Download Normal and Abnormal Puerperium

Normal and Abnormal
Puerperium
Assoc. Prof. Gazi YILDIRIM
Normal Puerperium
• Definition
1. The time from the delivery of the placenta through
the first few weeks after the delivery.
2. 6 weeks in duration.
3. By 6 weeks after delivery, most of the changes of
pregnancy, labor, and delivery have resolved and
the body has reverted to the nonpregnant state.
Normal Puerperium
•
1.
1)



The relevant anatomy and physiology in the
puerperium
Reproductive organs
Uterus
1000g → 50-100g
The endometrial lining rapidly regenerates (16
days)
The placental site undergoes a series of changes in
the postpartum period
Normal Puerperium
2) Cervix
 it never returns to the nulliparous state.
 the external os is closed to the extent that a finger
could not be easily introduced.
3) Vagina
 shrinks to a nonpregnant state
 resolution of the increased vascularity and edema
occurs by 3 weeks
 the vaginal epithelium appears atrophic on smear.
This is restored by weeks 6-10.
Normal Puerperium
4) Perineum
 swelling and engorgement are completely gone
within 1-2 weeks
 the muscle tone may or may not return to normal,
depending on the extent of injury.
5) Ovaries
 ovulate as early as 27 days after delivery (not
breastfeed ); 12 weeks (most); 7-9 weeks (mean).
 the suppression of ovulation due to the elevation
in prolactin
Normal Puerperium
6) Breasts
 Lactation can occur by 16 weeks' gestation.
 Lactogenesis is initially triggered by the delivery
of the placenta (E↓P↓and prolactin).
 the prolactin levels decrease and return to normal
within 2-3 weeks (not breastfeeding)
 The colostrum (the first 2-4 days)
 The milk continues to change throughout the
period of breastfeeding to meet the changing
demands of the baby.
Normal Puerperium
2.
1)


2)


Systemic change
Cardiovascular system
Blood volume returns to nonpregnant levels by
the tenth days of puerperium
Cardiac output ↑(immediately after delivery) →
slowly declines→ reach late pregnancy levels 2
days postpartum→ normal 2-6 weeks.
Hematologic changes
Hemoglobin concentration↑on the first
postpartum days
Several clotting factors (fibrinogen) ↑on the first
days
Management of normal puerperium
 The majority of mothers are perfectly
well during the puerperium and
should be encouraged to establish
normal activities.
 Immediately following the delivery of
the placenta observation of :
Management of normal
puerperium
1. Vital signs (P,BP,Temp,R.R)
+ contraction of the uterus (uterin involution)
+ Lochia (amount; colure ,and odder)
=Every 5 min. for ½ hours , then every ½
hourly for 2 hours, then transfer the
mother to the postnatal ward and
observation every 2 hours for 6 hourly;
then 6 hourly till discharge.
Management of normal puerperium
2 ) - Breast examination+lawer limb
examination for the detection of signs
of DVT every day.
3 ) - The mother should be encouraged
to pass urine.
Management of normal
puerperium
4 ) - Early mobilization.
5 ) - Management of episiotomy ;and perennial
tears.
6 ) -In normal delivery the mother can go home
48 hours after delivery ;and 10 days in C.S.
7 ) - Diet regime.
8 ) - postnatal visit.
9 ) - Advising for contraception and spacing of
pregnancy.
breast feeding
Puerperal Infection
• Puerperal Infection
any bacterial infection of the genital tract after
delivery. Incidence: 6%. The most important cause
of maternal death.
• Puerperal Morbidity
temperature 38.0℃ or highter, the temperature to
occur on any 2 of the first 10days postpartum,
exclusive of the first 24 hours, and to be taken by
mouth by a standard technique at least four times
daily.
Puerperal Infection
•
1.
2.
3.
4.
5.
Risk factors
PROM
Anemia
Hemorrhage
EP and CS
Placenta retain
Puerperal Infection
•
1.


Common pathogens
Aerobes
Group A, B, and D streptococci
Gram-negative bacteria: Escherichia coli,
Klebsiella
 Staphylococcus aureus
Puerperal Infection
2.




3.


Anaerobes
Petococcus species
Petostreptococcus species
Bacteroides fragilis group
Clostridium species
Other
Chlamydia trachomatis
Mycoplasma species
Puerperal Infection
•





Manifestation
Acute vulvitis vaginitis and cervicitis
Uterine infection
Adnexal infections
Septic pelvic thrombophlebitis
Sapremia
Puerperal Infection
•




Diagnosis
History
Physical examination and PV
Lab finding
Differential diagnosis
Puerperal Infection
• Treatment
1. Nutrition: anemia prevention
2. Antimicrobial treatment
broad-spectrum, high dose, long time
3. Drainage
4. Treatment of thrombophlebitis
Late Postpartum Hemorrhage
• Definition
Uterine bleeding by 24 hours after delivery.
• Etiology
 Placenta or membrane or decidua retain
 Abnormal redintegration
 Infection
 Problems of incision
END