
42. 9-Back pain:
*Back pain is a common symptom during pregnancy and postpartum
period due to multiple factors, including weight gain, changes in
posture, mechanical impact of anesthesia, bad posture during care
of baby, lactation and sleeping positions. In addition, the changing
hormone balance that relaxes the strong ligaments of the pelvis in
preparation for childbirth can affect the back.
*Many of the common causes of back pain during pregnancy
continue after delivery and women also complain of cervical,
thoracic and lower back dysfunctions.
*After delivery refereed back pain also may be due to involutionary
uterine contractions or urinary tract infections.
43. Physical Therapy Assessments for Postpartum Back pain
-Complete history.
-Active then passive physiological movements.
-Passive segmental motion.
-Passive accessory motion.
-Assessment of myotome, dermatome and reflexes.
-Special tests for some cervical disorders -Special tests for some low back disorders
*For Thoracic outlet syndrome (TOS): *For facet joint arthropathy:
-Roos test. -Quadrant test.
*For cervicogenic headache: *For sciatica:
-Flexion rotation test. -Straight leg raising test.
-Piriformis test or active piriformis test.
*For Spondylolisthesis:
-Test of anterior lumbar spine stability.
-passive lumbar extension test.
44. Physical Therapy Treatments for
Postpartum Back pain
-Hot packs & Kinesio tape
-Ultrasonic therapy & LLLT.
-TENS & Interferential currents.
-Myofascial release techniques & IASTM.
-Core stability exercises.
-Postural correction techniques.
-Gentle mobilization techniques & MWM.
-Pelvic floor and pelvic rocking exercises.
-Gentle stretching exercises.
-Abdominal and hip extensors strengthening exercises.
-Ergonomic considerations.
-Avoid spinal manipulation to postpartum women.
45. 10-Symphysis pubis dysfunctions:
*Symphysis pubis diastasis is a rare cause of pelvic pain in pregnancy
but may be underdiagnosed. It is a complication of pregnancy and
vaginal delivery in which the pubic symphysis separates, resulting in
acute pelvic pain, and may lead to severe long-term consequences.
Provocative tests (when positive, they are helpful in diagnosing SPD):
*Patrick’s Faber sign:
The test is positive when there is pain in
either sacroiliac joint or symphysis pubis.
*Active straight leg raise (ASLR)
*Flamingo test: Pain at symphysis when
standing on one leg is a positive sign.
46. 11-Sacroiliac joint dysfunctions:
*Sacroiliac dysfunctions are common during pregnancy and these
dysfunctions may continue after delivery (postpartum period).
*pregnancy-induced bone marrow edema at the sacroiliac joints, as a
result of prolonged mechanical stress, was present in 63.3% of women
during the early postpartum period and may mimic sacroiliitis of axial spondylarthritis.
Provocative tests (when positive, they are helpful in diagnosing SI dysfunctions):
*Cluster of Laslett: *Passive extension and medial rotation of ilium on sacrum
-Posterior thigh thrust *Passive flexion and lateral rotation of ilium on sacrum
-Gapping test *Thomas test
-Compression test *Piriformis test
-Sacral thrust test *Leg length discrepancy
*Functional test of supine active straight leg raise
*Functional test of prone active straight leg raise
47. Physical Therapy Treatments for Sacroiliac and
Symphysis pubis dysfunctions
-Reassurance and Relaxation training.
-Hot packs:15-30 min. or Cold packs:10 min.
-Ultrasonic therapy ( Pulsed, Not Continuous )
-phonophoresis and Lidocaine iontophoresis.
-TENS & LLLT.
-Muscle energy tech. & trigger points release.
-Positional release (strain counter strain tech).
-Gentle mobilization techniques.
-Lumbopelvic supports and Kinesio tape.
-Core stability exercises.
-Stretching exercises.
-Strengthening exercises for ipsilateral hip extensors and contralateral latissimus dorsi.
48. 12-Coccydynia:
*Coccydynia is inflammation localized to the tailbone (coccyx).
*Symptoms and signs of coccydynia include focal dull aching pain and
tenderness at the tailbone.
*Postpartum coccydynia is pain that appears as soon as a sitting position
is adopted after delivery. Coccyx morphology, body mass index, vaginal delivery,
instrumental delivery, multiparity, advanced maternal age and short perineum are risk factors.
*Childbirth is usually related to damage of the sacrococcygeal ligaments during vaginal
delivery and the passage of the fetus through the birth canal may cause acute trauma to the
coccyx, this can be further aggravated by forceps delivery.
*Giving birth is one of the most common causes of coccydynia.
The coccyx becomes more flexible towards the end of pregnancy.
This allows coccyx, and sacrum, to bend and give way during labor.
49. Evidence of Physical Therapy
Treatments for coccydynia
*Patients with coccydynia are initially advised to avoid
provocative factors. Initial treatment includes ergonomic
adjustments such as using a donut-shaped pillow or gel
cushion when sitting for a long period of time.
*Stretching of piriformis and iliopsoas muscles and
Maitland's rhythmic oscillatory thoracic mobilization over
the hypomobile segments for 3 weeks, 5 sessions per
week showed significant improvement in pain pressure
threshold and pain free sitting in patients with
coccydynia (Mohanty and Pattnaik, 2017).
50. *Extracorporeal shortwave therapy was more effective and satisfactory
in reducing discomfort and disability caused by coccydynia 3,000 shock
waves per session of 2 bar at 21 Hz frequency directed to the coccyx
(Haghighat and Asl., 2016).
*Adequate pelvic floor muscle training can produce cranial movement of the coccyx tip
(Fujisaki et al., 2018).
*Combined manual therapy and corticosteroid injection were more effective in the
treatment of Coccydynia and patients following the treatment were completely pain free at the
end of the year (Chakraborty, 2012).
*Ultrasound therapy: Intensity-2w/cm2, Frequency-3MHZ,
Mode- continuous and Duration-10min. is an excellent non pharmacologic,
noninvasive method for alleviating post partum coccydynia (El-Mekawy et al., 2006).
51. 13-Dequervain’s tenosynovitis:
*De Quervain's tenosynovitis is a common wrist disorder involving
the abductor pollicis longus and extensor pollicis brevis tendons of
the first dorsal compartment.
*Mild symptoms may be present during the later stages of pregnancy
and then increase markedly at or shortly after delivery. Patients who
have persistent symptoms have reported that the activities of the
infant care often aggravate the condition.
*Finkelstein's test is a test used to diagnose de Quervain's
tenosynovitis in people who have wrist pain.
Classical descriptions of the Finkelstein's test are when the examiner
grasps the thumb and ulnar deviates the hand sharply. If sharp pain
occurs along the distal radius, it is a positive sign.
52. Physical therapy for De quervain’s tenosynovitis
-Cryotherapy: for 10 min.
-TENS: If acute – high frequency TENS for 3o min.
If chronic – low frequency TENS for 15-20 min.
-Ultrasonic therapy:
If acute – 3MHZ, 0.5W/CM2, Pulsed 25% duty cycle.
If chronic –3MHZ, 1W/CM2, continuous 100% duty cycle.
-Phonophoresis and Iontophoresis.
-Low Level Laser Therapy (LLLT).
-DTF and stretching exercises.
-Mobilization with movement technique (MWM).
-Graduated strengthening exercises.
-Splints and Ergonomic considerations.
-Kinesiotaping.
53. 14-Carpal tunnel syndrome:
*Carpal tunnel syndrome (CTS) is an entrapment neuropathy caused by
compression of the median nerve as it travels through the wrist's carpal tunnel.
and it is the most common nerve entrapment neuropathy, accounting for
90% of all neuropathies.
*The main symptoms are pain, numbness and tingling in the thumb, index finger,
middle finger and the thumb side of the ring finger. after a long period of time the
thenar muscles may waste away.
*Carpal tunnel syndrome (CTS) is a frequent complication of pregnancy,
But it may persist in 15% of postpartum women due to care of baby.
*The Phalen's test, reverse Phalen's test and Nerve conduction studies
(NCS) are useful in diagnosis.
54. Physical therapy for Carpal Tunnel Syndrome
-Ice pack: for 10 min.
-Contrast baths: hot water (45°С) for 3min. then cold water (15 °С) for 1min.
and repeat for 3 times, Begin and end with hot water.
-Ultrasonic therapy (Pulsed or Continuous) and phonophoresis.
-TENS.
-Low Level Laser Therapy (LLLT).
-Pulsed magnetic field therapy (PMFT).
-Myofascial release technique and DTF.
-Gentle stretching exercises.
-Carpal bone especially Scaphoid mobilization.
-Median nerve mobilization.
-Strengthening exercises for hand grip & ant. forearm ms.
-Ergonomic considerations, Splint & Kinesiotaping.