The document summarizes key anatomical, physiological, and clinical aspects of the postpartum period known as the puerperium. It describes changes that occur in the vagina, uterus, cervix, breasts, blood, and other organs in the weeks following childbirth. These include uterine involution, endometrial regeneration, breastfeeding, weight loss, and the establishment of lactation and contraception. The summary provides an overview of the postpartum recovery process for new mothers.
Cervical incompetence is the inability for the cervix to retain an intra-uterine pregnancy till term as a result of structural and functional defects of the cervix.
Cervical incompetence is the inability for the cervix to retain an intra-uterine pregnancy till term as a result of structural and functional defects of the cervix.
Uterine Rupture
Deepa Mishra
Assistant Professor (OBG)
Introduction
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth
Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present.
Disability or death of the mother or baby may result.
Definition
Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus.
Incidence
Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9%
Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.
In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000
Risk of death of the baby is about 6%
Etiology
Risk Factors
Previous cesarean section
Myomectomy
Dysfunctional labor
Labor augmentation by oxytocin or prostaglandins
High parity
First pregnancy- very rare
Types of uterine rupture
Complete Rupture
All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity.
Usually results in death
Incomplete Rupture
Visceral peritoneum is intact and usually the fetus remains in the uterine cavity
Sign & Symptoms
Uterine dehiscence and abdominal pain and vaginal bleeding
Deterioration of fetal heart rate
Loss of fetal station on manual vaginal exam
Hypovolemic shock due to intrabdominal bleeding
Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum
Cessation of uterine contractions
Palpation of fetus outside the uterus
Signs of abdominal pregnancy
Post term pregnancy
Diagnosis
Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring
Absent fetal heart sound
On PV hot, dry vagina with a large caput over the presenting part
Prevention
Early diagnosis and management of CPD mal presentation and obstructed labor
Proper selection of cases for vaginal delivery
Carefull monitoring of oxytocin infusion specially in multipara
Avoid intra uterine manipulation no version in single fetus
Instrumental delivery after cervical dilatation
Immediate CS in obstructed labor
Hospital delivery for high risk cases
ECV should be avoided during general anaesthesia
Careful manual removal of placenta
Treatment
Resuscitation with adequate hydration and blood transfusion
Laprotomy
Hysterectomy
Repair
Complication
Rupture uterus with haemorrhage, shock and sepsis
Fetal loss is high in spontaneous and traumatic rupture
Mortality is low in LSCS scar rupture
Physiological Process that occur in a woman who has given birth up to 6wks postpartum, abnormal processes and their risk factors, clinical assessment and management
Lastly a brief review of anatomy of the breast
Physiological changes in pregnancy. It includes changes in the genital organs, uterus, cardiovascular changes, respiratory, metabolic, alimentary, skin, skeleton, psychological changes, urinary changes and weight gain in pregnancy.
VACUUM DELIVERY - OBSTETRICS AND GYNAECOLOGY-
DEALS WITH THE DELIVERY OF HUMAN BABY BY VACUUM IN SPECIAL OBSTETRIC CONDITIONS.
VACUUM is an instrumental device designed to assist delivery by creating a vacuum between it and the fetal scalp.
Uterine Rupture
Deepa Mishra
Assistant Professor (OBG)
Introduction
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth
Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present.
Disability or death of the mother or baby may result.
Definition
Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus.
Incidence
Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9%
Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.
In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000
Risk of death of the baby is about 6%
Etiology
Risk Factors
Previous cesarean section
Myomectomy
Dysfunctional labor
Labor augmentation by oxytocin or prostaglandins
High parity
First pregnancy- very rare
Types of uterine rupture
Complete Rupture
All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity.
Usually results in death
Incomplete Rupture
Visceral peritoneum is intact and usually the fetus remains in the uterine cavity
Sign & Symptoms
Uterine dehiscence and abdominal pain and vaginal bleeding
Deterioration of fetal heart rate
Loss of fetal station on manual vaginal exam
Hypovolemic shock due to intrabdominal bleeding
Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum
Cessation of uterine contractions
Palpation of fetus outside the uterus
Signs of abdominal pregnancy
Post term pregnancy
Diagnosis
Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring
Absent fetal heart sound
On PV hot, dry vagina with a large caput over the presenting part
Prevention
Early diagnosis and management of CPD mal presentation and obstructed labor
Proper selection of cases for vaginal delivery
Carefull monitoring of oxytocin infusion specially in multipara
Avoid intra uterine manipulation no version in single fetus
Instrumental delivery after cervical dilatation
Immediate CS in obstructed labor
Hospital delivery for high risk cases
ECV should be avoided during general anaesthesia
Careful manual removal of placenta
Treatment
Resuscitation with adequate hydration and blood transfusion
Laprotomy
Hysterectomy
Repair
Complication
Rupture uterus with haemorrhage, shock and sepsis
Fetal loss is high in spontaneous and traumatic rupture
Mortality is low in LSCS scar rupture
Physiological Process that occur in a woman who has given birth up to 6wks postpartum, abnormal processes and their risk factors, clinical assessment and management
Lastly a brief review of anatomy of the breast
Physiological changes in pregnancy. It includes changes in the genital organs, uterus, cardiovascular changes, respiratory, metabolic, alimentary, skin, skeleton, psychological changes, urinary changes and weight gain in pregnancy.
VACUUM DELIVERY - OBSTETRICS AND GYNAECOLOGY-
DEALS WITH THE DELIVERY OF HUMAN BABY BY VACUUM IN SPECIAL OBSTETRIC CONDITIONS.
VACUUM is an instrumental device designed to assist delivery by creating a vacuum between it and the fetal scalp.
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.
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These are fungal infections of the body which occur almost exclusively in debilitated patients whose normal defence mechanisms are impaired.
The organisms involved are cosmopolitan fungi which have a very low inherent virulence. The increased incidence of these infections and the diversity of fungi causing them, has parallelled the emergence of AIDS, more aggressive cancer and post-transplantation chemotherapy and the use of antibiotics, cytotoxins, immunosuppressives, corticosteroids and other macro disruptive procedures that result in lowered resistance of the host.
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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.
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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. PUERPERIUM
• Period of time
encompassing the
first few weeks(between 4 t
o 6 weeks) after birth
• May be a time of
intense anxiety for
many women
3. ANATOMICAL, PHYSIOLOGICAL
AND CLINICALASPECTS
OF PUERPERIUM
VAGINA AND VAGINAL OUTLET
• Early Puerperium: Vagina and its outlet form a
capacious, smooth-walled passage that gradually
diminishes in size but rarely returns to nulliparous
dimensions.
• 3rd week : rugae begin to reappear but are less
prominent than before.
• Myrtiform caruncles –
scarred small tags of tissue in the hymen
• 4th to 6th week : vaginal epithelium begins to
proliferate (coincidental with ovarian estrogen
production)
4. ANATOMICAL, PHYSIOLOGICAL
AND CLINICALASPECTS
OF PUERPERIUM
• UTERINE
VESSELS During pregnancy:
• Massively increased uterine blood
flow
• Significant hypertrophy
and remodelling of all pelvic
vessels
• After delivery
• caliber of extrauterine vessels decr
eases to equal, or at least closely
approximates, that of the prepregn
ant state.
• larger blood vessels are obliterated
by hyaline changes, gradually
resorbed, and replaced by
smaller ones.
• Minor vestiges
of the larger vessels, however, may
persist for years.
5. ANATOMICAL, PHYSIOLOGICAL
AND CLINICALASPECTS
OF PUERPERIUM
CERVIX
• external os is usually lacerated, especially
laterally
• cervical opening contracts slowly, and for a
few days
immediately after labor readily admits two
fingers.
End of 1stweek:
• Cervix narrows, thickens, and a
canal reforms
• external os does not completely
resume its pregravid appearance
• It remains wider and bilateral depressions
at the site of laceration – PAROUS CERVIX
6. ANATOMICAL, PHYSIOLOGICAL
AND CLINICAL ASPECTS OF
PUERPERIUM
• UTERINE INVOLUTION
• after placental expulsion, the fundus of
the contracted uterus is slightly below
the umbilicus
• Anterior and posterior walls, in close
apposition, each measures 4 to 5 cm
thick
• ischemic organ (vessels are
compressed by the contracted
myometrium) -puerperal uterus
• reddish-purple hyperemic organ –
pregnant
• 2 days after delivery-uterus begins to
involute
• 2 weeks after delivery-uterus
descended into the cavity of the true
pelvis
7. ANATOMICAL, PHYSIOLOGICAL
AND CLINICAL ASPECTS OF
PUERPERIUM
• UTERINE INVOLUTION
• 4 weeks after delivery-uterus
regains its previous nonpregnant
size
• Immediately postpartum, the
uterus weighs approximately 1000 g
• 1 week later it weighs about 500 g
• 2 weeks later it weighs about 300 g,
and soon thereafter to 100 g or less
• total number of muscle cells does
not decrease, but instead, the
individual cells decrease markedly
in size.
8. CROSS SECTIONS OF
UTERI MADE AT THE
LEVEL OF THE
INVOLUTING PLACENTAL
SITE AT VARYING TIMES
AFTER DELIVERY CROSS
SECTIONS OF UTERI
MADE AT THE LEVEL OF
THE INVOLUTING
PLACENTAL SITE AT
VARYING TIMES AFTER
DELIVERY
Cross sections of uteri made at the level of the involuting
placental site at varying times after delivery. p.p. = postpartum.
9. ANATOMICAL, PHYSIOLOGICAL
AND CLINICAL ASPECTS OF
PUERPERIUM
• Sonographic Findings:
• It takes up to 5 weeks for
the uterine cavity to
regress to its
nonpregnant state of a
potential space
• By Doppler studies,
there is continuously
increasing uterine artery
vascular resistance
during the first 5
postpartum days
Sonographic measurements of uterine involution
during the first 9 days postpartum. AP = anteroposterior.
(Data from Hytten, 1995.)
10. ANATOMICAL, PHYSIOLOGICAL AND
CLINICAL ASPECTS OF PUERPERIUM
• ENDOMETRIAL REGENERATION
• 2 or 3 days after delivery, the remaining
decidua becomes differentiated into two layers
• superficial layer- becomes necrotic, and it is
sloughed in the lochia
• basal layer- adjacent to the myometrium,
remains intact and is the source of new
endometrium
• The endometrium arises from proliferation of
the endometrial glandular remnants and the
stroma of the intraglandular connective tissue
11. ANATOMICAL, PHYSIOLOGICAL AND CLINICAL
ASPECTS OF PUERPERIUM
• Endometrial regeneration is rapid, except at the placental site
• Full restoration of the endometrium is obtained 16th day onward
• HISTOLOGIC ENDOMETRITIS – part of normal reparative process
• ACUTE SALPINGITIS seen in almost half of postpartum women
between 5 and 15 days
12. ANATOMICAL, PHYSIOLOGICAL AND CLINICAL ASPECTS OF PUERPERIUM
• AFTER PAINS
• Similar but milder that the pain of labor
contractions
• primiparas, the puerperal uterus tends to
remain tonically contracted
• multiparas, the uterus often contracts
vigorously at intervals, and gives rise to
afterpains
• more pronounced as parity increases
• worsen when the infant suckles
• decrease in intensity and become mild by
the third day
13. ANATOMICAL, PHYSIOLOGICAL AND CLINICAL ASPECTS OF PUERPERIUM
• LOCHIA
• sloughing of decidual tissue results in a
vaginal discharge of variable quantity
• consists of erythrocytes, shredded decidua,
epithelial cells, and bacteria
• LOCHIA RUBRA- first few days after delivery,
there is blood sufficient to color it red
• LOCHIA SEROSA- After 3 or 4 days, lochia
becomes progressively pale in color
• LOCHIA ALBA- After about the 10th day,
because of an admixture of leukocytes and
reduced fluid content, lochia assumes a white
or yellowish-white color
14. ANATOMICAL,
PHYSIOLOGICAL
AND CLINICAL
ASPECTS OF
PUERPERIUM
PLACENTAL SITE INVOLUTION- a process of exfoliation,
consequence of sloughing of infarcted and necrotic
superficial tissues followed by a reparative process.
placental site is about the size of the palm of the hand,
rapidly decreases thereafter
end of the second week, it is 3 to 4 cm in diameter.
Complete extrusion of the placental site takes up to 6 weeks
when it is defective, late-onset puerperal hemorrhage may
ensue
15. ANATOMICAL,
PHYSIOLOGICAL
AND CLINICAL
ASPECTS OF
PUERPERIUM
• SUBINVOLUTION
• an arrest or retardation of involution
• prolongation of lochial discharge
• irregular or excessive uterine bleeding
• uterus is larger and softer than would be
expected
• due to retention of placental fragments and
pelvic infection
16. ANATOMICAL, PHYSIOLOGICAL AND
CLINICAL ASPECTS OF PUERPERIUM
• Management of Subinvolution
• Ergonovine or methylergonovine, 0.2 mg every 3 to 4 hours for 24 to 48 hours
• Antibiotic therapy for bacterial metritis
• Chlamydia trachomatis
• cause of almost third of late postpartum uterine infection;
• treated with Azithromycin or Doxycycline
17. LATE POSTPARTUM
HEMORRHAGE
• develops 1 to 2 weeks into
the puerperium
• result of abnormal
involution of the placental
site, retention of a portion
of the placenta
• initial treatment may be
best directed to medical
control of the bleeding with
intravenous oxytocin,
ergonovine,
methylergonovine, or
prostaglandins
• curettage is carried out only
if appreciable bleeding
persists or recurs after
medical management
18. URINARY TRACT
CHANGES
• diuresis that occurs postpartum (2nd-5th day) is a
physiological reversal of increase in extracellular
water in normal pregnancy
• puerperal bladder has an increased capacity and a
relative insensitivity to intravesical fluid pressure
• paralyzing effect of analgesics, especially epidural
and spinal blocks are contributory
• Overdistention, incomplete emptying, and
excessive residual urine are common
• dilated ureters and renal pelves return to their
prepregnant state over the course of 2 to 8 weeks
after delivery
• dilated renal pelves and ureters, and traumatized
bladder create an optimal condition for the
development of UTI
19. INCONTINENCE
3% to 26% of women
report daily episodes
of incontinence in the
3 to 6 months after
delivery
Can be due to
Impaired muscle
function in or around
the urethra as a result
of vaginal delivery
correlated with
obstetrical factors
such as length of
second-stage labor,
infant head
circumference,
birthweight, and
episiotomy
women whose
deliveries had all
been vaginal had a
70-percent higher risk
of incontinence than
women whose
deliveries had all
been by cesarean
20. PERITONEUM
AND
ABDOMINAL
WALL
abdominal wall remains soft and flaccid due
to rupture of elastic fibers in the skin and the
prolonged distention caused by the pregnant
uterus
several weeks are required for these
structures to return to normal
DIASTASIS RECTI- marked separation of the
rectus muscles ,midline abdominal wall is
formed only by peritoneum, attenuated
fascia, subcutaneous fat, and skin
21. BLOOD AND
FLUID
CHANGES
• marked leukocytosis and thrombocytosis occur
during and after labor
• relative lymphopenia and an absolute
eosinopenia
• during the first few postpartum days, hemoglobin
concentration and hematocrit fluctuate
moderately
• 1 week after delivery, the blood volume has
returned nearly to its nonpregnant level
22. WEIGHT LOSS
loss of about 5 to 6 kg due to
uterine evacuation and
normal blood loss
loss of about 2 to 3 kg
through diuresis
23. MAMMARY GLANDS
composed of 15 to 25 lobes
arranged radially and are
separated from one another by
varying amounts of fat
lobe consists of several lobules,
which are made up of large
numbers of alveoli, every alveolus
is provided with a small duct
alveolar secretory epithelium
synthesizes the various milk
constituents Schematic of the alveolar and ductal system during
lactation. Note the myoepithelial fibers (M) that surround
the outside of the uppermost alveolus. The secretions from the
glandular elements are extruded into the lumen of the alveoli (A)
and ejected by the myoepithelial cells into the ductal system (D),
which empties through the nipple. Arterial blood supply to the
alveolus is identified by the upper right arrow and venous drainage
by the arrow beneath.
A
A
D
D
M
24. BREASTFEEDING
• COLOSTRUM- deep lemon-yellow-colored liquid,
expressed from the nipples by the 2nd postpartum
day, contains more minerals and protein, much of
which is globulin, but less sugar and fat
• secretion persists for about 5 days, with gradual
conversion to mature milk during the ensuing 4
weeks
• content of immunoglobulin A (IgA) may offer
protection for the newborn against enteric
pathogens
• host resistance factors that are found in colostrum
and milk:
• complement, macrophages, lymphocytes,
lactoferrin, lactoperoxidase, and lysozymes
25. HUMAN MILK
• a suspension of fat and protein in a carbohydrate-mineral solution
• nursing mother easily makes 600 mL of milk per day
• Whey is milk serum and has been shown to contain large amounts of
interleukin-6 (IL-6)
• positive correlation between its concentration and the number of mononuclear
cells in human milk
• IL-6 was associated closely with local IgA production by the breast
• Prolactin and Epidermal growth factor
• All vitamins except K are found in human milk
• Vitamin K administration to the infant soon after delivery is required to prevent
hemorrhagic disease of the newborn
26. ENDOCRINOLOGY OF
LACTATION
Progesterone ,estrogen, and placental lactogen,
prolactin, cortisol, and insulin: stimulate the
growth and development of the milk-secreting
apparatus of the mammary gland
Decrease estrogen and progesterone
Removes the inhibitory influence of progesterone
on the production of alpha lactalbumin by the
rough endoplasmic reticulum
increased alpha lactalbumin stimulate lactose
synthase
increase milk lactose
neurohypophysis secretes oxytocin in pulsatile
fashion
stimulates milk expression from a lactating
breast by causing contraction of myoepithelial
cells in the alveoli and small milk ducts
27. IMMUNOLOGICAL CONSEQUENCES OF
BREASTFEEDING
predominant immunoglobulin in milk is secretory IgA
• SECRETORY IgA is secreted across mucous membranes and has important antimicrobial
functions
• breast-fed infants are less prone to enteric infections than bottle-fed infants
• human milk also provides protection against rotavirus infections,Escherichia coli infections
• contains both T and B lymphocyte
• milk T lymphocytes are almost exclusively composed of cells that exhibit specific membrane
antigens
28. NURSING
• Human milk is ideal food for neonates. It provides species- and age-specific
nutrients for the infant. In addition to the proper balance of nutrients,
immunological factors, and antibacterial properties, human milk contains
factors that act as biological signals for promoting cellular growth and
differentiation
• provides strong evidence that human milk feeding decreases the incidence
and/or severity of diarrhea, lower respiratory infection, otitis media,
bacteremia, bacterial meningitis, botulism, urinary tract infection, and
necrotizing enterocolitis. There are a number of studies that
• shows a possible protective effect of human milk feeding against sudden
infant death syndrome, insulin-dependent diabetes mellitus, Crohn disease,
ulcerative colitis, lymphoma, allergic diseases, and other chronic digestive
diseases.
• Breast feeding has also been related to possible enhancement of cognitive
development
29. NURSING
Ideal for neonates
Provides species and age specific nutrients
Promotes cellular growth & differentiation
Decreases incidence of infections
Protective against: SIDS, IDDM, IBD, Lymphoma,
Allergy, Chronic Digestive disease
Enhances Cognitive development
30. LACTATION
INHIBITION
• Milk leakage, engorgement, and breast pain
peak at 3 to 5 days postpartum
• Ice packs and oral analgesics for 12 to 24 hours
may be required to relieve
• Bromocriptine ,a commonly used drug for
lactation inhibition, had been associated with
strokes, myocardial infarctions, seizures, and
psychiatric disturbances.
31. CONTRACEPTION
FOR
BREASTFEEDING
WOMEN
• Recommendations for Hormonal Contraception if Used
by Breast Feeding Women
• Progestin-only oral contraceptives prescribed or
dispensed at discharge from the hospital to be started 2–3
weeks postpartum—for example, the first Sunday after the
newborn is 2 weeks of age.
• Depot medroxyprogesterone acetate initiated at 6
weeks postpartum.a
• Hormonal implants inserted at 6 weeks postpartum.
• Combined estrogen–progestin contraceptives, if
prescribed, should not be started before 6 weeks
postpartum, and only when lactation is well established
and the infant's nutritional status well monitored
32. CONTRAINDICATIONS
TO BREASTFEEDING
• in women who take street drugs or do not control their
alcohol use
• have an infant with galactosemia
• have human immunodeficiency virus (HIV) infection
• have active, untreated tuberculosis
• take certain medications
• undergoing treatment for breast cancer
• *although hepatitis B virus is excreted in milk, breast feeding
is not contraindicated if hepatitis B immune globulin is given
to infants of seropositive mothers.
• * Maternal hepatitis C infection is also not a
contraindication to breast feeding
• * Women with active herpes simplex virus may suckle their
infants if there are no breast lesions and if particular care is
directed to hand washing before nursing.
33. NIPPLE CARE
CLEANLINESS AND
ATTENTION TO FISSURES
CLEANING OF THE AREOLA
WITH WATER AND MILD
SOAP IS HELPFUL BEFORE
AND AFTER NURSING
WHEN THE NIPPLES ARE
IRRITATED, USE A NIPPLE
SHIELD FOR 24 HOURS OR
LONGER
35. Drugs That Have Been Associated with
Significant Effects on Some Nursing
Infants
• *cytotoxic drugs may interfere with the cellular metabolism
of the infant and potentially cause immune suppression
or neutropenia, affect growth, or, at least theoretically,
increase the risk of cancer
• 1.cyclophosphamide
• 2.cyclosporine
• 3.doxurubicin
• 4.methotrexate
• * Radioactive isotopes of copper, gallium, indium, iodine,
sodium, and technetium rapidly appear in breast milk. This
ranges from 15 hours up to 2 weeks, depending on the
isotope used.
36.
37. BREAST FEVER
• breasts become distended, firm, and nodular
• a transient elevation of temperature (ranged
from 37.8 to 39°)
• Treatment: supporting the breasts with a
binder or brassiere, applying an ice bag, an
analgesic, pumping of the breast or manual
expression of milk
38. MASTITIS
• infection of the mammary glands during the
puerperium and lactation or antepartum
• unilateral, and marked engorgement usually precedes
the inflammation.
• first sign of inflammation is chills or actual rigor, soon
followed by fever and tachycardia.
• About 10 % of women with mastitis develop an
abscess
• ETIOLOGY: Staphylococcus aureus – 40 %; coagulase-
negative staphylococci and viridans streptococci
• Immediate source of organisms almost always the
infant's nose and throat
•
39. TREATMENT:
MASTITIS
• clinicians recommend that milk be expressed from
the affected breast onto a swab and cultured
• initiate antimicrobial therapy:
• staphylococcal infections are usually sensitive to
penicillin or a cephalosporin
• Dicloxacillin 500 mg orally four times daily, may
be started empirically
• Erythromycin is given to women who are
penicillin sensitive
• Vancomycin is effective against MRSA
• treatment should be continued for 10 to 14 days
• If the infected breast is too tender to allow
suckling, gently pumping until nursing can be
resumed is recommended.
40. BREAST ABSCESS
• development is either from failure of defervescence within 48 to 72 hours or
development of a palpable mass
• TREATMENT: Traditional therapy is surgical drainage less invasive alternative is
ultrasonographic-guided needle aspiration using local anesthesia
• GALACTOCOELE
• result of the clogging of a duct by inspissated secretion,milk may accumulate in
one or more lobes of the breast
• excess may form a fluctuant mass that may give rise to pressure symptoms
• resolve spontaneously or require aspiration
41. SUPERNUMERARY
BREAST
• so small as to be mistaken for pigmented moles, or when without a
nipple, for a lipoma
• situated in pairs on either side of the midline of the thoracic or
abdominal walls, usually below the main breasts; also found in the
axillae, and more rarely on other portions of the body, such as the
shoulder, flank, groin, or thigh
• no obstetrical significance
ABNORMALITIES OF NIPPLES
• Inverted- draw the nipple out, using traction with fingers.
• Normal size and shape- may become fissured lesions
provide a convenient portal of entry for pyogenic bacteria effort
should be made to heal such fissures
43. CARE OF THE MOTHER
DURING PUERPERIUM
• HOSPITAL CARE
• first hour after delivery, blood pressure and
pulse should be taken every 15 minutes, or more
frequently if indicated
• amount of vaginal bleeding is monitored
• significant hemorrhage is greatest immediately
postpartum
• fundus should be palpated to ensure that it is well
contracted
• If relaxation is detected, the uterus should be
massaged through the abdominal wall until it
remains contracted.
44. EARLY AMBULATION
• Women are out of bed within a few hours
after delivery
• Advantages of early ambulation include
less frequent bladder complications and
constipation
• Reduced the frequency of puerperal
venous thrombosis and pulmonary
embolism
45. CARE OF THE VULVA
• cleanse the vulva from anterior to
posterior (vulva toward anus)
• ice bag applied to the perineum may help
reduce edema and discomfort during the
first several hours after episiotomy repair.
• Beginning about 24 hours after delivery,
moist heat as provided with warm sitz
baths can be used to reduce local
discomfort. Tub bathing after
uncomplicated delivery is allowed
46. BLADDER
FUNCTION
OXYTOCIN, IN DOSES THAT
HAVE AN ANTIDIURETIC
EFFECT, AS A CONSEQUENCE
OF INFUSED FLUID AND THE
SUDDEN WITHDRAWAL OF THE
ANTIDIURETIC EFFECT OF
OXYTOCIN, RAPID BLADDER
FILLING IS COMMON
BLADDER SENSATION AND
CAPABILITY TO EMPTY
SPONTANEOUSLY MAY BE
DIMINISHED BY ANESTHESIA,
ESPECIALLY CONDUCTION
ANALGESIA, AS WELL AS BY
EPISIOTOMY, LACERATIONS,
OR HEMATOMAS
IT USUALLY IS BEST TO LEAVE
THE CATHETER IN PLACE FOR
AT LEAST 24 HOURS,
WHENEVER THE BLADDER
BECOMES OVERDISTENDED
IF THE WOMAN CANNOT VOID
AFTER 4 HOURS, SHE SHOULD
BE CATHETERIZED AND URINE
VOLUME MEASURED
47. BLADDER
FUNCTION IF THE WOMAN CANNOT VOID AFTER 4 HOURS, SHE
SHOULD BE CATHETERIZED AND URINE VOLUME
MEASURED.
IF THERE IS MORE THAN 200 ML OF URINE, IT IS
APPARENT THAT THE BLADDER IS NOT
FUNCTIONING APPROPRIATELY. THE CATHETER
SHOULD BE LEFT IN PLACE AND THE BLADDER
DRAINED FOR ANOTHER DAY. IF LESS THAN 200 ML
OF URINE IS OBTAINED, THE CATHETER CAN BE
REMOVED AND THE BLADDER RECHECKED
SUBSEQUENTLY AS DESCRIBED.
48. SUBSEQUENT
DISCOMFORT
uncomfortable for a variety of reasons, including
afterpains, episiotomy and lacerations, breast
engorgement, and at times, postspinal puncture
headache
Early application of an ice bag may minimize swelling
and discomfort
severe pain warrants careful examination
episiotomy incision normally is firmly healed and
nearly asymptomatic by the third week
49. DEPRESSION
• postpartum blues- degree of depressed
mood a few days after delivery
• The emotional letdown that
follows the excitement and fears
that most women experience
during pregnancy and delivery.
• The discomforts of the early
puerperium.
• Fatigue from loss of sleep during
labor and postpartum.
• Anxiety over her capabilities for caring
for her infant after leaving the hospital.
• Fears that she has become less attractive
• *effective treatment need be nothing
more than anticipation, recognition, and
reassurance
• *mild disorder is self-limited and usually
remits after 2 to 3 days, although it
sometimes persists for up to 10 days
50. ABDOMINAL WALL
RELAXATION
• Exercises to restore abdominal wall
tone may be started any time after
vaginal delivery and as soon as
abdominal soreness diminishes after
cesarean delivery
51. DIET
NO dietary restrictions for women who have been
delivered vaginally
• if there are no complications likely to necessitate an anesthetic, the
woman should be allowed to eat if she desires
The diet of lactating women, compared with that
consumed during pregnancy, should be increased in
calories and protein, as recommended by the Food
and Nutrition Board of the National Research Council
• If the mother does not breast feed, dietary requirements are the
same as for a nonpregnant woman
52. THROMBOEMBOLIC
DISEASE
• Half of thromboembolic events
associated with pregnancy develop in the
puerperium,
• Pressure on branches of the
lumbosacral nerve plexus during
labor may be manifest by
complaints of intense neuralgia or
cramplike pains extending down one
or both legs as soon as the head
begins to descend into the pelvis
• If the nerve is injured, pain
continues after delivery and may be
accompanied by variable degrees of
sensory loss or muscle paralysis
supplied by the damaged nerve
53. OBSTETRICAL
NEUROPATHIES
• If the nerve is injured, pain continues after
delivery and may be accompanied by variable
degrees of sensory loss or muscle paralysis
supplied by the damaged nerve
• Lateral femoral cutaneous neuropathies
were the most common
• Nulliparity and prolonged second-stage of
labor were independent risk factors for nerve
injury.
• Separation of the symphysis pubis or one of
the sacroiliac synchondroses during labor may
be followed by pain and marked interference
with locomotion
54. PELVIC JOINT
SEPARATION
• 1 in 600 to 1 in 30,000 deliveries
• the onset of pain is acute at delivery
• Treatment: lateral decubitus position and an appropriately
fitted pelvic binder
• surgery may be necessary when symphyseal
separation is more than 4 cm Recurrence is more
than 50 percent in subsequent pregnancy, cesarean
delivery be considered.
• IMMUNIZATION
• D-negative woman who is not isoimmunized and whose
infant is D-positive is given 300
• microgram of anti-D immune globulin shortly after
delivery
55. TIME OF DISCHARGE
• Following vaginal delivery, if there are no complications,
hospitalization is seldom warranted for more than 48
hours.
• Receive instructions regarding:
• normal physiological changes of the puerperium,
including lochia patterns, weight loss from diuresis,
and when to expect milk let-down
• what to do if she becomes febrile, has excessive
vaginal bleeding, or develops leg pain, swelling, or
tenderness,any shortness of breath or chest pain
warrants immediate concern
• EARLY DISCHARGE
• “”The norms are hospital stays of up to 48 hours
following uncomplicated vaginal delivery and up to 96
hours following uncomplicated cesarean delivery.”
• American Academy of Pediatrics, American Academy of
Obstetricians and Gynecologists, 2002
56. CONTRACEPTION
• effort should be made to
provide family planning
education
• If a woman is not
breastfeeding, menses
usually return within 6 to 8
weeks
• Ovulation is much less
frequent in women who
breast feed compared with
those who do not
• lactating women, the first
period may occur as early
as the second or as late as
the 18th month after
delivery
57. CONTRACEPTION
Clearly, there is delayed resumption of ovulation with breast feeding,
although as already emphasized, early ovulation is not precluded by
persistent lactation.
Other findings included the following:
1.Resumption of ovulation was frequently marked by return of normal
menstrual bleeding
2.Breast feeding episodes lasting 15 minutes seven times each day
delayed resumption of ovulation.
3. Ovulation can occur without bleeding.
4.Bleeding can be anovulatory.
5.The risk of pregnancy in breast feeding women was approximately 4
percent per year.
58. HOME CARE
• COITUS - no definite time after delivery when coitus should
be resumed
• The median interval between delivery and intercourse was 5
weeks range was 1 to 12 weeks
• reasons cited for not resuming intercourse included perineal
pain, bleeding, and fatigue
• -coitus may be resumed based on the patient's desire and
comfort
• B. INFANT FOLLOW UP
• importance of subsequent neonatal and well-baby care
should be stressed and an emphasis placed on infant
immunizations.
• Any neonate discharged early should be term, normal, and
have stable vital signs.
• Initial hepatitis B vaccine should be administered, and all
screening tests required by law should be performed
59. FOLLOW UP
CARE
• only half of women
regained their usual level
of energy by 6 weeks
postpartum
Postnatally, most
societies did not
restrict maternal
work activity, and
about half
expected a return
to full duties
within 2 weeks
• Ideally, the care and
nurturing of the neonate
should be provided by
the mother with ample
help from the father.
Women who
delivered vaginally
were twice as
likely to have
normal energy
levels at this time
compared with
those with a
cesarean delivery.
60. Puerperal
Morbidity in
Percent Reported
by Women After
Hospital Discharge
Morbidity By 8 weeks Post
partum
2 to 18 months Post-
partum
1 Tiredness 59 54
2 Breast Problems 36 20
3 Anemia 25 7
4 Backache 24 20
5 Haemorrhoids 23 15
6 Headache 22 15
7 Tearfulness/depression 21 17
8 Constipation 20 7
9 Stitches breaking down 16 -
10 Vaginal discharge 15 8
11 Others 2-7 1-8
12 At least one of the above 87 76
the period of about six weeks after childbirth during which the mother's reproductive organs return to their original nonpregnant condition.
Capacious: having a lot of space inside
diameter, length, width, and volume of the uterus has been obtained for the nulliparous women in the age range 17–24 years.
9 x 6 x 4 cm
UltrasoundX-ray computed tomographyMagnetic resonance imagingHysterosalpingography
Approximative diameter of the uterus in nulliparous premenopausal women.
Rugae is a term used in anatomy that refers to a series of ridges produced by folding of the wall of an organ. Most commonly the term is applied to the internal surface of the stomach (gastric rugae).
Obliterated definition, to remove or destroy all traces of; do away with; destroy completely.
a trace of something that is disappearing or no longer exists.
"the last vestiges of colonialism"
PREGRAVID: Prior to pregnancy
Acute salpingitis is an infection of the fallopian tubes. These tubes carry the eggs from the ovary to the uterus. Pelvic pain is the main symptom of acute salpingitis.
leukemia, ovarian cancer, breast cancer
Cyclosporine is used to prevent organ rejection in people who have received a liver, kidney, or heart transplant.
It slows or stops the growth of cancer cells by blocking an enzyme called topo isomerase 2.
Methotrexate is used to treat certain types of cancer or to control severe psoriasis or rheumatoid arthritis that has not responded to other treatments.
Accessory breasts, also known as polymastia, supernumerary breasts, or mammae erraticae, is the condition of having an additional breast. Extra breastsmay appear with or without nipples or areolae.
early ambulation. : a technique of postoperative care in which a patient gets out of bed and engages in light activity (such as sitting, standing, or walking) as soon as possible after an operation.