Presentation is loading. Please wait.

Presentation is loading. Please wait.


Similar presentations

Presentation on theme: "NORMAL PUERPERIUM."— Presentation transcript:


2 What is puerperium? Period following childbirth
Pelvic organs & other body tissues Revert to pre-pregnant state Anatomically & physiologically

3 Begins as soon as placenta is expelled
lasts for appx 6 weeks(42 days) 3 stages Immediate-within 24hrs Early -upto 7 days Remote – upto 6wks

4 Involution of the Uterus
Anatomical consideration At delivery-20 x 12 x 7.5cm and appox. 1000g After involution-reverted to non-preg size of appox. 60g Lower uterine segment isthmus in a few weeks Contour of cervix regained in 6 wks External os never reverts back to nulliparous state


6 Fibrinoid end arteritis
Steroid hormones withdrawn Inc Collagenase & Proteolytic enzymes Autolysis Myometrial cell size reduced Physiological Consideration Muscles: Endometrium: regen starts on day 7 from uterine gland mouths and interglandular stromal cells completed by day 16 placental site Blood Vessels Endophlebitis Thrombosis Fibrinoid end arteritis Hyalinisation

7 Clinical assessment of Involution of uterus
Fundus lies 13.5cm above sypmphysis pubis for the 1st 24hrs following delivery Steady decrease by 0.5'' in nxt 24 hrs Day 14- not palpable- pelvic organ Completed by 6 wks

8 Involution of other Pelvic structures
Vagina 4-8 weeks; Does not revert to original state Broad/round ligaments Long time d/t stretching during parturition Pelvic floor & Fascia Involution of other Pelvic structures

9 Lochia Lochia Rubra Lochi Serosa Lochia Alba
Vaginal discharge for the 1st fortnight during puerperium Odour: offensive fishy smell Colour and composition Lochia Rubra Lochi Serosa Lochia Alba 1-4 days Blood,fetal memb & decidua shreds,lanugo,meconium 5-6 days Leucocytes,Cx mucus,wound exudates,microorganisms 10-15 days Decicual cells,leucocytes,mucus,cholestrin crystals,fatty epithelial cells,microorganisms

10 Clinical importance Puerperal Sepsis d\t E. Coli Malodorous Infection
Lochiometra Scanty/absent Excessive Subinvolution Retained conceptus Causes secondary PPH Red color persist Local genital infection L.Alba beyond 3 wks

11 Mamogenesis Lactogenesis Galactopoiesis Galactokinesis
Changes in breast & lactation Mammary duct-gland growth & development Mamogenesis Initiation Of milk secretion in alveoli Lactogenesis Maintenance of Lactation Galactopoiesis Removal of Milk from Gland Galactokinesis

12 General Physiological Changes Pulse: Temperature: Urinary Tract:
raises but settles down to normal on 2nd day Temperature: Any rise above 0.5C suggestive of infection of genito-urinary tract Urinary Tract: Pronounced Diuresis on 2nd - 3rd day over distension incomplete emptying presence of residual urine high risk of infection GIT: increased thirst constipation Weight Loss: 5-6kg expulsion of fetus placenta, liqour, blood 2kg- during puerperium d\t diuresis Continued upto 6 months of delivery

13 Blood Values: Menstruation: Ovulation:
immediate-reduced blood volume; Normal in 2 weeks rise in cardiac output; Normal in 1 week leuycocyotsis d\t stress Hypercoagulable state for 48 hrs Fibrinolytic activity enhanced in 4 days Menstruation: if not breast feeding- resumes in 6 to 8 wks Ovulation: non-lactating mother- 4 wks lactating mother- 10 weeks Exclusive Breastfeeding- 98% contraception up 6 months

14 Management of normal Puerperium To restore health of Mother
Rest and Early ambulation Emotional support Diet of patients choice Sleep Immunization- anti-D- Gamma globulin Maternal-infant Bonding Postnatal exercise

15 To take care of the Breasts & promote breast feeding
To prevent infection Care of bladder & Vulva Care of episiotomy wound Maintenance of asepsis and proper hygiene Immunization- Rubella vaccine, TT To take care of the Breasts & promote breast feeding To motivate mother for contraception

16 Treatment of minor ailments
After pains Uterus massage Ibuprofen Anti-spasmodic Pain at site of perineum Sitz bath analgesics Treatment of Anaemia Supplementary Iron therapy

17 Abnormal Puerperium Puerperal fever/ pyrexia Puerperal Sepsis Pelvic pain Fever Foul smelling vaginal discharge Subinvolution

18 Breast Problems Retracted/cracked nipples Breast engorgement Mastitis Breast abscess Failure of lactation

19 Urinary Problems Retention Incontinence Infection Venous thrombosis Secondary Hemorrhage Puerperal psychosis Obstetric palsy



Similar presentations

Ads by Google