The document discusses the normal puerperium period following childbirth. It defines puerperium as the period of approximately 6 weeks postpartum where the body reverts back to its pre-pregnant state anatomically and physiologically. It describes the anatomical changes like uterine involution and the physiological changes in various body systems. It also discusses lactation, nursing management including care of the mother and newborn, management of minor ailments, and checkups before discharge.

1. MS.SASIKALA .N, MSC (N),
OBSTETRICS & GYNECOLOGICAL NURSING
LECTURER
GANGA COLLEGE OF NURSING
COIMBATORE

2. Normal Puerperium

3. Content Overview
• Puerperium : Definition
• Duration
• Anatomical Changes
• Physiological changes
• Lactation
• Nursing Management
• Management Of Minor Ailments
• Records
• Check up And Advice On Discharge.

4. Introduction
 Postpartum period is the period beginning
immediately after the birth of a child and
extending for about six weeks
 The WHO describes the Postnatal period as the
most critical and yet the most neglected phase in
the lives of mothers and babies; most death occurs
during the Postnatal period.

5. Definition – Puerperium
• Puerperium is the period following the childbirth
during which the body tissues, specially the pelvic
organs revert back approximately to the pre
pregnant state both Anatomically and
Physiologically
• Involution is the process whereby the genital
organs revert back approximately to the state as
they were before pregnancy.
The women is termed as Puerpera.

6. Duration
• Puerperium begins as soon as the placenta
expelled and last for approximately 6 weeks when
Maternal system return to pregnant state.
Immediate : within 24 hours
Early : up to 7days
Remote : up to 6weeks.

7. Anatomical changes during Puerperium
1. Involution of uterus :
Uterus :
• Becomes firm and retracted with hardening and
softening.
• Measures about 20x12x7.5cm(Length x Breadth x
Thickness) and weighs about 1000gm
• At the end of 6 weeks become non pregnant state
weight about 60gm.

8. Cont..
Lower uterine segment :
● Immediately following delivery, the
Lower segment becomes a Thin, Flabby,
Collapsed structure.
● It takes few weeks to get revert back to pre-
pregnant state.

9. Cont…

10. Cont…
Clinical assessmentof Involutionofuterus
• Funduslies13.5cm forthe 1st24hrs following delivery
• Steady decrease by1.25cminnext24hrs
• At Day14(2ndweek)-notpalpable-pelvicorgan
Cervix contracts slowly,
• External os : for few days can admit 2 fingers.by
the end of 1st week narrow down can admit tip of
finger only.
• Cervix never return back to nulliparous state.
• Internal os : closes as before

11. Physiological changes
 Muscles:
myometrial
autolysis cellsizereduced
Inc.
steroid collagenase
hormones andproteolyticenzyme
Endophlebitis Thrombosis
Fibrinoid endarteritis Hyalinisation
BloodVessels

12. Cont…
 Endometrium
 Regenerationstartson day 10
 Endometrium arises from proliferation of
endometrial glandular and stroma of the inter
glandular
• By the 10th day : regeneration of epithelium
completed.
• By the 16th day : the endometrium is restored.
• At about 6 weeks : the endometrium of placental
site is restored

13. Placental site involution

14. Other pelvic structure
4-8weeks;
It regain its tone. but
Does not revert to
originalstate.
Hymen is lacerated and it
is like a nodular tag.
Vagina
Long time
d/t
stretching
during
parturition
Pelvicfloor&Fascia

15. Lochia
• Vaginal discharge for the 1stfortnight during
puerperium
● Odor: Offensive fishysmell
● Reaction :Alkaline reaction

16. Colour and Composition of Lochia
 Lochia Rubra : 1-4days
• Blood
• Fetal membrane & decidua
 Lochia serosa : 5-9days
• Less RBC
• Leucocytes, Microorganisms
• Shreds, Lanugo, Meconium
 LochiaAlba : 10-15days
• Leukocytes, Micro organism,
• Cholestrin crystals & Decidual cells

17. Measurement of discharge
• If it is excessive the number of pad changes can be
measured in every 15mins
• Weighing measures : 1 gram = 1 ml of blood
• By inch tape :
• Scanty = <1 inch stain
• Small = <4 inch
• Moderate = < 6 inch
• Heavy = > 6 inch
• Excessive : pad saturation with in 15mins

18. Clinical Importance
•Puerperal Sepsis,
•E.Coli, retained tissues.
•Infection
•Lochiometra
•Infection
•Sub involution
•Retainedconceptus
•Causes secondaryPPH
•Local genitalinfection
Malodorous
Scanty/absent
Excessive
Red colorpersist
Lochia Alba
beyond 3weeks

19. General physiological changes
 Pulse:
 Raises following delivery but settles down to
normal on 2nd day
 Temperature:
 It should not exceed 99 degree Fahrenheit.
Any raise above suggestive of infection of
Genito-urinarytract
 GIT:
 Increased thirstduetoexcessivebloodloss
 Constipation due to intestinal paresis
 Reduced abdominal muscle tone.

20. cont…
 UrinaryTract:
 Pronounced Diuresison 2nd -3rdday
 Overdistension
 Presence of residualurine
 High riskofinfection
 Weight Loss:
 5-6kgexpulsionof fetusplacenta, liqour,
blood
 2kg-during puerperium dt diuresis
 Continued up to 6monthsof delivery

21. Cont..
 BloodValues:
 Immediate-reduced blood volume;Normalin
2weeks
 Riseincardiacoutput; Normal in1week
 Leukocytosis dt stress
 Plateletcountreduced;normalstatewithin2wks.
 Menstruation:
 Ifnot breastfeeding- resumesin6wks in
40% cases and by 12th week in 80%
cases.
 If breast fed her baby then, the
menstruation occur until the baby stops
breast fed.

22. Cont..
 Ovulation:
 Non-lactating mother- 4wks
 Lactating mother- 10weeks
 Exclusive Breastfeeding- 98%contraception
up6months

23. Lactation
• Colostrum : First secretion from the beast milk is
called colostrum

24. Lactation reflex arc and the role of prolactin and
oxytocin

25. Changes in Breast and Lactation
• Mammary duct-
gland growth and
development
• Initiation of milk
secretion in alveoli
• Maintenance of
lactation
• Removal of milk
from gland

26. Physiology of lactation

27. Cont…
Composition of colostrum
 Deep yellow serous fluid
 High specific gravity
 High protein
 High vitamin A and chloride content
 Low carbohydrate fat and sodium content
Advantages :
 The Ab( IgA, IgG and IgM) and humoral factors
(lactoferrin) provide immunological defense to the
newborn
 It has laxative action on the baby because of large
fat globules

28. Nursing care of mother during
puerperium (immediate care)
Principles :
• To give all out attention to restore the health status
of the mother
• To prevent infection
• To take care of the breast, to promote lactation and
to take care of the child
• To motivate the mother for contraception

29. 1.Rest and ambulance
• Good rest to feel fresh and can breast feed the
baby.
• Good sleep is in need for both physical and mental
health
Early ambulation :
• To provide sense of wellbeing.
• Bladder complications and constipation are
reduced
• Facilitates uterine drainage and hastens involution
of the uterus
• Lessens puerperal venous thrombosis and

30. 2.Diet
Normal diet :
• High calories, adequate protein, fat, plenty of
fluids, minerals and vitamins

31. 3.Care of bowel and bladder
• The mother is encouraged to pass urine following
delivery as soon as convenient
• A diet containing sufficient roughage and fluids is
enough to move the bowel

32. 4. Care of vulva and episiotomy wound
• After delivery vulva and buttocks are washed with
soap and water down over the anus and a sterile
pad is applied.
• Personal cleanliness of the vulval region.
• The perineal wound should be dressed with spirit
and antiseptic powder after micturition and
defecation.
• Change sanitary pads atleast every 2-4hours
• Encourage sitz bath 20mnts thrice a day.
• Educate mother to take well balanced diet(rich
protein and vitamin)

33. Cont..
• Avoid from scratching or touching the wound site
unnecessarily.
• Educate the mother regarding signs of
infection(swelling, redness etc.)
• Early ambulation to help healing process of
episiotomy wound.
• Kegel exercise to strengthen the pelvis and lessen
perineal pain.

34. 5.Call doctor or health care provider if
mother has
• Repeated clots the size of a quarter or larger passing
from the vagina.
• Heavy or gushing bleeding from the vagina.
• Discharge that has a bad odor.
• Severe pain in the abdomen or increased pain near
your stitches.
• Fever or chill.
• No bowel movement within one week after the birth
of your baby.
• Pain or urgency with urination or inability to urinate.

35. 6.Care of breast
• The Nipple should be washed with water before
each feeding.
• It should be kept dry after the feeding is over
• Support he breast with brassiere.
• Avoid Nipple soreness.

36. 7.Maternal infant bonding-rooming in
• It starts from first few moments after birth.
• The baby should be kept in her bed or in a cot
besides her bed.
• Rooming in promotes parent infant bonding.
• Initiate breast feeding.

37. Positions and attachment

38. 8.Asepsis and antiseptics
• Maintain asepsis during perineal wound dressing
• Use clean bed linen and clothing
• Clean surroundings
• Limited number of visitors to prevent infection

39. 9.Management of ailments
After pain :
• Abdominal pain due to presence of placental bits
or blood clots
Nursing care:
• Massaging the uterus
• Check for expulsion of the clots
• Administer analgesics and antispasmodics
• If there is a pain in the perineum check for vulval
hematoma
Nursing care :
• Sitz bath with hot or cold water

40. Records
• Vital signs : record twice a day
• Measurement of height of the uterus above the
symphysis pubis once a day same time(check for
involution of the uterus)
• Character of lochia
• Bowel and bladder movement
For new born:
• Vital signs
• Weight
• Nutrition(sucking well)
• Bowel and bladder

41. Check up and advice on discharge
• Continuance of supplementary iron therapy
• Postnatal exercise
• Return back to routine physical activity
• Breast feeding and care of the New born
• Avoidance of intercourse 4-6weeks until
lacerations or episiotomy wound healing
• Family planning advice and guidance
• Postnatal check up after 6weeks.