1. Puerperium

2. • Puerperium : Is period during which the
reproductive organs and all the system of the
body returns to their normal condition
following the delivery of the placenta and
o Ends approximately 6 weeks later.
The Principal Changes
1. Uterine Involution :
2. Blood and Fluid Changes
3. Lactation

3. Involution of uterine corpus
Fundus of contracted uterus
: slightly below umbilicus
immediately after placental expulsion
- within 2 wks
: descend into a cavity of true pelvis
- within about 4 wks
: regain previous nonpregnant size

4. Endometrial regeneration
the remain decidua becomes differentiated into
2 layers within 2 or 3 days after delivery
superficial layer
: become necrotic, sloughed in the lochia
basal layer
: remains intact, source of new endometrium

5. cervix
• Cervix is very flaccid and curtain –like
after delivery but within a few days is
returning to the original form and
consistency .
The cervical channel become closed to a
finger during the second week of
Puerperium .

6. 2. Blood and Fluid Changes
leukocytosis and thrombocytosis occur during and
after labor
: by 1 week after delivery, blood volume return
nearly to nonpregnant level
Cardiac output remains elevated for at least 48
hours
postpartum
(due to increased stroke volume from venous
return)

7. Lactation
•
Two similar independent mechanisms for
successful lactation :
1. Prolactin release from A .p
mammary glandular tissue
stimulation of milk secretion .
 Prolactin is long chain of polypeptide it
has only physiological role that its action
on lactating breast .

8. 2 ) milk ejection reflex ( milk lead down )
mediated by release of oxytocin from
hypothalamus and ( p.p ):
 causing contraction of myoepithelial cells
around the milk –secretary .
 dilatation of main ducts .
So , Expelling milk from glands .
 oxytocin released in response to : suckling
, and sensory input like mother seeing or
hearing their baby crying .

9. Management of normal puerperium
1.Vital signs
+ contraction of the uterus (uterin involution) +
Lochia (amount; colure ,and odder)
=Every 5 min. for ½ hours , then every ½ hourly
for 2 hours, then transfer the mother to the
postnatal ward and observation every 2 hours
for 6 hourly; then 6 hourly till discharge.

10. 2.Breast examination+lawer limb examination
for the detection of signs of DVT every day.
3.The mother should be encouraged to pass
urine.
4. Early mobilization.
5. Management of episiotomy ;and perennial
tears.

11. 6. In normal delivery the mother can go home
48 hours after delivery ;and 10 days in C.S.
7. Diet regime.
8 .postnatal visit.
9. Advising for contraception and spacing of
pregnancy.