The document summarizes the normal postpartum period and changes that occur in the six weeks following childbirth. It discusses involution of the uterus and other organs, hormonal changes, wound healing, breastfeeding, weight loss, and potential complications like mastitis, urinary incontinence, and puerperal fever. Contraception options for breastfeeding mothers and contraindications to breastfeeding are also covered.
The document describes the physiological changes that occur during the postpartum period. It discusses the involution of the uterus, which returns to its non-pregnant size within 6 weeks. It also covers changes in other systems like the endocrine, cardiovascular, respiratory and urinary systems. The postpartum period allows the body to recover from pregnancy and birth by returning the organs to their pre-pregnancy state through processes like autolysis and homeostasis over a period of 6 weeks.
The document discusses common discomforts experienced during early and mid-late pregnancy and their causes and management. In early pregnancy, nipple soreness is caused by increased estrogen and progesterone levels and can be treated with bras with wide straps and calamine lotion. Constipation is caused by progesterone, weight of the uterus, and other dietary and lifestyle factors, and can be managed by increasing fiber intake, staying hydrated, and exercise. Nausea and vomiting in early pregnancy is due to high hormone levels and low blood sugar and can be treated by eating small, frequent meals and snacks and taking vitamin B6 supplements. Heartburn in pregnancy is caused by reduced gastric motility and uterine pressure and should be managed by small, frequent
The document discusses the process of puerperium, which is the period following childbirth where the body returns to its pre-pregnant state over approximately 6 weeks. Key changes include the uterus involuting from 1000g to 100g over this time, the return of ovarian function and menstruation between 8-12 weeks (or longer while breastfeeding), and the production and composition of colostrum and breastmilk. Proper breastfeeding and lactation is encouraged for infant health and development during this postpartum period of maternal physiological changes.
Lochia is the postpartum bleeding and discharge from the uterus after giving birth. It typically lasts 4 to 8 weeks and comes in three phases - lochia rubra (bright red bleeding), lochia serosa (pinkish discharge), and lochia alba (yellowish discharge). The causes of lochia include open blood vessels in the uterus where the placenta detached and the contractions that help the uterus return to its normal size. Breastfeeding can help reduce lochia by stimulating uterine contractions. Women should use heavy pads and avoid tampons for at least 6 weeks, and see a doctor if bleeding increases or has a foul smell, which could indicate infection.
The document defines the puerperium period as the 6 weeks following childbirth when the body reverts from its pregnant state. It has 3 stages: immediate (24 hours), early (up to 7 days), and remote (up to 6 weeks). During this time, the uterus involutes from 1000g to 60g, the cervix regains its shape by 6 weeks, and other pelvic structures like the vagina and ligaments take longer to revert due to stretching during birth. Women experience lochia discharge, breast and lactation changes, as well as general physiological changes like increased urination and weight loss. Proper management focuses on rest, hygiene and infection prevention. Abnormalities can include puer
Umbilical cord prolapse is a serious obstetric emergency where the umbilical cord precedes the fetus through the birth canal. It can be diagnosed by feeling the cord or detecting fetal heart abnormalities. Management involves manually lifting the presenting part off the cord, placing the mother in a position to relieve pressure on the cord, considering tocolysis to stop contractions, and delivering via the fastest route, typically an emergency c-section.
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.
The document provides information about the placenta, including its definition, characteristics, development, structure, functions, and conclusions. It defines the placenta as the structure developed in the pregnant uterus through which the fetus derives nutrition and establishes a connection between the mother and fetus via the umbilical cord. Key points covered include that the placenta is discoid, hemochorial and deciduate in nature. It develops from 6-12 weeks of gestation from the chorion frondosum and decidua basalis. At term, it is circular, 15-20cm in diameter, and weighs about 500g. Its functions include the transfer of nutrients and oxygen to the fetus, excretion of fetal waste
The document describes the physiological changes that occur during the postpartum period. It discusses the involution of the uterus, which returns to its non-pregnant size within 6 weeks. It also covers changes in other systems like the endocrine, cardiovascular, respiratory and urinary systems. The postpartum period allows the body to recover from pregnancy and birth by returning the organs to their pre-pregnancy state through processes like autolysis and homeostasis over a period of 6 weeks.
The document discusses common discomforts experienced during early and mid-late pregnancy and their causes and management. In early pregnancy, nipple soreness is caused by increased estrogen and progesterone levels and can be treated with bras with wide straps and calamine lotion. Constipation is caused by progesterone, weight of the uterus, and other dietary and lifestyle factors, and can be managed by increasing fiber intake, staying hydrated, and exercise. Nausea and vomiting in early pregnancy is due to high hormone levels and low blood sugar and can be treated by eating small, frequent meals and snacks and taking vitamin B6 supplements. Heartburn in pregnancy is caused by reduced gastric motility and uterine pressure and should be managed by small, frequent
The document discusses the process of puerperium, which is the period following childbirth where the body returns to its pre-pregnant state over approximately 6 weeks. Key changes include the uterus involuting from 1000g to 100g over this time, the return of ovarian function and menstruation between 8-12 weeks (or longer while breastfeeding), and the production and composition of colostrum and breastmilk. Proper breastfeeding and lactation is encouraged for infant health and development during this postpartum period of maternal physiological changes.
Lochia is the postpartum bleeding and discharge from the uterus after giving birth. It typically lasts 4 to 8 weeks and comes in three phases - lochia rubra (bright red bleeding), lochia serosa (pinkish discharge), and lochia alba (yellowish discharge). The causes of lochia include open blood vessels in the uterus where the placenta detached and the contractions that help the uterus return to its normal size. Breastfeeding can help reduce lochia by stimulating uterine contractions. Women should use heavy pads and avoid tampons for at least 6 weeks, and see a doctor if bleeding increases or has a foul smell, which could indicate infection.
The document defines the puerperium period as the 6 weeks following childbirth when the body reverts from its pregnant state. It has 3 stages: immediate (24 hours), early (up to 7 days), and remote (up to 6 weeks). During this time, the uterus involutes from 1000g to 60g, the cervix regains its shape by 6 weeks, and other pelvic structures like the vagina and ligaments take longer to revert due to stretching during birth. Women experience lochia discharge, breast and lactation changes, as well as general physiological changes like increased urination and weight loss. Proper management focuses on rest, hygiene and infection prevention. Abnormalities can include puer
Umbilical cord prolapse is a serious obstetric emergency where the umbilical cord precedes the fetus through the birth canal. It can be diagnosed by feeling the cord or detecting fetal heart abnormalities. Management involves manually lifting the presenting part off the cord, placing the mother in a position to relieve pressure on the cord, considering tocolysis to stop contractions, and delivering via the fastest route, typically an emergency c-section.
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.
The document provides information about the placenta, including its definition, characteristics, development, structure, functions, and conclusions. It defines the placenta as the structure developed in the pregnant uterus through which the fetus derives nutrition and establishes a connection between the mother and fetus via the umbilical cord. Key points covered include that the placenta is discoid, hemochorial and deciduate in nature. It develops from 6-12 weeks of gestation from the chorion frondosum and decidua basalis. At term, it is circular, 15-20cm in diameter, and weighs about 500g. Its functions include the transfer of nutrients and oxygen to the fetus, excretion of fetal waste
Induction of labour involves initiating uterine contractions before spontaneous labour begins. It can be done for various maternal or fetal indications when the risks of continuing pregnancy outweigh those of early delivery. Successful induction depends on factors like gestational age, cervical status assessed by Bishop score, and sensitivity to oxytocin. Cervical ripening methods include prostaglandins, misoprostol, oxytocin, mifepristone and mechanical methods. Once the cervix is ripe, oxytocin infusion is used to induce contractions. Artificial rupture of membranes is another surgical method to induce labour. Careful patient selection and monitoring are important for safe induction of labour.
Cord prolapse occurs when the umbilical cord slips below the presenting fetal part and out of the birth canal. It has an incidence of 1 in 300 deliveries and is more common in parous women. Risk factors include abnormal cord insertion, prematurity, and procedures that increase pressure on the cord before engagement. Clinical signs include bradycardia after rupture of membranes and variable or prolonged decelerations unresponsive to treatment. Management involves relieving pressure on the cord, positioning the mother, monitoring the fetus, and rapid delivery of the baby, usually by C-section.
The document discusses the physiology and management of the normal postpartum period, known as the puerperium. It begins immediately after delivery and lasts around 6 weeks. During this time, the body recovers from pregnancy and returns to a non-pregnant state. The uterus undergoes involution, decreasing in size over weeks. Other organs like the vagina, cervix, and breasts also undergo changes. The woman experiences vaginal bleeding called lochia that gradually decreases over weeks. Overall, the postpartum period involves a woman's body returning to its pre-pregnancy condition.
This document summarizes common complications that can occur during the puerperium period after childbirth. These include puerperal pyrexia (fever) which can be caused by infections in the genital tract, breast, respiratory tract, or urinary tract. Other causes include wound infections or thrombophlebitis. Problems with breastfeeding may also occur such as engorgement, cracked nipples, mastitis or breast abscess. Coagulation disorders can increase the risk of thromboembolism, which is a leading cause of maternal mortality. Finally, psychiatric disorders like postpartum blues, anxiety, depression or psychosis may develop during this time.
The placenta develops in the uterus during pregnancy and provides oxygen and nutrients to the growing fetus while removing waste products. It attaches to the uterine wall and the umbilical cord arises from the placenta. The placenta develops from the chorionic villi on the fetal side and the decidua basalis on the maternal side. It grows rapidly and eventually replaces most of the decidua basalis. At term, the placenta is a circular disc that is the site of maternal-fetal transfer of oxygen, carbon dioxide, nutrients, waste and various proteins and hormones essential to the development and survival of the fetus.
The puerperium is defined as the 6-week period following childbirth when the body recovers from pregnancy and returns to the non-pregnant state. This involves the involution of the uterus and other reproductive organs. The puerperium involves 3 stages - the immediate (first 24 hours), early (first week), and remote (weeks 2-6) periods. During this time the uterus decreases in size, the breasts produce milk, the vagina and perineum heal, and other systems such as the cardiovascular and respiratory systems return to normal. Proper care, rest, perineal exercises, and breastfeeding can help support the mother's recovery.
The document provides guidelines for the management of abortion in various situations:
1. Threatened abortion is to be managed conservatively with bed rest, avoiding intercourse, and following up with ultrasound to check for fetal cardiac activity. Hormone therapy or anti-D immunoglobulin may also be used.
2. For inevitable or incomplete abortions, evacuation of the pregnancy is necessary, along with resuscitation if needed. Prophylactic antibiotics and anti-D immunoglobulin should also be given.
3. Recurrent miscarriage can be managed with cervical cerclage if cervical incompetence is documented, while other causes like genetic issues require their own management approaches.
Cord prolapse is a frightening and life-threatening event that occurs in labor. Rapid identification and immediate appropriate response may well save the life of a neonate. Therefore, clinicians should be knowledgeable in its recognition and management.
3.physiolosical changes during pregnancyKHUSHBU PATEL
During pregnancy, the woman's body undergoes many physiological changes to support the growing fetus. The reproductive system changes include increased blood flow and size of the vagina, cervix, and uterus. The uterus grows enormously from about the size of a fist to over 1000 times larger by term. Other systems affected are cardiovascular (increased heart rate and blood volume), respiratory, digestive, urinary, endocrine, and musculoskeletal. Hormonal changes produced by the placenta, such as human chorionic gonadotropin, estrogen, progesterone, prolactin, and human placental lactogen, cause these adaptations to pregnancy.
This document discusses abortion, also known as miscarriage. Abortion is defined as the termination of a pregnancy by removing the fetus or embryo before it can survive outside the uterus. The document covers the incidence, classification, etiology, signs and symptoms, investigations, and management of different types of miscarriages such as threatened, inevitable, incomplete, missed, septic, and recurrent miscarriages. Nursing management involves close monitoring of symptoms and vital signs and notifying the healthcare provider immediately if bleeding is noticed.
The document discusses the physiology of lactation, including:
1. The anatomy of the breast and changes during pregnancy like increased size and vascularity.
2. The components of colostrum, which is higher in protein and vitamins than milk.
3. The four phases of lactation - preparation of breasts during pregnancy, milk synthesis after delivery stimulated by hormones like prolactin, ejection of milk, and maintenance of lactation.
This document discusses fetal distress, which is now referred to as non-reassuring fetal status. It describes the pathophysiology of fetal distress as being caused by chronic placental insufficiency and hypoxia, leading to lactic acid buildup and changes in fetal heart rate and meconium passage. It distinguishes between acute and chronic fetal distress and lists various causes. Diagnosis is made based on abnormal fetal heart rate patterns, meconium staining, low pH, and low Apgar scores. Management involves oxygen, monitoring the mother, addressing hypotension, and immediate delivery.
The document discusses the management of the third stage of labour, which begins with the birth of the baby and ends with delivery of the placenta. It describes the phases of placental separation, descent, and expulsion. It discusses expectant versus active management and the nursing care involved in each approach. The nursing diagnosis identifies risks for fluid deficit, lack of preparation for sensations, and energy expenditure from childbirth efforts. Nursing interventions include monitoring for signs of separation and bleeding, providing education and rest opportunities.
This document outlines the active management of normal labour in 4 stages: antenatal preparation, first stage (history, exam, procedures), second stage (delivery of baby), third stage (delivery of placenta), and fourth stage (postpartum care of mother and baby). The goal is a healthy delivery with minimal effects. Key procedures include monitoring contractions/fetal heart with a partogram, positioning, nutrition, analgesia, perineal support, and immediate newborn care.
This document discusses hydatidiform mole, which is an abnormal condition of the placenta characterized by cysts forming from degenerative and proliferative changes in the chorionic villi. There are two types: partial mole occurs due to fertilization abnormalities, while complete mole is caused by a sperm combining with an unfertilized egg. Symptoms include vaginal bleeding and abdominal pain. Diagnosis involves ultrasound and beta-HCG levels. Treatment is surgical evacuation of the uterus. Most cases are benign, but some may develop into persistent trophoblastic disease or choriocarcinoma, requiring chemotherapy. With treatment, survival rates are over 90% even in metastatic cases.
This document discusses fetal positioning and presentations during labor and delivery. It begins by defining non-vertex presentations including breech, face, brow, transverse, and compound. It then discusses the causes of non-vertex presentations and describes the different positions including occiput posterior. The document provides details on assessing various positions through abdominal and vaginal exams. It concludes by outlining the management of different non-vertex positions, including allowing natural rotation, augmentation of labor, operative vaginal delivery, or caesarean section if needed.
The document provides information on nursing care of the mother during the postpartum period. Key points include:
- The postpartum period lasts approximately 6 weeks as the body returns to its pre-pregnant state.
- Physiologic changes include uterine involution over 10 days and lochia discharge over 3 weeks. Engorgement may occur between days 3-5.
- Nursing assessments include monitoring vital signs, bleeding, breast engorgement, and bonding with the infant. Interventions focus on preventing infection, reducing pain and fatigue, and promoting breastfeeding and self-care.
This document discusses the diagnosis of pregnancy through signs and symptoms in the three trimesters. In the first trimester, common subjective symptoms include missed period, morning sickness, frequent urination, and breast tenderness. Objective signs are breast changes, softening of the cervix, and uterine enlargement. The second trimester brings symptoms like fetal movement and objective signs like linea nigra and increased fundal height. The third trimester involves advanced uterine growth and engagement of the fetus in the pelvis. Pregnancy can be confirmed through urine or blood tests detecting human chorionic gonadotropin.
An ectopic pregnancy occurs when a fertilized egg implants and grows outside the uterus, usually in one of the fallopian tubes. This is a medical emergency that requires prompt treatment to stop potentially life-threatening bleeding. Most ectopic pregnancies occur in the fallopian tubes. While the incidence of ectopic pregnancy is rising due to increased rates of pelvic inflammatory disease, early diagnosis and treatment have reduced maternal death and illness.
It explains the mechanism of normal labour to medical and para-medical staff.It also puts light on principle movements underlying mechanism of normal labour with pictures.Thank You Like an share it to the maximum.
The document discusses the normal puerperium period following childbirth. It defines key terms like puerperium, involution, lochia, lactation, and others. It describes the physiological changes that occur in the reproductive system like the involution of the uterus returning to its pre-pregnancy size over 6 weeks and changes in the cervix, ovaries, and vaginal canal. It also discusses general physiological changes like changes in pulse, temperature, the urinary tract, and gastrointestinal tract. Blood values and the return of menstruation and ovulation are also summarized.
Management of puerperium.pptx, Gynecology and obstetrical Nursing, class pres...SOUMISOM
Mrs. Keya Midya, 30 Years, delivered normally. On the second postnatal day, she found that her abdomen was flabby, her breasts were full, and she had vaginal bleeding. She felt inadequate to take care of the baby and received conflicting suggestions, leaving her confused and wanting help.
Induction of labour involves initiating uterine contractions before spontaneous labour begins. It can be done for various maternal or fetal indications when the risks of continuing pregnancy outweigh those of early delivery. Successful induction depends on factors like gestational age, cervical status assessed by Bishop score, and sensitivity to oxytocin. Cervical ripening methods include prostaglandins, misoprostol, oxytocin, mifepristone and mechanical methods. Once the cervix is ripe, oxytocin infusion is used to induce contractions. Artificial rupture of membranes is another surgical method to induce labour. Careful patient selection and monitoring are important for safe induction of labour.
Cord prolapse occurs when the umbilical cord slips below the presenting fetal part and out of the birth canal. It has an incidence of 1 in 300 deliveries and is more common in parous women. Risk factors include abnormal cord insertion, prematurity, and procedures that increase pressure on the cord before engagement. Clinical signs include bradycardia after rupture of membranes and variable or prolonged decelerations unresponsive to treatment. Management involves relieving pressure on the cord, positioning the mother, monitoring the fetus, and rapid delivery of the baby, usually by C-section.
The document discusses the physiology and management of the normal postpartum period, known as the puerperium. It begins immediately after delivery and lasts around 6 weeks. During this time, the body recovers from pregnancy and returns to a non-pregnant state. The uterus undergoes involution, decreasing in size over weeks. Other organs like the vagina, cervix, and breasts also undergo changes. The woman experiences vaginal bleeding called lochia that gradually decreases over weeks. Overall, the postpartum period involves a woman's body returning to its pre-pregnancy condition.
This document summarizes common complications that can occur during the puerperium period after childbirth. These include puerperal pyrexia (fever) which can be caused by infections in the genital tract, breast, respiratory tract, or urinary tract. Other causes include wound infections or thrombophlebitis. Problems with breastfeeding may also occur such as engorgement, cracked nipples, mastitis or breast abscess. Coagulation disorders can increase the risk of thromboembolism, which is a leading cause of maternal mortality. Finally, psychiatric disorders like postpartum blues, anxiety, depression or psychosis may develop during this time.
The placenta develops in the uterus during pregnancy and provides oxygen and nutrients to the growing fetus while removing waste products. It attaches to the uterine wall and the umbilical cord arises from the placenta. The placenta develops from the chorionic villi on the fetal side and the decidua basalis on the maternal side. It grows rapidly and eventually replaces most of the decidua basalis. At term, the placenta is a circular disc that is the site of maternal-fetal transfer of oxygen, carbon dioxide, nutrients, waste and various proteins and hormones essential to the development and survival of the fetus.
The puerperium is defined as the 6-week period following childbirth when the body recovers from pregnancy and returns to the non-pregnant state. This involves the involution of the uterus and other reproductive organs. The puerperium involves 3 stages - the immediate (first 24 hours), early (first week), and remote (weeks 2-6) periods. During this time the uterus decreases in size, the breasts produce milk, the vagina and perineum heal, and other systems such as the cardiovascular and respiratory systems return to normal. Proper care, rest, perineal exercises, and breastfeeding can help support the mother's recovery.
The document provides guidelines for the management of abortion in various situations:
1. Threatened abortion is to be managed conservatively with bed rest, avoiding intercourse, and following up with ultrasound to check for fetal cardiac activity. Hormone therapy or anti-D immunoglobulin may also be used.
2. For inevitable or incomplete abortions, evacuation of the pregnancy is necessary, along with resuscitation if needed. Prophylactic antibiotics and anti-D immunoglobulin should also be given.
3. Recurrent miscarriage can be managed with cervical cerclage if cervical incompetence is documented, while other causes like genetic issues require their own management approaches.
Cord prolapse is a frightening and life-threatening event that occurs in labor. Rapid identification and immediate appropriate response may well save the life of a neonate. Therefore, clinicians should be knowledgeable in its recognition and management.
3.physiolosical changes during pregnancyKHUSHBU PATEL
During pregnancy, the woman's body undergoes many physiological changes to support the growing fetus. The reproductive system changes include increased blood flow and size of the vagina, cervix, and uterus. The uterus grows enormously from about the size of a fist to over 1000 times larger by term. Other systems affected are cardiovascular (increased heart rate and blood volume), respiratory, digestive, urinary, endocrine, and musculoskeletal. Hormonal changes produced by the placenta, such as human chorionic gonadotropin, estrogen, progesterone, prolactin, and human placental lactogen, cause these adaptations to pregnancy.
This document discusses abortion, also known as miscarriage. Abortion is defined as the termination of a pregnancy by removing the fetus or embryo before it can survive outside the uterus. The document covers the incidence, classification, etiology, signs and symptoms, investigations, and management of different types of miscarriages such as threatened, inevitable, incomplete, missed, septic, and recurrent miscarriages. Nursing management involves close monitoring of symptoms and vital signs and notifying the healthcare provider immediately if bleeding is noticed.
The document discusses the physiology of lactation, including:
1. The anatomy of the breast and changes during pregnancy like increased size and vascularity.
2. The components of colostrum, which is higher in protein and vitamins than milk.
3. The four phases of lactation - preparation of breasts during pregnancy, milk synthesis after delivery stimulated by hormones like prolactin, ejection of milk, and maintenance of lactation.
This document discusses fetal distress, which is now referred to as non-reassuring fetal status. It describes the pathophysiology of fetal distress as being caused by chronic placental insufficiency and hypoxia, leading to lactic acid buildup and changes in fetal heart rate and meconium passage. It distinguishes between acute and chronic fetal distress and lists various causes. Diagnosis is made based on abnormal fetal heart rate patterns, meconium staining, low pH, and low Apgar scores. Management involves oxygen, monitoring the mother, addressing hypotension, and immediate delivery.
The document discusses the management of the third stage of labour, which begins with the birth of the baby and ends with delivery of the placenta. It describes the phases of placental separation, descent, and expulsion. It discusses expectant versus active management and the nursing care involved in each approach. The nursing diagnosis identifies risks for fluid deficit, lack of preparation for sensations, and energy expenditure from childbirth efforts. Nursing interventions include monitoring for signs of separation and bleeding, providing education and rest opportunities.
This document outlines the active management of normal labour in 4 stages: antenatal preparation, first stage (history, exam, procedures), second stage (delivery of baby), third stage (delivery of placenta), and fourth stage (postpartum care of mother and baby). The goal is a healthy delivery with minimal effects. Key procedures include monitoring contractions/fetal heart with a partogram, positioning, nutrition, analgesia, perineal support, and immediate newborn care.
This document discusses hydatidiform mole, which is an abnormal condition of the placenta characterized by cysts forming from degenerative and proliferative changes in the chorionic villi. There are two types: partial mole occurs due to fertilization abnormalities, while complete mole is caused by a sperm combining with an unfertilized egg. Symptoms include vaginal bleeding and abdominal pain. Diagnosis involves ultrasound and beta-HCG levels. Treatment is surgical evacuation of the uterus. Most cases are benign, but some may develop into persistent trophoblastic disease or choriocarcinoma, requiring chemotherapy. With treatment, survival rates are over 90% even in metastatic cases.
This document discusses fetal positioning and presentations during labor and delivery. It begins by defining non-vertex presentations including breech, face, brow, transverse, and compound. It then discusses the causes of non-vertex presentations and describes the different positions including occiput posterior. The document provides details on assessing various positions through abdominal and vaginal exams. It concludes by outlining the management of different non-vertex positions, including allowing natural rotation, augmentation of labor, operative vaginal delivery, or caesarean section if needed.
The document provides information on nursing care of the mother during the postpartum period. Key points include:
- The postpartum period lasts approximately 6 weeks as the body returns to its pre-pregnant state.
- Physiologic changes include uterine involution over 10 days and lochia discharge over 3 weeks. Engorgement may occur between days 3-5.
- Nursing assessments include monitoring vital signs, bleeding, breast engorgement, and bonding with the infant. Interventions focus on preventing infection, reducing pain and fatigue, and promoting breastfeeding and self-care.
This document discusses the diagnosis of pregnancy through signs and symptoms in the three trimesters. In the first trimester, common subjective symptoms include missed period, morning sickness, frequent urination, and breast tenderness. Objective signs are breast changes, softening of the cervix, and uterine enlargement. The second trimester brings symptoms like fetal movement and objective signs like linea nigra and increased fundal height. The third trimester involves advanced uterine growth and engagement of the fetus in the pelvis. Pregnancy can be confirmed through urine or blood tests detecting human chorionic gonadotropin.
An ectopic pregnancy occurs when a fertilized egg implants and grows outside the uterus, usually in one of the fallopian tubes. This is a medical emergency that requires prompt treatment to stop potentially life-threatening bleeding. Most ectopic pregnancies occur in the fallopian tubes. While the incidence of ectopic pregnancy is rising due to increased rates of pelvic inflammatory disease, early diagnosis and treatment have reduced maternal death and illness.
It explains the mechanism of normal labour to medical and para-medical staff.It also puts light on principle movements underlying mechanism of normal labour with pictures.Thank You Like an share it to the maximum.
The document discusses the normal puerperium period following childbirth. It defines key terms like puerperium, involution, lochia, lactation, and others. It describes the physiological changes that occur in the reproductive system like the involution of the uterus returning to its pre-pregnancy size over 6 weeks and changes in the cervix, ovaries, and vaginal canal. It also discusses general physiological changes like changes in pulse, temperature, the urinary tract, and gastrointestinal tract. Blood values and the return of menstruation and ovulation are also summarized.
Management of puerperium.pptx, Gynecology and obstetrical Nursing, class pres...SOUMISOM
Mrs. Keya Midya, 30 Years, delivered normally. On the second postnatal day, she found that her abdomen was flabby, her breasts were full, and she had vaginal bleeding. She felt inadequate to take care of the baby and received conflicting suggestions, leaving her confused and wanting help.
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.
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
Assessment and management of woman during postnatal periodHARSH786249
The document summarizes the normal physiological changes that occur during the postnatal period. Key points include:
- The postnatal period, also called the puerperium, lasts 6 weeks as the body returns to its pre-pregnant state. Involution of the uterus and other organs occurs through this period.
- Vital signs like temperature and pulse are monitored to check for issues like hemorrhage and infection. The uterus normally decreases in size steadily in the first weeks after delivery. Lochia discharge indicates the progress of involution.
This document discusses the anatomical and physiological changes that occur during the postpartum period known as the puerperium. It defines puerperium as the period following childbirth when the body reverts back to the pre-pregnant state, which typically lasts around 6 weeks. The document outlines the involution process of the uterus, cervix, vagina, blood vessels, and endometrium during this time. It also discusses other aspects of the postpartum period including lochia, breastfeeding, weight loss, and the return of menstruation and fertility.
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.
fundamental concept puerperium normal gynaecology.pdfschhataria
The document discusses the anatomical and physiological changes that occur during the postpartum period known as the puerperium. It begins immediately after delivery of the placenta and lasts approximately 6 weeks. During this time, the uterus and other reproductive organs revert back to their pre-pregnancy state through a process called involution. The document provides detailed information on the involution of the uterus, cervix, blood vessels, and endometrium as well as the characteristics, composition and clinical importance of lochia discharge during the puerperium.
The puerperium period lasts approximately 6 weeks after childbirth. During this time, the body reverts back to a non-pregnant state through the involution of organs like the uterus, cervix, and vagina. The uterus undergoes the most dramatic changes, decreasing in size from 1000g immediately after birth to about 50g by 6 weeks postpartum. Other physiological changes include a decrease in temperature, pulse rate returning to normal, diuresis and weight loss from fluid loss. Lochia discharge gradually decreases in amount and changes color over a 2-3 week period as the reproductive system completes its postpartum transformation.
Pregnancy causes many physiological changes in a woman's body to support the growth of the fetus. These include changes to the breasts, skin, genitals, weight gain and water retention, hematological and cardiovascular systems, metabolism, and more. The document discusses these changes in detail to provide an overview of the normal adaptations a woman's body undergoes during pregnancy.
The normal puerperium period begins after childbirth and lasts approximately 6 weeks as the body reverts back to the pre-pregnant state. Involution is the process by which the genital organs return to their pre-pregnant size and shape. Lochia is the vaginal discharge present for the first 2 weeks, providing information about the mother's health. Proper management includes rest, ambulation, bladder care, treatment of any complications, and promotion of breastfeeding.
ASSESSMENT AND MANAGEMENT OF WOMEN DURING POSTNATAL PERIOD.pptxRameeThj
The document summarizes the physiological changes that occur during the postnatal period known as the puerperium. Key points include:
- The puerperium lasts 6 weeks as the uterus and reproductive organs return to their pre-pregnancy size and state. This includes involution of the uterus from 1000g to 60g.
- Lochia is the vaginal discharge that occurs for the first 2 weeks as the endometrium regenerates and decidual tissue is shed.
- Breast development occurs during pregnancy and lactation is established through hormonal and physiological processes in response to suckling within 3-4 days of delivery.
- The reproductive, breastfeeding and lochial
Physiological changes in pregnancy affect many body systems. The reproductive tract undergoes changes like increased vascularity in the vulva, vagina and cervix to accommodate birth. The breasts enlarge due to ductal and alveolar growth in preparation for lactation. Metabolic changes increase calorie and protein needs to support the growing fetus. The uterus expands dramatically under the influence of hormones to carry the pregnancy.
- Puerperium refers to the 6-week period following delivery where the body returns to its pre-pregnant state. This involves involution of the uterus, breasts, and other organs as well as hormonal and physiological changes.
- Common issues during this period include uterine and breast involution, lochia, urinary changes, weight loss, endocrine changes, and psychological adjustment. Complications can include postpartum hemorrhage, infection, retained placenta, and painful perineum. Physical therapy modalities like cryotherapy, TENS, LLLT, and pelvic floor exercises can help manage pain.
Postpartum Hemorrhage and Uterine AtonyJerardLloyd
The document discusses normal physiological changes during the postpartum period, including uterine involution and lochia. It describes how the uterus decreases in size from 1000g immediately after birth to 50g by 6 weeks postpartum. Lochia is described as changing from red to pink/brown to white over the first 3 weeks. Guidelines for evaluating lochia include amount, consistency, pattern, odor, and absence. Risk factors for postpartum hemorrhage include uterine atony, issues with uterine tissue like fibroids, trauma during birth, and retained placental fragments. Uterine atony is identified as the most common cause due to the uterus' inability to contract after delivery.
NORMAL PUERPERIUM presentation notes for medical studentsIbrahimKargbo13
The document discusses the normal puerperium period following childbirth. It describes how over 6 weeks postpartum, a woman's body returns to its non-pregnant state as various physiological changes are reversed. Hormone levels fall, the uterus involutes to its pre-pregnant size, lactation is established, and the mother recovers from childbirth while bonding with her new infant. The management of a postnatal mother focuses on monitoring this recovery process and physiological changes.
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
Diagnosis of pregnancy and physiologic change during(1)Engidaw Ambelu
This document provides an overview of pregnancy diagnosis and physiologic changes during pregnancy. It begins with definitions of pregnancy terms and outlines methods for diagnosing pregnancy, including presumptive, probable, and positive signs and tests. The document then discusses the effects of pregnancy on specific organs like the uterus, cervix, and vagina. It concludes by summarizing systemic changes including increased blood volume, cardiovascular changes, respiratory changes, urinary changes, and more. The document comprehensively covers both local changes to reproductive organs and broader physiologic adaptations pregnancy requires.
The document summarizes key aspects of the puerperium period, which lasts approximately 6 weeks following childbirth. It describes the anatomical and physiological changes that occur as the body reverts to the non-pregnant state, including involution of the uterus, breasts, blood vessels, and other reproductive organs. It also covers lochia, lactation, vital signs, weight loss, urinary changes, and the general management and care of the mother during the puerperium period, including diet, sleep, immunizations and treatment of any ailments.
The document discusses various anatomical and physiological changes that occur in the mother's body during the postpartum period known as the puerperium. It lasts between 4 to 6 weeks as the body returns to a non-pregnant state. This involves the involution of the uterus, cervix, breasts, ovaries, endometrium, and vagina. The uterus decreases in size, the cervix closes, lochia discharge occurs, and the breasts undergo mammogenesis, lactogenesis, galactopoiesis, and galactokinesis to allow for breastfeeding. Keeping the mother and newborn together for 24 hours has benefits like promoting breastfeeding and protecting the infant's health.
Zoltan Veresh - Intrauterine growth retardationKatalin Cseh
Intrauterine growth restriction (IUGR) refers to impaired fetal growth and development due to reduced nutrient supply from the placenta. It affects 3-10% of pregnancies and increases risks of complications. Causes include fetal/genetic factors, maternal conditions, and placental insufficiency. Physical signs include disproportionately large head and wasted appearance. Management involves monitoring with tests like biophysical profile and timely delivery when indicated. Long term risks include increased mortality and morbidity as well as potential adult health issues. Prevention focuses on treating underlying maternal conditions and risk factors.
Gabor Jozsef Joo - Female urinary incontinenceKatalin Cseh
Female urinary incontinence and genital prolapse affect many women. Common causes include aging, childbirth, and menopause. Symptoms include urinary urgency and leakage. Diagnosis involves medical history, exams, and tests like cystometry. Treatment options include pelvic floor exercises, pessaries, medications, and surgeries like Burch repair, TVT, and vaginal wall repairs. Managing risk factors and treating reversible causes can help address these common women's health issues.
Akos Murber - Female endocrine functions - summaryKatalin Cseh
This document summarizes the female menstrual cycle and the roles of the hypothalamus, pituitary gland, and ovaries. It explains that the hypothalamus produces GnRH, stimulating the pituitary to release LH and FSH, controlling follicular growth and ovulation in the ovaries. The ovaries produce hormones like estrogen and progesterone that provide feedback to the hypothalamus and pituitary. Key events in the ovarian cycle include follicular growth, ovulation, luteal function after the corpus luteum forms, and luteal regression at the end of the cycle.
This document provides information for neonatologists on caring for newborns. It discusses the tasks of neonatologists, including informing parents and preparing for interventions if prenatal conditions are diagnosed. It also covers terminology related to newborns, the equipment and procedures needed for resuscitation of newborns in the labor ward, and assessing newborns using the APGAR scoring system. The document also summarizes potential problems that may require treatment or transfer to intensive care for newborns.
This document provides information on assisted reproduction including definitions of infertility, prevalence of infertility by age, forms of infertility, causes of female and male infertility, investigation of infertility, treatment of ovulation disorders, and in vitro fertilization and embryotransfer (IVF-ET). Key points include that infertility is defined as no conception after 1 year of regular unprotected intercourse, prevalence increases with female age from 2.1% at age 15-19 to 15.9% at age 40-44, causes of female infertility include ovulatory disorders (40%), anatomical factors (50%), and psychological factors (10%), and IVF-ET involves oocyte retrieval, fertilization in vitro, and embryo transfer.
This document discusses factors of care during pregnancy including prenatal care, screenings, diagnosis of pregnancy, initial prenatal visits, assessments, examinations, laboratory tests, nutrition, and preconception counseling. Prenatal care involves medical care and psychosocial support beginning before conception through delivery, with about 12 average visits. Screenings determine gestational age, fetal development and health, and maternal health risks. Initial visits involve assessments, exams, and establishing care plans. Follow up involves continued monitoring of maternal and fetal wellbeing.
Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women, affecting around 1 million females in Germany. It is characterized by menstrual irregularities, excess androgen levels, and polycystic ovaries. PCOS causes infertility due to chronic anovulation from hyperandrogenism and insulin resistance. Women with PCOS have an increased risk of obesity, diabetes, cardiovascular disease, and other metabolic complications. The cause of PCOS involves genetic and environmental factors, and its features vary in severity and combination of symptoms between individuals.
This document summarizes the female menstrual cycle and the roles of the hypothalamus, pituitary gland, and ovaries. It explains that the hypothalamus produces GnRH, stimulating the pituitary to release LH and FSH, controlling follicular growth and ovulation in the ovaries. The ovaries produce hormones like estrogen and progesterone that provide feedback to the hypothalamus and pituitary. Key events in the ovarian cycle include follicular growth, ovulation, luteal function after the corpus luteum forms, and luteal regression at the end of the cycle.
The document discusses ultrasound screening and testing during pregnancy in Hungary. It recommends five ultrasound examinations - one diagnostic and four screenings - according to guidelines from the Hungarian Society of Ultrasound in Obstetrics and Gynecology (MSZNUT). The screenings have defined protocols and occur at 11-13, 18-20, 30-31, and 36-37 weeks gestation. Different healthcare levels are required depending on the exam, and MSZNUT ensures regular training to meet proficiency standards. Fetal well-being testing like non-stress tests and biophysical profiles may also be used for high-risk pregnancies starting at 32 weeks.
This document discusses various abnormalities that can occur during labour and delivery, categorized as abnormalities of the power (uterine contractility), abnormalities involving the passenger (fetus), or abnormalities of the passage (pelvis). It provides details on specific issues like uterine dysfunction, fetopelvic disproportion, abnormal fetal presentations (breech, transverse lie), prolapsed umbilical cord, and shoulder dystocia. Management strategies are discussed for each abnormality, including oxytocin use, operative vaginal delivery, and Caesarean section when appropriate. The goal is to identify abnormalities early to guide management and prevent adverse maternal-fetal outcomes from difficult labor.
Norbert Sipos: Principles of cancer therapyKatalin Cseh
The document discusses principles of cancer therapy including chemotherapy and radiation therapy. It covers topics like evaluating malignancies, determining likelihood of response to treatment, cell cycle specifics of chemotherapy, and principles of combination chemotherapy. The document also provides details on treating specific cancers like vulvar cancer through surgery, radiation, and chemotherapy.
Gyula Richard Nagy: Prenatal diagnostic methodsKatalin Cseh
This document discusses prenatal diagnostic methods. It covers several topics:
- The objectives of prenatal diagnosis, which include detecting abnormalities, allowing termination if desired, and providing informed choices to couples.
- Invasive diagnostic methods like amniocentesis and chorionic villus sampling, which allow testing the fetus but carry risks of miscarriage.
- Non-invasive methods like ultrasound and cell-free DNA testing from maternal blood, which do not risk the pregnancy but have limitations.
- The various indications for offering prenatal diagnosis based on factors like advanced maternal age, family history, ultrasound findings, and maternal health issues.
Gyula Richard Nagy: Genetic counselingKatalin Cseh
This document discusses genetic counseling in obstetric care. It describes the historical stages of obstetric care including avoiding maternal death, infant mortality, and preventing birth defects. Genetic counseling involves communicating the risk of genetic disorders recurring within a family based on their medical and family history. During counseling, the disease is discussed, its severity and prognosis, how it is inherited to determine recurrence risk, and options for prevention like prenatal diagnosis. Prenatal diagnosis aims to provide unaffected children for high-risk families and prevent birth of seriously defective fetuses. Termination of pregnancy may be permitted under certain medical conditions and risk levels.
Gyula Richard Nagy: Obstetric operationsKatalin Cseh
This document discusses various obstetric operations including induced abortion, forceps delivery, vacuum extraction, and cesarean section. It provides detailed information on the techniques, indications, and complications of each procedure. Induced abortion is described for both the first and second trimester using methods such as D&C, medical induction, and curettage. Forceps delivery techniques include outlet, low, and mid forceps operations. Vacuum extraction is outlined as an alternative to forceps. Cesarean section is indicated when the cervix is not fully dilated or the head is not engaged.
Cervical cancer is a major health problem globally. HPV is the main cause, with high-risk HPV types 16 and 18 responsible for most cancers. Screening via Pap tests and HPV testing helps detect pre-cancerous lesions early. Treatment depends on the stage but may include surgery, radiation, and chemotherapy. Prophylactic HPV vaccines have been introduced which are effective at preventing infection from the types most linked to cancer. Continued screening remains important even with vaccination.
At Malayali Kerala Spa Ajman, Full Service includes individualized care for every client. We specifically design each massage session for the individual needs of the client. Our therapists are always willing to adjust the treatments based on the client's instruction and feedback. This guarantees that every client receives the treatment they expect.
By offering a variety of massage services, our Ajman Spa Massage Center can tackle physical, mental, and emotional illnesses. In addition, efficient identification of specific health conditions and designing treatment plans accordingly can significantly enhance the quality of massaging.
At Malayali Kerala Spa Ajman, we firmly believe that everyone should have the option to experience top-quality massage services regularly. To achieve that goal we offer cheap massage services in Ajman.
If you are interested in experiencing transformative massage treatment at Malayali Kerala Spa Ajman, you can use our Ajman Massage Center WhatsApp Number to schedule your next massage session.
Contact @ +971 529818279
Visit @ https://malayalikeralaspaajman.com/
As Mumbai's premier kidney transplant and donation center, L H Hiranandani Hospital Powai is not just a medical facility; it's a beacon of hope where cutting-edge science meets compassionate care, transforming lives and redefining the standards of kidney health in India.
CHAPTER 1 SEMESTER V COMMUNICATION TECHNIQUES FOR CHILDREN.pdfSachin Sharma
Here are some key objectives of communication with children:
Build Trust and Security:
Establish a safe and supportive environment where children feel comfortable expressing themselves.
Encourage Expression:
Enable children to articulate their thoughts, feelings, and experiences.
Promote Emotional Understanding:
Help children identify and understand their own emotions and the emotions of others.
Enhance Listening Skills:
Develop children’s ability to listen attentively and respond appropriately.
Foster Positive Relationships:
Strengthen the bond between children and caregivers, peers, and other adults.
Support Learning and Development:
Aid cognitive and language development through engaging and meaningful conversations.
Teach Social Skills:
Encourage polite, respectful, and empathetic interactions with others.
Resolve Conflicts:
Provide tools and guidance for children to handle disagreements constructively.
Encourage Independence:
Support children in making decisions and solving problems on their own.
Provide Reassurance and Comfort:
Offer comfort and understanding during times of distress or uncertainty.
Reinforce Positive Behavior:
Acknowledge and encourage positive actions and behaviors.
Guide and Educate:
Offer clear instructions and explanations to help children understand expectations and learn new concepts.
By focusing on these objectives, communication with children can be both effective and nurturing, supporting their overall growth and well-being.
Sectional dentures for microstomia patients.pptxSatvikaPrasad
Microstomia, characterized by an abnormally small oral aperture, presents significant challenges in prosthodontic treatment, including limited access for examination, difficulties in impression making, and challenges with prosthesis insertion and removal. To manage these issues, customized impression techniques using sectional trays and elastomeric materials are employed. Prostheses may be designed in segments or with flexible materials to facilitate handling. Minimally invasive procedures and the use of digital technologies can enhance patient comfort. Education and training for patients on prosthesis care and maintenance are crucial for compliance. Regular follow-up and a multidisciplinary approach, involving collaboration with other specialists, ensure comprehensive care and improved quality of life for microstomia patients.
This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
VEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdfVedanta A
Air Ambulance Services In Rewa works in close coordination with ground-based emergency services, including local Emergency Medical Services, fire departments, and law enforcement agencies.
More@: https://tinyurl.com/2shrryhx
More@: https://tinyurl.com/5n8h3wp8
R3 Stem Cell Therapy: A New Hope for Women with Ovarian FailureR3 Stem Cell
Discover the groundbreaking advancements in stem cell therapy by R3 Stem Cell, offering new hope for women with ovarian failure. This innovative treatment aims to restore ovarian function, improve fertility, and enhance overall well-being, revolutionizing reproductive health for women worldwide.
This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...DrDevTaneja1
Digital India will need a big trained army of Health Informatics educated & trained manpower in India.
Presently, generalist IT manpower does most of the work in the healthcare industry in India. Academic Health Informatics education is not readily available at school & health university level or IT education institutions in India.
We look into the evolution of health informatics and its applications in the healthcare industry.
HIMMS TIGER resources are available to assist Health Informatics education.
Indian Health universities, IT Education institutions, and the healthcare industry must proactively collaborate to start health informatics courses on a big scale. An advocacy push from various stakeholders is also needed for this goal.
Health informatics has huge employment potential and provides a big business opportunity for the healthcare industry. A big pool of trained health informatics manpower can lead to product & service innovations on a global scale in India.
Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...
Puerperium
1. Puerperium
Normal and abnormal
postpartum period
Attila Molvarec, MD, PhD
1st Department of Obstetrics and Gynecology,
Semmelweis University, Budapest, Hungary
Director: Prof. János Rigó
2. The puerperium is strictly defined as the
period of confinement during and just after
birth. By popular use, however, the meaning
usually includes the six subsequent weeks.
•Wound recovery
•Hormonal changes
•Involution of the organs
•Evolution of the breast
4. Uterine Vessels
After delivery, the caliber of extrauterine vessels
decreases to that of the prepregnant state
Within the puerperal uterus, larger blood vessels
are obliterated by hyalin changes, gradually
resorbed and replaced by smaller ones. Minor
vestiges of the larger vessels, however, may
persist for years
5. Cervix and Lower Uterine
Segment
The cervical opening contracts slowly. By the end of the
first week, it has narrowed. As the opening narrows, the
cervix thickens, and a canal reforms. At the completion
of involution, the external os remains somewhat wider
than before pregnancy with bilateral depressions at the
site of lacerations.
The lower uterine segment contracts and retracts, but not
as forcefully as the body of the uterus. Over the course
of a few weeks, the lower segment is converted into
uterine isthmus located between the uterine corpus and
the internal cervical os.
6. Involution of the Uterine Corpus
Two days after delivery, the uterus begins to shrink, and
within 2 weeks it has descended into the cavity of the
pelvis. It regains its nonpregnant size about 4 weeks
after delivery. The total number of muscle cells does not
decrease appreciably, but instead, the individual cells
decrease markedly in size.
In primiparas, the puerperal uterus remains tonically
contracted, whereas in multiparas, the uterus often
contracts vigorously at intervals, giving rise to afterpains.
7. Lochia
Early in the puerperium, sloughing of decidual tissue
results in a vaginal discharge of variable quantity; this is
termed lochia. It consists of erythrocytes, shredded
decidua, epithelial cells and bacteria.
lochia rubra: For the first few days, 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, due to leukocytes
and reduced fluid content, lochia assumes a white or
yellowish-white color.
Lochia persists for up to 4-8 weeks after delivery.
8. Endometrial Regeneration
Within 2 or 3 days after delivery, the remaining decidua
becomes differentiated into two layers. The superficial layer
becomes necrotic, and it is sloughed in the lochia. The
basal layer remains intact and is the source of new
endometrium.
The endometrium arises from proliferation of the
endometrial glandular remnants and the stroma of the
interglandular connective tissue.
Endometrial regeneration is rapid, except at the placental
site. The entire endometrium is restored by the third week.
Histological endometritis is part of the normal reparative
process.
9. Placental Site Involution
It takes up to 6 weeks.
Within hours of delivery, the placental site normally
consists of many thrombosed vessels that
ultimately undergo organization.
Sloughing of infarcted and necrotic superficial
tissues is followed by a reparative process.
Exfoliation consists of both extension and
„downgrowth” of endometrium from the margins of
the placental site and the development of
endometrial tissue from the glands and stroma that
are left deep in the decidua basalis after placental
separation.
11. Subinvolution
This term describes an arrest or retardation of
involution.
Symptoms: prolongation of lochial discharge,
irregular or excessive uterine bleeding
On bimanual examination, the uterus is larger and
softer than would be expected.
Some causes of subinvolution are retention of
placental fragments and pelvic infection.
Late postpartum hemorrhage can be associated
with noninvoluted uteroplacental arteries.
12. Late Postpartum Hemorrhage
Uterine bleeding after the first postpartum day.
Serious uterine hemorrhage occasionally develops
1 to 2 weeks into the puerperium.
It can be the result of abnormal involution of the
placental site. It may also be caused by retention
of a portion of the placenta (placental polyp).
Initial treatment may be best directed to medical
control of the bleeding with intravenous oxytocin,
ergotamine, or prostaglandins. Curettage is carried
out only if appreciable bleeding persists or recurs
after medical management.
14. Urinary tract changes
The puerperal bladder has an increased capacity
and a relative insensitivity to intravesical fluid
pressure. Overdistention, incomplete emptying,
and excessive residual urine are common.
The dilated ureters and renal pelves return to their
prepregnant state over the course of 2 to 8 weeks
after delivery.
Urinary tract infection is thus a concern because
residual urine and bacteriuria in a traumatized
bladder, coupled with the dilated renal pelves and
ureters, create optimal conditions for development
of infection.
15. Incontinence
3 to 26% of women report daily episodes of
incontinence in the 3 to 6 months after delivery.
7% of women report the development of stress
incontinence after delivery, which correlated with
obstetrical factors such as length of second-stage
labor, infant head circumference, birthweight, and
episiotomy.
Pathophysiology: impaired muscle function in or
around the urethra as a result of vaginal delivery
Women whose deliveries had all been vaginal had
a 70-percent higher risk of incontinence than
women whose deliveries had all been by
cesarean.
16. Vaginal outlet relaxation and
uterine prolapse
Extensive lacerations of the perineum during
delivery are followed by relaxation of the vaginal
outlet. Even when external lacerations are not
visible, stretching may lead to marked relaxation.
Moreover, changes in pelvic support during
parturition predispose to uterine prolapse and to
urinary stress incontinence. In general, operative
correction is postponed until childbearing is ended,
unless serious disability.
18. Peritoneum and abdominal wall
As a result of the rupture of elastic fibers in the
skin and the prolonged distention caused by the
pregnant uterus, the abdominal wall remains soft
and flaccid. Several weeks are required for these
structures to return to normal. Recovery is aided
by exercise. Except for silvery striae, the
abdominal wall usually resumes its prepregnancy
appearance. When muscles remain atonic,
however, the abdominal wall also remains lax.
There may be a marked separation of the rectus
muscles (diastasis recti).
19. Blood and fluid changes
• Leukocytosis and thrombocytosis occur during and after
labor. The leukocyte count sometimes reaches
30,000/µL, with the increase predominantly from
granulocytes.
• During the first few postpartum days, hemoglobin
concentration and hematocrit fluctuate moderately.
• By 1 week after delivery, the blood volume has returned
nearly to its nonpregnant level. The cardiac output
remains elevated for at least 48 hours postpartum.
• By 2 weeks, these changes have returned to normal
nonpregnant values.
• Pregnancy-induced changes in blood coagulation factors
persist for variable periods during the puerperium.
21. Weight Loss
In addition to the loss of about 5 to 6 kg due
to uterine evacuation and normal blood loss,
there is usually a further decrease of 2 to 3
kg through diuresis.
Most women approach their self-reported
prepregnancy weight 6 months after delivery
but still retain an average surplus of 1.5 kg.
22. Breast feeding
Colostrum
After delivery, the breasts begin to secrete colostrum,
which is a deep lemon-yellow-colored liquid.
Compared with mature milk, colostrum contains more
minerals and protein, much of which is globulin, but less
sugar and fat.
Colostrum secretion persists for about 5 days. Its content of
immunoglobulin A (IgA) may offer protection for the
newborn against enteric pathogens.
Other host resistance factors that are found in colostrum
and milk include complement, macrophages, lymphocytes,
lactoferrin, lactoperoxidase, and lysozymes.
23. Breast feeding
Milk
• Human milk is a suspension of fat and protein in a
carbohydrate-mineral solution.
• A nursing mother easily makes 600 mL of milk per day.
• Milk is isotonic with plasma, with lactose accounting for
half of the osmotic pressure.
• Major proteins, including α-lactalbumin, β-lactoglobulin,
and casein, are also present.
• Essential and non essential amino acids.
• contains large amounts of interleukin-6 (IL-6)
• Prolactin and epidermal growth factor (EGF) have also
been identified.
• All vitamins except K are found in human milk.
24. Endocrinology of Lactation
• Progesterone, estrogen, and placental lactogen, as well
as prolactin, cortisol, and insulin, appear to act in concert
to stimulate the growth and development of the milk-
secreting apparatus.
• With delivery, there is an abrupt and profound decrease
in the levels of progesterone and estrogen, which
removes the inhibitory influence of progesterone.
• A stimulus from the breast curtails the release of
prolactin-inhibiting factor from the hypothalamus, and
transiently induces increased prolactin secretion.
• The neurohypophysis secretes oxytocin in pulsatile
fashion. This stimulates milk expression from a lactating
breast. Milk ejection (letting down) is a reflex initiated
especially by suckling, which stimulates oxytocin
secretion.
27. Immunological Consequences of
Breast Feeding
The predominant immunoglobulin in milk is
secretory IgA. IgA exerts its action by preventing
bacterial adherence to epithelial cell surfaces, thus
preventing tissue invasion.
Milk contains both T and B lymphocytes. Memory T
cells seem to be another mechanism by which the
neonate benefits from maternal immunological
experience.
IL-6 is present and appears to stimulate an
increase in mononuclear cells in breast milk.
28. Nursing
Human milk is ideal food for neonates. It provides
species- and age-specific nutrients for the infant. It
has antibacterial properties and contains
immunological factors and factors that promote
cellular growth and differentiation.
Vitamin K and D supplementation is recommended
for infants who are breast fed exclusively.
For both mother and infant, the benefits of breast
feeding are likely long-term (lower risk of breast
cancer, increased adult intelligence).
65 percent of women who have undergone
augmentation mammoplasty have lactation
insufficiency.
29. Protective Effects of Human Milk
and Breast Feeding on Infants
Strong evidence:
diarrhea, lower respiratory infection, otitis media,
bacteremia, bacterial meningitis, botulism, urinary
tract infection, necrotizing enterocolitis
Possible protective effect:
sudden infant death syndrome, insulin-dependent
diabetes mellitus, Crohn disease, ulcerative colitis,
lymphoma, allergic diseases, other chronic
digestive diseases
Possible enhancement of cognitive development
30.
31. Contraception for breast feeding
women
If the woman does not nurse her child, menses usually
return within 6 to 8 weeks. In lactating women, the first
period may occur 2-18 months after delivery.
Ovulation is much less frequent in women who breast feed
compared with those who do not. However, the risk of
pregnancy in breast feeding women is 4% per year.
Progestin-only contraceptives (mini-pills and depot
medroxyprogesterone) do not affect the quality or decrease
milk volume. They are preferred along with IUDs.
Combined estrogen-progestin contraceptives have been
shown to reduce the quantity and quality of breast milk.
32. Contraindications to breast
feeding
• street drugs
• excessive alcohol use
• infant with galactosemia
• active, untreated tuberculosis
• take certain medications (cytotoxic drugs,
lithium)
• treatment for breast cancer
• human immunodeficiency virus (HIV) infection
33. Breast Fever
For the first 24 hours after commencement of
lactation, it is not unusual for the breasts to
become distended, firm, and nodular. Breast
engorgement may be accompanied by a transient
elevation of temperature. 13 percent of all
postpartum women have fever that ranged from
37.8 to 39°C from this cause.
Other causes of fever, especially those due to
infection, must be excluded.
Treatment consists of supporting the breasts with
a binder or brassiere, applying an ice bag, and an
analgesic. Pumping of the breast may be
necessary.
34. Mastitis
It is estimated to occur from 2 to
33 percent of breast feeding
women.
Infection almost invariably is
unilateral, preceded by marked
engorgement.
Symptoms: chills or actual rigor,
soon followed by fever and
tachycardia. The breast becomes
hard and reddened, and the
woman complains of severe pain.
10 % of women with mastitis
develop an abscess (fluctuation,
US).
35. Mastitis
The most commonly isolated organism is Staphylococcus
aureus. Other commonly isolated organisms are
coagulase-negative staphylococci and viridans
streptococci.
The source of these organisms is the infant’s nose and
throat. The infecting organism can usually be cultured from
milk.
Even staphylococcal infections are usually sensitive to
penicillin or a cephalosporin. Erythromycin is given to
women who are penicillin sensitive. Vancomycin is effective
against MRSA. Treatment is necessary for 10-14 days.
Breast feeding should be continued or gently pumping is
recommended.
Traditional therapy of breast abscess is surgical drainage,
which usually requires general anesthesia.
36. Puerperal fever
Puerperal infection is a general term used to describe any
bacterial infection of the genital tract after delivery.
Along with preeclampsia and obstetrical hemorrhage,
puerperal infection formed the lethal triad of causes of
maternal deaths for many decades of the 20th century.
In the US, infection made up 13 percent of pregnancy-
related deaths and was the fifth leading cause of death.
Puerperal fever is defined as follows: a temperature of
38.0°C or higher, which occurs on any 2 of the first 10
days postpartum, exclusive of the first 24 hours, and which
is taken orally by a standard technique at least four times
daily.
39. Uterine infection
The preferred term is metritis with pelvic cellulitis.
The route of delivery is its most significant risk factor.
Vaginal Delivery
Metritis following vaginal delivery is relatively uncommon.
The incidence is nearly 6 percent in women with
prolonged membrane rupture and labor, multiple cervical
examinations, and internal fetal monitoring.
If there is intrapartum chorioamnionitis, the risk of infection
increases to 13 percent.
Other risk factors for metritis are stillbirth, low birthweight,
preterm delivery, and serious neonatal morbidity.
40. Uterine infection
Cesarean Delivery
The incidence of metritis following surgical delivery varies
with socioeconomic factors, and over the years this has
been altered substantively by almost universal use of
perioperative antimicrobials.
The use of single-dose perioperative antimicrobial
prophylaxis has done more to decrease the incidence
and severity of postcesarean delivery pelvic infections
than any other innovation in the past 25 years.
Women whose infants were delivered for cephalopelvic
disproportion, and who were not given perioperative
prophylaxis had an incidence of serious pelvic infection
that was nearly 90 percent.
41. Uterine infection
Other Risk Factors
• Anemia
• Malnutrition
• Bacterial colonization: group B streptococcus, Chlamydia
trachomatis, Mycoplasma hominis, Gardnerella vaginalis
and Ureaplasma urealyticum
• Multifetal gestation
• Young maternal age and nulliparity
• Prolonged labor induction
• Obesity
• Meconium-stained amnionic fluid
44. Clinical course of metritis
• Fever is the most important criterion for
the diagnosis of postpartum metritis.
• Chills may accompany fever and suggest
bacteremia.
• Women usually complain of abdominal
pain, and parametrial tenderness.
• An offensive odor may develop.
• Leukocytosis may range from 15,000 to
30,000 cells/µL.
45. Treatment of metritis
Management
• If mild metritis develops after the woman has been
sent home following vaginal delivery, treatment with an
oral antimicrobial agent is usually sufficient.
• For moderate to severe infections, however,
including those following cesarean delivery,
intravenous therapy with a broad-spectrum
antimicrobial regimen is indicated.
• Complications of metritis that cause persistent fever
despite appropriate therapy include a parametrial
phlegmon or an area of intense cellulitis, a surgical
incisional or pelvic abscess, an infected hematoma,
and septic pelvic thrombophlebitis.
46. Specific antimicrobial treatment
of metritis
• Therapy is empirical.
• Initial treatment is broad-spectrum antimicrobial
coverage.
• 90 percent of infections following vaginal delivery
respond to regimens such as ampicillin plus gentamicin.
• Women given the clindamycin-gentamicin regimen had a
95-percent rate of infection resolution.
• Because of enterococcal infections, many add ampicillin
to the clindamycingentamicin regimen, either initially or if
there is no response by 48 to 72 hours.
• Metronidazole has superior in vitro activity against most
anaerobes, and it may be given with ampicillin and an
aminoglycoside in serious pelvic infections.
• Imipenem + cilastatin is reserved for more serious
infections.
47. Prevention of infection
• The use of perioperative antimicrobial
prophylaxis reduces the rate of puerperal
endometritis by 70 to 80 percent.
• Single agents such as ampicillin and first-
generation cephalosporins are ideal prophylactic
antimicrobials.
• Antepartum treatment of asymptomatic women
with vaginal infections has not been shown to
prevent postpartum metritis.
48. Complications of pelvic infections
WOUND INFECTIONS
• The incidence of abdominal incisional infections
following cesarean delivery ranges from 3 to 15 percent,
with an average of about 6 percent. When prophylactic
antimicrobials are given, the incidence is less than 2
percent.
• Wound infection is the most common cause of
antimicrobial failure in women treated for metritis. Risk
factors include obesity, diabetes, corticosteroid therapy,
immunosuppression, anemia, and poor hemostasis with
hematoma formation.
• In case of abdominal incisional abscesses, the treatment
includes antimicrobials and surgical drainage.
49. Complications of pelvic infections
WOUND INFECTIONS
• Necrotizing fasciitis is the most serious form of
wound infections with high mortality.
• It may involve abdominal incisions following SC
or may complicate episiotomy or perineal
lacerations.
• Risk factors: diabetes, obesity, hypertension
• Infections are more commonly polymicrobial.
• Treatment includes resection of the necrotic
tissue along with a broad-spectrum antimicrobial
regimen.
51. Complications of pelvic infections
• Parametrial phlegmon develops if parametrial cellulitis
is intensive and forms an area of induration.
• It may extend laterally to the lateral pelvic wall or
posteriorly to the rectovaginal septum.
• In most women, clinical improvement follows continued
treatment with a broad-spectrum antimicrobial regimen.
• Surgery is reserved for women in whom uterine
incisional necrosis is suspected (hysterectomy and
surgical debridement).
• Pelvic abscess is formed if a parametrial phlegmon
suppurates. Surgical drainage is required.
• Infected hematomas also require drainage.
• Adnexal infections and peritonitis rarely develop from
puerperal infection.
52. Complications of pelvic infections
SEPTIC PELVIC THROMBOPHLEBITIS
• Puerperal infection may extend along venous routes and
cause thrombosis. Lymphangitis often coexists.
• It frequently involves one or both ovarian venous
plexuses. The clot may extend into the inferior vena
cava.
• Clinical findings: persistent fever with chills, pain and a
tender mass lateral to the uterine cornu on either side
(ovarian vein thrombophlebitis)
• Diagnosis: pelvic CT with contrast, MRI
• Treatment: continued antimicrobial therapy
• The addition of heparin did not hasten recovery or
improve outcome.
53. Infections of the perineum, vagina
and cervix
• Episiotomy infections are not often. With infection,
dehiscence is a concern.
• Vaginal and cervical lacerations may become infected.
Parametrial extension may result in lymphangitis and
parametritis.
• In case of infected episiotomies, sutures are removed
and the infected wound opened.
• Prior to attempting early repair of episiotomy dehiscence,
the surgical wound must be properly cleaned and free of
infection.
• Necrotizing fasciitis may complicate perineal and
vaginal wound infections. Necrotizing fasciitis of the
episiotomy site may extend to the thighs, buttocks and
abdominal wall.
• Treatment includes extensive debridement of all infected
tissue, antimicrobials and intensive care.
54. Toxic shock syndrome
This acute febrile illness with severe multisystem
derangement has a case-fatality rate of 10 to 15 percent.
Symptoms: fever, headache, mental confusion, diffuse
macular erythematous rash, subcutaneous edema,
nausea, vomiting, watery diarrhea, and marked
hemoconcentration. Renal failure may be followed by
hepatic failure, disseminated intravascular coagulation,
and circulatory collapse.
Staphylococcus aureus has been recovered.
Staphylococcal exotoxin, termed toxic shock syndrome
toxin causes the syndrome by provoking profound
endothelial injury.
56. Toxic shock syndrome
Principal therapy for toxic shock is supportive,
while allowing reversal of capillary endothelial
injury. In severe cases, treatment requires
massive fluid replacement, mechanical
ventilation with positive end-expiratory pressure,
and renal dialysis.
Antimicrobial therapy with antistaphylococcal
drugs is given. With evidence for uterine
infection, antimicrobial therapy must include
agents used for all puerperal infections.
Cases of streptococcal toxic shock syndrome often
require hysterectomy.
57. Other complications of the
puerperium
• Some degree of depressed mood a few days after
delivery is fairly common. This is termed postpartum
blues. It usually remits after 2 to 3 days. If postpartum
blues persist or worsen, major depression should be
considered.
• Thromboembolic disease: half of thromboembolic events
associated with pregnancy develop in the puerperium.
• Obstetrical neuropathies: lateral femoral cutaneous
neuropathies are the most common, followed by femoral
neuropathies.
• Pelvic joint separation: separation of the symphysis
pubis or one of the sacroiliac synchondroses during
labor may be followed by pain and interference with
locomotion.
• Treatment is conservative, with rest and a pelvic binder.