The puerperium period begins immediately after childbirth when the placenta is expelled and lasts around 6 weeks. During this time, the uterus and other pelvic organs revert back to their pre-pregnant state through the process of involution. The uterus decreases in size from over 1000g back down to 60g through contractions, shedding of the endometrium, and reduction in blood vessels and tissue. Other changes include a return of the vagina, breasts, and pelvic floor to their original states. Lochia discharge occurs for the first 2 weeks as the uterus heals. Management of normal puerperium focuses on rest, self-care, breastfeeding support, immunizations and prevention of

1. NORMAL
PUERPERIUM

2. WHAT ISPUERPERIUM?
 Period following childbirth
 Pelvic organs & other body tissues
 Revert to pre-pregnant state
 Anatomically & physiologically

3.  Begins as soon as placenta is
expelled
 lasts for appx 6 weeks(42 days)
 3 stages
I. Immediate-within 24hrs
II. Early -upto 7 days
III. Remote – upto 6wks

4. INVOLUTION OF THE UTERUS
Anatomical consideration
● At delivery-20 x 12 x 7.5cm and appox. 1000g
● After involution-reverted to non-preg size of
appox. 60g
● Lower uterine segment isthmus in a few weeks
● Contour of cervix regained in 6 wks
● External os never reverts back to nulliparous state

6. Physiological Consideration
 Muscles:
 Endometrium:
 regen starts on day 7
 from uterine gland mouths and interglandular stromal cells
 completed by day 16
 except @placental site
Steroid
hormones
withdrawn
Inc
Collagenase
& Proteolytic
enzymes
Autolysis
Myometrial
cell size
reduced
Endophlebitis T
hrombosis
Fibrinoid end arteritis Hyalinisation
Blood Vessels

7. Clinical assessment of Involution of uterus
•Fundus lies 13.5cm above sypmphysis pubis
for the 1st 24hrsfollowing delivery
•Steady decrease by 0.5'' in nxt 24 hrs
•Day 14- not palpable-pelvic organ
•Completed by 6 wks

8. Vagina
4-8 weeks;
Does not revert
to original state
Broad/roun
d
ligament
s
Long time d/t
stretching
during
parturition
Pelvic
floor
&
Fascia
Long time d/t
stretching
during
parturition
Involution of other Pelvic structures

9. LOCHIA
• Vaginal discharge for the 1st fortnight during puerperium
● Odour:offensive fishy smell
● Colourand composition
Lochia Rubra
•1-4 days
•Blood,fetal memb & decidua
shreds,lanugo,meconium
Lochi Serosa •Leucocytes,Cx mucus,wound
•5-6 days
exudates,microorganisms
•10-15 days
Lochia Alba •Decicual
cells,leucocytes,mucus,cholestrin
crystals,fatty
epithelial
cells,microorganisms

10. • Puerperal Sepsisd t E. Coli
Malodorous
• Infection
• Lochiometra
Scanty/absent
• Infection
Excessive
• Subinvolution
• Retained conceptus
• Causes secondary PPH
Red color persist
• Local genital infection
L.Alba beyond 3 wks
Clinical importance

11. CHANGES INBREAST & LACTATION

12. General Physiological Changes
 Pulse:
 raisesbut settlesdown to normal on 2nd day
 Temperature:
 Any rise above 0.5C suggestive of infection of genito-urinary tract
 Urinary Tract:
 Pronounced Diuresison 2nd - 3rd day
 over distension
 incomplete emptying
 presence of residual urine
 high riskof infection
 GIT
:
 increased thirst
 constipation
 Weight Loss:
 5-6kg expulsion of fetus placenta, liqour, blood
 2kg-during puerperium d t diuresis
 Continued upto 6 months of delivery

13.  Blood Values:
 immediate-reduced blood volume; Normal in 2 weeks
 rise in cardiac output; Normal in 1 week
 leuycocyotsisd t stress
 Hypercoagulable state for 48 hrs
 Fibrinolytic activity enhanced in 4 days
 Menstruation:
 if not breast feeding-resumesin 6 to 8 wks
 Ovulation:
 non-lactating mother-4 wks
 lactating mother-10 weeks
 Exclusive Breastfeeding- 98%contraception up 6 months

14. Management of normal Puerperium
 To restore health of Mother
 Rest and Early ambulation
 Emotional support
 Diet of patients choice
 Sleep
 Immunization- anti-D- Gamma globulin
 Maternal-infant Bonding
 Postnatal exercise

15. To prevent infection
Care of bladder & Vulva
Care of episiotomy wound
Maintenance of asepsis and proper hygiene
Immunization- Rubella vaccine, T
T
To take care of the Breasts & promote breast
feeding
To motivate mother for contraception

16. • After pains
• Uterus massage
• Ibuprofen
• Anti-spasmodic
• Pain at site of perineum
• Sitz bath
• analgesics
• T
reatment of Anaemia
• Supplementary Iron therapy
Treatment of minor ailments

17. Abnormal Puerperium
 Puerperal fever/ pyrexia
 Puerperal Sepsis
• Pelvic pain
• Fever
• Foul smelling vaginal discharge
• Subinvolution

18.  Breast Problems
• Retracted/cracked nipples
• Breast engorgement
• Mastitis
• Breast abscess
• Failure of lactation

19.  Urinary Problems
• Retention
• Incontinence
• Infection
 Venous thrombosis
 Secondary Hemorrhage
 Puerperal psychosis
 Obstetric palsy

20. THANQ