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NORMAL PUERPERIUM. WHAT IS PUERPERIUM?  Period following childbirth  Pelvic organs & other body tissues  Revert to pre-pregnant state  Anatomically.

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Presentation on theme: "NORMAL PUERPERIUM. WHAT IS PUERPERIUM?  Period following childbirth  Pelvic organs & other body tissues  Revert to pre-pregnant state  Anatomically."— Presentation transcript:

1 NORMAL PUERPERIUM

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 I. Immediate-within 24hrs II. Early -upto 7 days III. 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

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7  from uterine gland mouths and interglandular stromal cells  completed by day 16  placental site Steroid hormones withdrawn Inc Collagenase & Proteolytic enzymes Autolysis Myometrial cell size reduced EndophlebitisThrombosis Fibrinoid end arteritisHyalinisation Blood Vessels

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

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

9 LOCHIA Vaginal discharge for the 1 st 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 days Decicual cells,leucocytes,mucus,cholestrin crystals,fatty epithelial cells,microorganisms

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

11 CHANGES IN BREAST & LACTATION

12 General Physiological Changes  Pulse:  raises but settles down to normal on 2 nd day  Temperature:  Any rise above 0.5C suggestive of infection of genito-urinary tract  Urinary Tract:  Pronounced Diuresis on 2 nd - 3 rd 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:  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 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 After pains Uterus massage Ibuprofen Anti-spasmodic Pain at site of perineum Sitz bath analgesics Treatment of Anaemia Supplementary Iron therapy Treatment of minor ailments

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

20 THANQ


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