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.
This topic contains detailed description about labour, its definition, date of onset of labour, calculations of date of delivery, causes of onset of labour, physiology of normal labour, and events, clinical course and management of each stages of labour.
Hydatidiform Mole (HM) is a rare mass or growth that forms inside the uterus at the beginning of a pregnancy. It is a type of gestational trophoblastic disease (GTD).
When a normal sperm cell fertilizes one of these oocytes, the resulting embryo has only one set of chromosomes. Because the embryo has no genes from the mother, the pregnancy cannot develop normally, resulting in a hydatidiform mole.
Series of events that takes place in the genital organ in an effort to expel the viable products of conception out of the womb through the vagina into the outer world is called labour.
there are four stages of labour.
This topic contains detailed description about labour, its definition, date of onset of labour, calculations of date of delivery, causes of onset of labour, physiology of normal labour, and events, clinical course and management of each stages of labour.
Hydatidiform Mole (HM) is a rare mass or growth that forms inside the uterus at the beginning of a pregnancy. It is a type of gestational trophoblastic disease (GTD).
When a normal sperm cell fertilizes one of these oocytes, the resulting embryo has only one set of chromosomes. Because the embryo has no genes from the mother, the pregnancy cannot develop normally, resulting in a hydatidiform mole.
Series of events that takes place in the genital organ in an effort to expel the viable products of conception out of the womb through the vagina into the outer world is called labour.
there are four stages of labour.
This ppt is made by Mr. arkab khan pathan under guidance of Mrs. RAKHI GOAR. this ppt contain the detail and all the lecture notes of HEG.
THANK YOU.
Arkab khan
This ppt is made by Mr. arkab khan pathan under guidance of Mrs. RAKHI GOAR. this ppt contain the detail and all the lecture notes of HEG.
THANK YOU.
Arkab khan
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 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
Obstetrics All lecture for exam, Obstetrics and gynecology is a field thought of as traditionally serving women because of its focus on the female reproductive system, leading care providers to make assumptions about patients' gender identity and expression in "women's health clinics" when many transgender or nonbinary patients may also seek care from
It is a chapter in obstetrics. it is important to know what happens after pregnancy. it includes definition, involution of the uterus,lochia, general physiological changes , lactation, physiology of lactation etc. it is very knowledgeable ppt. please read this vey carefully.
This topic contains Gametogenesis- oogenesis and spermatogenesis, ovulation, fertilization, development of fertilized ovum/ zygote, implantation, development of decidua, chorion and chorionic villi, development of inner cell mass.
This topic includes menstruation:- its definition, anatomical aspects- follicular growth and atresia, germ cells, premodial follicle; menstrual cycle/ ovarian cycle:- definition, phases- recruitment of groups of follicles (premature phase), selection of dominant follicle and its maturation, ovulation, follicular atresia; Endometrial cycle:- division of endometrium- basal zone, functional zone and its phases- stage of regeneration, stage of proliferation, secretory phase, menstrual phase, mechanism of menstrual bleeding, role of prostaglandins, hormones in relation to ovarian and menstrual cycle, ovulation, luteal-follicular shift, menstrual symptoms, menstrual hygiene, anovular menstruation, artificial postponement; cervical cycle, vaginal cycle and general changes in follicular and luteal phase.
This topic includes difference between female and male pelvis, various pelvis types, general description of pelvis bones, division of pelvis, landmarks of pelvis, plane, axis, sacral angle, diameters of inlet, cavity and outlet.
This topic includes Introduction for analgesia and anesthesia used in obstetrics, maternal risk factors for anesthesia, anatomical and physiological considerations, analgesia during labour and delivery, sedatives and analgesia, opioid analgesics, combination of narcotics and antiemetics, inhalation methods, commonly used local anesthesia in obstetrics, spinal anesthesia, infiltration anesthesia, patient controlled anesthesia, psychoprophylaxis, general anesthesia for cesarean section, complication of general anesthesia and its management.
This topic includes Introduction, common side effects from maternal medications on infants, guidelines for medication during lactation, effects of various medications on lactation and neonates
This topic contains anticonvulsants used in obstetrics such as magnasium sulphate, diazepam, phenytoin and anticoagulants such as heparin and warfarin.
It is from biochemistry subject and continuation of previous topic from organization of matter. This topic contains definition of Chemistry, Matter, Mass, Weight. Description of physical state of matter and chemical structure of matter.
link for previous topic: organization of matter- important terms
https://www.slideshare.net/priyankagohil10/organization-of-matter-important-terms-237314150
Vital statistics related to maternal health in indiaPriyanka Gohil
This topic contains introduction of vital statistics, list of important statistics, birth rate, death rate, specific death rates, infant mortality rate, neonatal mortality rate, under five mortality rate, maternal mortality rate (detailed), perinatal mortality rate (detailed), expectation of life, general fertility rate and still births.
This topic contains Meaning and definitions of midwifery, obstetrics, obstetrical nursing, midwife, scope of midwifery, basic competencies of a midwife, history of midwifery in nursing and development of maternity services in India.
This topic contains definition, instruments, indications, contraindications, prerequisites, advantages, procedure, complications and hazards of ventouse or vaccum delivery.
Presentation on this topic is available on link 👇
https://youtu.be/d_JgNiYv7eU
This topic contains detail about genital prolapse in pregnancy, It's definition, incidence, types, stages, causes, risk factors, clinical features, effect of prolapse, effect on pregnancy, effect during labour and puerperium, prevention, treatment and nursing management during pregnancy, labour and puerperium.
This topic contains definition, incidence, varieties, causes, risk factors, dangers, diagnosis, prognosis, prevention and management of inversion of uterus.
This topic contains definition, meaning, classification, pathophysiology, clinical menifestations, metabolic and general changes, management of obstetrical shock
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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2. Definition
“Puerperium is the period following
childbirth during which the body tissues,
specially the pelvic organs revert back
approximately to the prepregnant state both
anatomically and physiologically.”
3. The retrograssive changes are mostly
confined to the reproductive organs with the
exception of the mammary glands which in
fact show features of activity.
“ is the process whereby the
genital organs revert back approximately to
the state as they were before pregnancy.”
The woman is termed as a puerpera.
4. Duration
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 period is arbitrarily divided into:-
a) Immediate - Within 24 hours
b) Early - Up to 7 days
c) Remote - Up to 6 weeks
Similar changes occur following abortion but takes a
shorter period for the involution to complete.
6. I. ANATOMICAL CONSIDERATION
UTERUS
Immediately following delivery, the uterus
becomes firm and retract with alternate
hardening and softening.
The uterus measures about 20 x 12 x 7.5 cm
(length, breadth and thickness) and weighs
about 1000 gm.
At the end of 6 weeks, its measurement is
almost similar to that to the non-pregnant
state and weighs about 60 gm.
7. The placental site contracts rapidly presenting a
raised surface with measures about 7.5 cm and
remains elevated even at 6 weeks when it
measures about 1.5 cm.
CERVIX
The cervix contracts slowly, the external os
admits two fingers for a few days but by the end
of first week, narrows down to admit the tip of a
finger only.
The contour of the cervix takes a longer time (6
weeks) to remain and the external os never
reverts back to the nulliparous state.
8.
9. II. PHYSIOLOGICAL CONSIDERATION
The physiological process of involution is most
marked in the body of the uterus.
MUSCLES
There is marked hypertrophy and hyperplasia
of muscle fibres during pregnancy and the
individual muscle fibre enlarges to the extent of
10 times in length and 5 times in breadth.
During puerperium, the number of muscle
fibres is not decreased but there is substantial
reduction of the myomatrial cell size.
10. Withdrawal of the steroid hormones, estrogen
and progesterone, may lead to increase in the
activity of the uterine collagenase and the
release of proteolytic enzyme.
Autolysis of the protoplasm occurs by the
proteolytic enzyme with liberation of peptones
which enter the blood stream.
These are excreted through the kidneys as urea
and creatinine.
This explains the increased excretion of the
products in the puerperal urine.
11. The connective tissues also undergo the same
type of degeneration.
The conditions which favours involution are...
a. efficacy of the enzymatic action
b. relative anoxia induced by effective
contraction and retraction of the uterus.
12. BLOOD VESSELS
The changes of the blood vessels are pronounced
at the placental site.
The arteries are constricted by contraction of its
wall and thickening of the intima followed by
thrombosis.
During the first week, the arteries undergo
thrombosis, hyalinization and fibrinoid end
arteritis.
The veins are obliterated by thrombosis,
hyalinization and endophlebitis.
New blood vessels grow inside the thrombi.
13. 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 endomatrium left behind varies in the
thickness from 2-3 mm.
The superficial part containing the degenerated
decidua, blood cellsvand bits of fetal
membranes becomes necrotic and is cast off in
the lochia.
14. Regeneration starts by 7th day.
It occurs from the epithelium of the uterine
gland mouths and interglandular stromal
cells.
Regeneration of the epithelium is completed
by 10th day and the entire endomatrium is
restored by the 16, except at the placental
site where it takes about 6 weeks.
15. CLINICAL ASSESSMENT OF INVOLUTION OF UTERUS
The rate of involution of the uterus can be
assessed clinically by noting the height of the
fundus of the uterus in relation to the symphysis
pubis.
The measurement should be taken carefully at a
fixed time every day, preferbly by the same
observer.
Bladder must be emptied before hand and
preferably the bowel too, as the full bladder and
the loaded bowel may arise the level of the
fundus of the uterus.
16. The uterus is to be centralized and with a
measuring tape, the fundal height is measured
above the symphysis pubis.
Following delivery, the fundus lies about 13.5
cm above the symphysis pubis.
During the first 24 hours, the level remains
constant, thereafter, there is a steady decrease
in hight by 1.25 cm in 24 hours, so that by the
end of second weeks the uterus becomes a
pelvic organ.
17. The rate of involution thereafter slows down
until by 6 weeks, the uterus becomes almost
normal in size.
The involution may be affected adversely and
is called subinvolution.
Sometimes the involution may be continued in
women who are lactating so that the uterus
may be smller in size- superinvolution.
The uterus however returns to normal size if
the lactation is withheld.
18. VAGINA
The distensible vagina, noticed soon after
birth takes a long time (4-8 weeks) to
involute.
It regains its tone but never to the virginal
state.
The mucosa remains delicate for the first few
weeks and submucous venous congestion
persists even longer.
It is the reason to withhold surgery on
puerperal vagina.
19. Rugae partially reappear at the third week but
never to the same degree as in prepregnant
state.
Hymen is lacerated and is represented by
nodular tags- the carunculate myrtiformes.
BROAD LIGAMENTS AND ROUND LIGAMENTS
Require considerable time to recover from the
stretching and laxation.
PELVIC FLOOR AND PELVIC FACIA
Take a long time to involute from the
stretching effect during parturition.
20. “It is the vaginal discharge for the first
fortnight during puerperim.”
The discharge originates from the uterine
body, cervix and vagina.
Odor and reaction
It has got a pecular offensive fishy smell.
Its reaction is akaline tending to become acid
towards the end.
21. Color
Depending upon the variation of the color of
the discharge it is names as:
1. Lochia Rubra (red) 1-4 days
2. Lochia Serosa (5-9 days) the color is
yellowish or pink or pale brownish
3. Lochia Alba (10-15 days ) pale white
22. Composition
1. Lochia Rubra consists of blood, shreds of fetal
membranes and decidua, vernix caseosa lanugo and
meconium.
2. Lochia Serosa consists of less RBC but more
leukocytes, wound exudate, mucus from thhe cervix
and microorganisms (anaerobic streptococci and
staphylococci). The presence of bacteria is not
pathognomonic unless associated with clinical signs of
sepsis.
3. Lochia Alba contains plenty of decidual cells
leukocytes, mucus, cholestrin crystals, fatty and
granular epithelial cells and microorganism.
23. Amount
The average amount of discharge for the first 5-6 days,
is estimated to be 250 ml.
Normal duration
The normal duration may extend up to 3 weeks.The red
lochia may persist for longer duration especially in
women who get up from the bed for the first time in
later period.
The discharge may be scanty, especially following
premature labours or may be excessive in twin delivery
or hydramnios.
24. Clinical importance
The character of the lochia discharge gives useful
information about the abnormal puerperal state.
The vulval pads are to be inspected daily to get
information:
Ordor
If malordorous, indicates infection. Retained plug or
cotton piece inside the vagina should be kept in mind.
Amount
Scanty or absent- signifies infection or lochiometra.
If excessive-indicates infection
25. Color
Persistence of red color beyond the normal limit
signifies subinvolution or retained bits of cenceptus.
Duration
Duration of the lochia alba beyond 3 weeks suggests
local genital lesion.
26. PULSE
For a few hours after normal delivery the pulse rate
is likely to be raised, which settles down to normal
durine the second day.
However, the pulse rate often rises with after-pain or
excitement.
TEMPERATURE
The temperature should not be above 37.2 ℃ within
the first 24 hours.
There may be slight reactionary rise following
delivery by 0.5 ℉but comes down to normal within
12 hours.
27. On the 3rd day there may be slight rise of temperature
due to breast engorgement which shpuld not last for
more than 24 hours.
However, genitourinary tract infection should be
excluded if there is rise of temperature.
URINARY TRACT
The bladder mucosa becomes edematous and often
shows evidence of submucous extravasation of blood.
The bladder capacity is increased.
The bladder may be overdistended without any desire
to pass urine.
28. The common urinary problems are: over distension,
incomplete emptying and presence of residual urine.
Urinary stasis is seen in more than 50 % of women.
The risk of urinary tract infection is therefore high.
Dilated ureters and renal pelves return to normal size
within 8 weeks.
There is pronounced diuresis on the second or third
day of the peurperium.
Only 'clean catch' sample of urine should be collected
and sent for examination, with lochia should be
avoided.
29. GASTROINTESTINAL TRACT
Increased thirst in early puerperium is due to
loss of fluid during labor, in the lochia diuresis
and perspiration.
Constipation is a common problem for the
following reasons:delayed GI motility, mild ileus
following delivery, together with perineal
discomfort.
Some women may have the problem of anal
incontinence.
30. WEIGHT LOSS
In addition to the weight loss (5-6 kg) as a
consequence of the expulsion of the fetus,
placenta, liqour and blood loss, a further loss of
about 2 kg (5 lb) occurs during puerperium
chiefly caused by diuresis.
This weight loss may continue up to 6 months
of delivery.
31. FLUID LOSS
There is a net fluid loss of at least 2 litres
during the first week and an addition 1.5 liters
during the next 5 weeks.
The amount of loss depends on the amount
retained during pregnancy, dehydration during
labour and blood loss during delivery.
The loss of salt and water are larger in women
with preeclampsia and eclampsia.
32. BLOOD VALUE
Immediately following delivery, there is slight
decrease of blood volume due to blood loss and
dehydration.
Blood volume returns to non-pregnant level by
the second week.
Cardiac output rises soon after delivery to
about 80 % above the pre-labor value but
slowly returns to normal within one week.
33. RBC Volume and hematocrit values returns to
normal by 8 weeks postpartum after the
hydremia disappears.
Leukocytosis to the extent of 25,000 per cumm
occurs following delivery probably in respone
to stress of labour.
Platelet count decreases soon after the
separation of the placenta but secondary
elevation occurs withincrease in platelet
adhesiveness between 4-10 days.
34. Fibrinogen level remains high up to the second
week of puerperium.
A hypercogulable state persists for 48 hours
postpartum and fibrinolytic activity is enhanced
in first 4 days.
The secondary increase in fibrinogen, factor VIII
and platelets in the first eek increases therisk
for thrombosis.
The increase in fibriolytic activity acts as a
protective mechanism.
35. MENSTRUATION AND OVULATION
The onset of the first menstrual period
following delivery is very variable and depends
on lactation.
If the woman does not breasdfeed her baby, the
menstruation returns by 6th week following
delivery in about 40 % and by 12th week in 80 %
of cases.
In non-lactating mothers ovulation may occur as
early as 4 weeks and in lactating mothers about
10 weeks after delivery.
36. A woman who is exclusively breastfeeding, the
contraceptive protection is about 90 % up to 6
months of postpartum.Thus, lactation provides a
natural method of contraceptio.
However, ovulation may precede the first
menstrual period in about one-third and it is
possible for the patient to become pregnant
before she menstrautes following her
confinement.
Non-lactating mother should use contraceptive
measures in 3rd postpartum week and the
lactating mother in 3rd postpartum month.
37.
38. For the first two days following delivery, no further
anatomic changes in the breast occurs.
The secretion from the breasts called colostrum
which starts during pregnancy becomes more
abundant during the period.
COMPOSITION OF THE COLOSTRUM
It is deep yellow serous fluid, alkaline in reaction.
It has got a higher specific gravity, a higher protein,
vitamin A, sodium and chloride content but has got
lower carbohydrate, fat and potassium than the
breast milk.
It contains antibody (IgA) produced locally.
39.
40. MICROSCOICALLY
It conrains fat globules, colostrum corpuscles and
acinar epithelial cells.
The colostrum corpuscles are large polynuclear
leukocytes, oval or round in shape containing
numerous fat globules.
ADVANTAGES
The antibodies (IgA, IgG, IgM) and hormonal
factors (lactoferrin) provides immunological
defence to the new born.
It has laxative action on the baby because of
large fat globules.
41. Although lactation starts following delivery, the
preparation for effective lactation starts during
pregnancy.
The physiological basis of lactation is divided in to
four phases:
1. Mammogenesis -Preparation of breast
2. Lactogenesis -Synthesis and secretion from the
breast alveoli
3. Galactokinesis -Ejection of milk
4. Galactopoiesis -Maintenance of lactation
42. Mammogenesis
Pregnancy is associated with a remarkable growth
of both the ductal and lobualveolar system.
An intact nerve supply is not essential for the growth
of the mammary glands during pregnancy.
Lactogenesis
Though some secretory activity is evident
(colostrum) during pregnancy and accelerated
following delivery, milk secretion actually starts on
3rd or 4th postpartum day.
Around this time, the breasts becomes engorged,
tense, tender and feel warm.
43. Inspite of a high prolactin level during pregnancy, milk
secretion is kept in abeyance.
Probably the steroids- estrogen and progesterone
circulating during pregnancy make the breast tissues
unresponsive to prolactin.
When the estrogen and progesterone are withdrawn
following delivery, prolactin begins its milk sectretory
activity in previously fully developed mammary glands.
Prolactin and glucocorticoids are the important
hormones in this stage.
The secretory activity is enhanced directly or indirectly
by also growth hormone, thyroxine and insulin.
For milk secretion to occur, nursing effort is not
essential.
44. Galactokinesis
Discharge of milk from the mammary glands
depends not only on the suction exerted by the baby
during suckling but also on the contractile
mechanism which expresses the milk from the alveoli
into the ducts.
Oxytocin is major galactokinesis hormone.
During suckling,a conditioned reflex is set up.
The ascending tackle impulses from the nipple and
areola pass via thoracic sensory (4,5 and 6) afferent
neural arc to the paraventricular and supraoptic
nuclei of the hyppthalamus to synthesize and
transport oxytocin to the posterior pitutary.
45. Oxytocin (efferent arc via blood), is liberated from the
posterior pitutary, produces contraction of the
myoepithelial cells of the alveoli and the ducts
containing the milk.
This is the “milk ejection” or “milk let down” reflex
whereby he milk is forced down into the ampulla of the
lactiferous ducts, where from it can be expressed by
the mother or sucked out by the baby.
Presence of the infant or infant's cry can induce let
down without suckling.
A sensation of rise of pressure in the breasts by milk
experienced by the mother at the beginning of sucking
is called “draught”.
This can be also produced by the injection of oxytocin
46. The milk ejection reflex is inhibited by factors such
as pain, breast engorgement or adverse psychic
condition.
The ejection reflex may be deficient for several days
following initiation of milk secretion and results in
breast engorgement.
47. Galactopoiesis
Prolactin appears to be the single most important
galactpoietic hormone.
For maintenance of effective and continuous
lactation, suckling is essential.
It is not only essential for the removal of milk from
the glands, but it also causes the release of prolactin.
Secreation is continuous process unless suppressed
by congestion or emotional disturbances.
Milk pressure reduces the rate of production and
hence periodic breastfeeding is neccessary to relieve
the pressure which in turn maintains the secreation.
48.
49. MILK PRODUCTION
A healthy mother will produce about 500-800 ml of
milk a day to feed her infant.
This require about 700 Kcal/day for the mother,
which must be made up from diet or from her body
store.
For this purpose a store of about 5 kg of fat during
pregnancy is essential to make up any nutritional
deficit during lactation.
50. STIMULATION OF LACTATION
Mother is motivated as regard the benifits of
breastfeeding sincethe early pregnancy.
No prelacteal feeds (honey, water) are given to the
infant.
Following delivery important steps are:
1. To put the baby to the breast at 2-3 hours interval
from t first day.
2. Plenty of fluids to drink.
3. To avoid breast engorgement.
Early (1/2-1 hour) and exclusive breastfeeding in
correct position are encouraged.
51. INADEQUATE MILK PRODUCTION (Lactation Failure)
It may be due to infrequent suckling or due to
endogenous supression of prolactin (ergot
preparation, pyridoxin, diuretics or retained placental
bits)
Pain, anxiety and insecurity may be the hidden
reasons.
Unrestricted feeding at short interval (2-3 hours) is
helpful.
52. DRUGS TO IMPROVE MILK PRODUCTION (Galactogogues)
Metoclopramide (10 mg thrice daily) increases milk
volume (60-100%) by increasing prolactin levels.
Sulpuride (dopamine antagonist) has also been found
effective.
Intranasal oxytocin contracts myoepithelial cells and
causes milk let down.
53. LACTATION SUPPRESION
It may be needed for women who cannot breastfeed for
personal or medical reasons.
Lactation is suppressed when the baby is born dead or
dies in the neonatal period or if breastfeeding is
contraindicated.
Methods commonly used are:
1. To stop breastfeeding
2. To avoid pumping or milk expression
3. To wear breast support
4. Ice packs to prevent engagement
5. Analgesics (aspirin) to relieve pain
6. A tight compression bandage is applied for 2-3 days
54. MEDICAL METHODS OF SUPPRESION
With estrogen, androgen or bromocriptine is
not recommended.
The side effects of bromocriptine are:
hypotenaion, rebound secretion, seizures,
myocardial infarction and puerperal stroke.
55. Breast milk for premature infant is beneficial by
many ways (psychological, nutritional and
immunological).
Metabolic disturbances like azotemia,
hyperaminoacidemia and metabolic acidosis are
less with breast milk compared to formula.
It gives immunological protection to the
premature infant.
There are methods for collection (manual
expression or electric pumps), and milk
preservation
56. Principles in management
1. To restore the health of the mother.
2. To prevent infection.
3. To care of the breasts, including promotion
of breastfeeding.
4. To motivate the mother for contraception.
57. IMMEDIATE ATTENTION
Immediately following delivery, the patient should be
closely observed as outlined in the management of the
fourth stage of labour.
She may be given a drink of her choice or something
to eat, if she is hungry.
Emotional support is essential.
Usually the first feeling of mother is the sense of
happiness and relief, with the birth of a healthy baby.
The woman needs emotional support when she
suffers from postpartum blues or stress due to
newborn's prematurity, illness,congenital
malformation or death.
58. REST AND AMBULANCE
Early ambulation after delivery is beneficial.
After a good resting period, the patient becomes fresh
and can breastfeed the baby or moves out of bed to go
to the toilet. Early ambulation is encouraged.
Advantages:-
1. Provides a sense of well-being.
2. Bladder complications and constipation are less
3. Facilitates uterine drainage and hastens involution
4. Lessens puerperal venous thrombosis and embolism.
Following an uncomplicated delivery, climbing stairs,
lifting objects, daily household work, cooking may be
resumed.
59. HOSPITAL STAY
Early discharge from the hospital is an important
universal procedure.
If adequate supervision by trained health visitors is
provided, there is no harm in early discharge.
Most women are discharged fit and healthy after 2
days of spontaneous vaginal delivery with proper
education and instructions.
Early discharge may be done in few selected women.
Some need prolonged hopsitalization due to
morbidities. (infections of urinary tract, or the perineal
wound, pain, or breastfeeding problems).
60. DIET
The patient should be on normal diet of her choice.
If the patient is lactating, high calories, adequate
protein, fat, plenty of fluids, minerals and vitamins are
to be given.
However, in non-lactating mothers, a diet as in non-
pregnant is enough.
61. CARE OF THE BLADDER
The patient is encouraged to pass urine following
delivery as soon as convenient.
At times, the patient fails to pass the urine and causes
are:-
1. Unaccustomed position
2. Reflex pain from the perineal injuries.
This is common after a difficult labour or a forceps
delivery.
If the patient still fails to pass urine, catheterization
should be done.
62. Catheterization is also indicated in case of incomplete
emptying of the bladder evidenced by the presence of
residual urine of more than 60 ml.
Continuous drainage is kept until the bladder tone is
regained.
The underlying principle of the bladder care is to
ensure adequte drainage of urine so that infection and
cystitis are avoided.
63. CARE OF THE BOWEL
The problem of constipation is much less because of
early ambulation and liberalization of the dietary
intake.
A diet containing sufficient roughage and fluids is
enough to move the bowel.
If neccessary, mild laxative may given at bed time.
64. SLEEP
The patient is in need of rest,both physical and
mental.
So she should be protected against worries and undue.
Sleep is ensured providing adequate physical and
emotional support.
If there is any discomfort, such as after pains or
painful piles or engorged breasts, they should be
dealth with adequate analgesics. (Ibuprofen)
65. CARE OF THE VULVA & EPISIOTOMY WOUND
Shortly after delivery, the vulva and buttocks are
washed with soap water down over the anus and a
sterile pad is applied.
The patient should look after personal cleanliness of
the vulval region.
The perineal wound should be dressed with spirit and
antiseptic powder after each act of micturition and
defication or atleast twice a day.
The nurse should use sterilised gloves during dressing.
Cold (ice) sitz baths relieve pain.
66. When the perineal pain is persistant, a vaginal and
rectal examination is done to detect any hematoma,
wound gaping or infection.
For pain Ibuprofen is safe for nursing mothers.
67. CARE OF THE BREASTS
The nipple should be washed with sterile water before
each feeding.
It should be cleaned and kept dry after the feeding is
over.
A nursing brassiere provides comfortable support.
Nipple soreness is avoided by frequent short feedings
rather than the prolonged feeding, keeping the nipple
clear and dry.
Candida infection may be another cause.
68. Nipple confusion is the situation where the infant
accepts the artificial nipple but refuses the mother's
nipple.
This is avoided by making the mother's nipple more
protractile and not offering any supplemental fluids to
the infant.
69. MATERNAL-INFANT BONDING (Rooming-In)
It starts from the first few moments after birth.
This is manifested by fondling, kissing, cuddling and
gazing at the infant.
The baby should be kept in her bed or in a cot besides
her bed.
This not only establishes the mother-child telationship
but the mother is conversant with the art of baby care
so that she can take full care of the baby while at
home.
Baby friendly hospital initiative promotes parent-
infant-bonding, baby rooming with the mother and
breast feeding.
70. ASEPSIS AND ANTISEPTICS
Asepsis must be maintained especially during the first
week of puerperium.
Liberal use of local antiseptics, aseptic measures
during perineal wound dressing, use of clean bed linen
and clothings are positive steps.
Clean surroundings and limited number of visitors
could be of help in reducing nosocomial infection.
71. IMMUNIZATION
Administration of anti-D-gamma globulin to
unimmunized Rh-negative mother bearing Rh-positive
baby.
Women who are susceptible to rubella can be
vaccinated safely with attenuated rubella virus.
Mendatory postponement of pregnancy for at
least two months following vaccination can easily
be achieved.
The booster dose of tetanus toxoid should be given at
the time of discharge, if it is not given during
pregnancy.
72. After pain
It is the infrequent, spasmodic pain felt in the
lower abdomen after delivery for a variable
period of 2-4 days.
Presence of blood clots or bits of the after-
births lead to hypertonic contractions of the
uterus in an attempt to expell them out.
This is commonly met in primipara.
The pain may also be due to vigorous uterine
contractions especially in multipara.
73. The mechanism of pain is similar to cardiac
anginal pain induced by ischemia.
Both the types are excited during
breastfeeding.
The treatment induces massaging the uterus
with expulsion of the clot followed by
administration of analgesics (Ibuprofen) and
antispasmodics.
74. Pain on the perineum
Never forget to examine the pernium when
analgesic is given to relieve pain.
Early detection of vulvo-vaginal hematoma
can thus be made.
Sitz baths (hot or cold) can give additional
pain relief.
75. Correction of anemia
Majority of the women in the tropics remain in
an anemic state following delivery.
Supplimentary iron therapy (ferrous sulfate 200
mg) is to be given daily for a minimum period of
4-6 weks.
Hypertension is to be treated until it comes to a
normal limit.
The physician should be consulted if
proteinuria persists.
76. TO MAINTAIN A CHART
A progress chart is to be maintained noting the
following:-
Pulse, respiration and temperation recording
6 hourly or at least twice a day.
Measurement of the height of the uterus
above the symphysis pubis once a day in a
fixed time with prior evacuation of the
bladder and preferably the bowel too.
Charater of lochia
Urination and bowel movement.
77.
78. POSTPARTUM EXERCISE
The objectives of postpartum execises are:-
To improve the muscle tone, which are
stretched during pregnancy and labour
especially the abdominal and perineal
muscles.
To educate about correct posture to be
attained when the patient is getting up from
her bed.
This also includes the correct principle of
lifting and working positions during day-to-
day activities.
79. Advantages gained thereby are
To minimize the risk of puerperal venous
thrombosis by promoting arterial circulation
and preventing venous stasis
To prevent backache
To prevent genital prolapse and stress
incontinence of urine.
80. Procedure
Initially, she is taught breathing exercise and
leg movements lying in bed.
Gradually, she is instructed to tone up the
abdominal and peineal muscles and to
correct the postural defects.
These can well be taught by a trained
physiotherapist.
The exercise should be continued for at least
3 months.
81. The common exercises prescribed are...
a. To tone up the pelvic floor muscles
The patient is asked to contract pelvic muscles in a
manner to withhold the act of defecation or
urination and then to relax.
The process is to be repeated as often as posible
each day.
b. To tone up the abdominal muscles
The patient is to lie in dorsal position with the
knees bent and the feet flat on the bed.
The abdominal muscles are cntracted and relaxed
alternately and the process is to be repeated
several times a day.
82. c. To tone up the back muscles
The patient is to lie on her face with the arms by
her side.
The head and the shoulders are slowly moved up
and down.
The procedure is to be repeated 3-4 times day and
gradually increased each day.
83. Physical activity should be resumed without delay.
Sexual activity may be resumed (after 6 weeks)
when the perineum is comfortable and bleeding has
stopped.
Some women may get “flaring response” of some
autoimmune disorders due rebound effect of the
immune supression during pregnancy.
84. CHECK-UP & ADVICE ON DISCHARGE
A thorough check-up of the mother and the
baby is mandatory prior to discharge of the
patient from the hospital.
Discharge certificate should have all the
important information as regard the mother
and baby.
85. Advices include
Measures to improve her general health. Continuation
of supplimentary iron therapy.
Postnatal exercises
Procedures for a gradual return to day-to-day
activities
Breastfeeding and care of the newborn
Avoidance of intercourse for a reasonable period of 4-
6 weeks until lacerations or episiotomy wound are
well healed.
Family planning advice and guidance- Non lactating
woman should practice some form of contraceptive
measures after 3 weeks and the lactating women
should start 3 months after delivery
86. The method of contraception will depend upon
breastfeeding status, state of health and number
of children.
Natural methods cannot be used until mentrual
cycles are regular.
Exclusive breastfeeding provides 98%
contraceptive protection for 6 months.
Barrier methods m used.
Steroid contraceptions- combined preparations
are suitable for non-lactating women and should
be started 3 weeks after.
87. In lactating women it is avoided due to its
suppressive effects.
Progestin only pill may be better choice for
them.
Other progestins (DMPA, Levonorgestrel
implants) may be used.
IUDs are also a satisfactory method irrespective
of breastfeeding status.
Sterilization (puerperal) is suitable for those
who have completed their families.
88. Postnatal care includes systematic
examination of the mother and the baby and
appropriate advise given to the mother during
postpartum period.
The first postnatal examination is done and
the advise is given on discharge of the patient
from the hospital.
The second routine postnatal care is
conducted at the end of 6th week postpartum.
89. Aims and objectives
To assess the health status of the mother.
Medical disorders like diabetes, hypertension
should be reassessed.
To detect and treat at the earliest any
gynecological condition arising out of obstetric
legacy.
To note the progress of the baby including the
immunization schedule for the infant.
To impart family planning guidance.
91. Examination of the mother
Routine examination includes recording weight, pallor,
blood pressure and tone of the abdominal muscles and
examination of the breasts.
Pelvic examination should be done only when indicated.
The following should be noted:
A cervical smear may be taken for exfoliative cytological
examination if this h not been done previously and
insertion of intrauterine contraceptive device may be
done when desired.
Laboratory investigations depends on the clinical need
may be advised.
92. Examination of the baby
This should be conducted by a pediatrician.
In this respect, an attached well baby clinic to the
postpartum unit is an ansolute necessity.
The progress of the baby is evaluated and
preventive or curative steps are to be taken.
Immunization to the baby is started.
93. Advice given
General:
If the patient is in sound health she is allowed to do
her usual duties.
Postpartum excercise may be continued for another
4-6 weeks.
To evaluate the progress of the baby periodically
and to continue breastfeeding for 6 months.
Family planning counseling and guidance
94. Management of ailments
Additional investigation and appropriate
therapy is given according to the
abnormalities detected during check up.
Management of some common gynecological
problems are given below. Some women need
psychological support also.
95. Irregular vaginal bleeding
It is not uncommon to encounter irregular or at
times, heavy bleeding after 4-6 weeks following
an uneventfull period after delivery.
This is usually the first period especially in non-
lactating women and simple assurance is enough.
Persistence of bleeding dating back from
childbirth is likely due to retained bits of
conceptus and usually requires ultrasound
examination followed by dilated and curettage
operation.
96. Leukorrhea
Profuse white discharge might be due to ill health,
vaginis, cervicitis or subinvoltution.
Improvement of the general health and specific therapy
cure the condition.
Cervical ectopy (erosion)
Cervical ectopy (erosion) met during this period
without any symptom should not be treated surgically.
Hormone induced ectopy during pregnancy takes a
longer time (about 12 weeks) to regress.
Thus, asymptomatic ectopy should be examined again
after 6 weeks and if it still persists, cauterization is to be
considered.
97. Backache
It is mostly due to sacroiliac or lumbosacral
strain.
Bachache situated over the sacrum is likely due
to pelvic pathology, but if it is over the lumbar
region, it might be due to an orthopedic
condition and is often relieved by physiotherapy.
Retroversion seldom proceduced backache.
If associated with subinvolution with symptoms,
a pessary is inserted after correcting the position
and is to be kept about 2 months.
98. Slight degree of uterine descent with cystole,
stress incontinence and relaxed perimium are the
common findings at this stage.
These can be cured by effective pelvic floor
exercise.
However, if the prolapse is marked, effective
surgery should be done after three months.