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NORMAL PUERPERIUM

NORMAL PUERPERIUM. What is puerperium ?. Period following childbirth Pelvic organs & other body tissues Revert to pre-pregnant state Anatomically & physiologically. Begins as soon as placenta is expelled lasts for appx 6 weeks(42 days) 3 stages Immediate-within 24hrs Early -upto 7 days

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NORMAL PUERPERIUM

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  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 • 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

  5. Physiological Consideration Muscles: Endometrium: regenstarts on day 7 from uterine gland mouths and interglandularstromal cells completed by day 16 except @ placental site

  6. 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

  7. Involution of other Pelvic structures

  8. Lochia Vaginal discharge for the 1st fortnight during puerperium Odour: offensive fishy smell Colour and composition

  9. Clinical importance

  10. Changes in breast & lactation

  11. General Physiological Changes Pulse: 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. Abnormal Puerperium • Puerperal fever/ pyrexia • Puerperal Sepsis • Pelvic pain • Fever • Foul smelling vaginal discharge • Subinvolution

  17. Breast Problems • Retracted/cracked nipples • Breast engorgement • Mastitis • Breast abscess • Failure of lactation

  18. Urinary Problems • Retention • Incontinence • Infection • Venous thrombosis • Secondary Hemorrhage • Puerperal psychosis • Obstetric palsy

  19. THANQ

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