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    Normal Puerperium & Postnatal

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    Girish Waru
    This document discusses postnatal care and potential issues that can arise during the postnatal period. It defines normal puerperium as the 6-week period after childbirth and describes the physiological changes that occur, including involution of the uterus and changes in lactation. It also outlines aspects of postnatal care like checkups, management of normal puerperium, treatment of minor issues, and postnatal exercises. Abnormalities like puerperal fever, sepsis, and other infections are defined and their causes, diagnosis, and management described. Other issues like secondary hemorrhage, puerperal psychosis, and obstetric palsy are also summarized.

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    Normal Puerperium & Postnatal

    Uploaded by

    Girish Waru
    71 views38 pages
    This document discusses postnatal care and potential issues that can arise during the postnatal period. It defines normal puerperium as the 6-week period after childbirth and describes the physiological changes that occur, including involution of the uterus and changes in lactation. It also outlines aspects of postnatal care like checkups, management of normal puerperium, treatment of minor issues, and postnatal exercises. Abnormalities like puerperal fever, sepsis, and other infections are defined and their causes, diagnosis, and management described. Other issues like secondary hemorrhage, puerperal psychosis, and obstetric palsy are also summarized.

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    This document discusses postnatal care and potential issues that can arise during the postnatal period. It defines normal puerperium as the 6-week period after childbirth and describes the physiological changes that occur, including involution of the uterus and changes in lactation. It also outlines aspects of postnatal care like checkups, management of normal puerperium, treatment of minor issues, and postnatal exercises. Abnormalities like puerperal fever, sepsis, and other infections are defined and their causes, diagnosis, and management described. Other issues like secondary hemorrhage, puerperal psychosis, and obstetric palsy are also summarized.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    71 views38 pages

    Normal Puerperium & Postnatal

    Uploaded by

    Girish Waru
    This document discusses postnatal care and potential issues that can arise during the postnatal period. It defines normal puerperium as the 6-week period after childbirth and describes the physiological changes that occur, including involution of the uterus and changes in lactation. It also outlines aspects of postnatal care like checkups, management of normal puerperium, treatment of minor issues, and postnatal exercises. Abnormalities like puerperal fever, sepsis, and other infections are defined and their causes, diagnosis, and management described. Other issues like secondary hemorrhage, puerperal psychosis, and obstetric palsy are also summarized.

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    Download as PDF, TXT or read online from Scribd
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    of 38

    Post natal care &

    complaints during post natal


    period

    Vijay Zutshi
    MAMC & Lok Nayak Hospital, New Delhi
    Normal puerperium
    and Postnatal Care
    Objectives
    ◼ Definition of normal puerperium
    ◼ Various physiological changes during
    normal puerperium
    ◼ Various aspects of lactation
    ◼ Care of a woman during puerperium
    ◼ Explain the postnatal exercises to be
    practiced during puerperium.
    Definition of Normal Puerperium
    Child birth – 6 weeks(42 days)

    ▪ First 24 hours
    ▪ Early- up to 7 days
    ▪ Remote- up to 6 weeks
    Points to remember for puerperium:
    •Prevention of sepsis at placental site
    •Newborn care
    •Initiation of breast feeding
    •Role of post-natal exercises
    Physiological changes in Normal
    Puerperium
    ◼ Changes in Genital Tract
    ◼ Changes in breast and Lactation
    ◼ Changes in other systems
    Changes in Genital Tract

    ◼ Involution of the Uterus


    ◼ Lochia
    ◼ Involution of Other Pelvic Organs
    ◼ Menstruation
    Changes in Breast and Lactation

    ◼ Mamogenesis (Mammary duct-gland growth & dev.)

    ◼ Lactogenesis (Initiation Of milk secretion in alveoli)

    ◼ Galactopoiesis (Maintenance of Lactation)


    ◼ Galactokinesis (Removal of Milk from Gland)
    Changes in other system
    ◼ Fatigue
    ◼ Pulse slow
    ◼ Temp. subnormal
    ◼ Shivering
    ◼ Fever up to first 24 hours
    ◼ Hb. Rises
    ◼ TLC increases
    ◼ Diuresis- 2nd to 5th day post delivery
    Postnatal Care
    ◼ Postnatal Check Up
    ◼ Detection of risk at earlier stage & its
    management
    ◼ Management of Normal puerperium
    ◼ Treatment of Minor Ailments
    ◼ Treatment of anaemia
    ◼ Health & nutrition education
    ◼ Postnatal Exercise
    Postnatal Check Up
    ◼ General health check up
    ◼ Monitoring of involution process
    ◼ For satisfactory establishment of lactation
    ◼ For examination of newborn
    Management of Normal Puerperium
    ◼ First hour– important for PPH
    ◼ Early ambulation
    ◼ Avoid strenuous activities for 6 weeks
    ◼ 8-10 hours sleep
    ◼ Needs 300 calories more
    ◼ Care of MLE stitches if any
    ◼ Care of nipples and areola.
    Treatment of Minor Ailments
    ◼ After pains
    ◼ Retention of urine
    ◼ Pain at site of perineum
    ◼ Engorgement of breast
    ◼ Treatment of Anaemia
    Health & nutrition education
    ◼ Family planning advise
    ◼ Sexual intercourse can be resumed after 6
    weeks after delivery
    ◼ Breast feeding is best
    ◼ Immunization of child
    ◼ Calorie need per day-2200+700 =2900
    ◼ Role of post natal exercises
    Postnatal Exercise
    ◼ Pelvic floor exercise
    ◼ Abdominal tightening
    ◼ Pelvic tilting or rocking
    ◼ Rectus gap
    ◼ Hip hitching
    ◼ Foot and Leg Exercise
    ABNORMAL PUERPERIUM
    OBJECTIVES
    ◼ Importance of puerperal infections to maternal
    morbidity and mortality
    ◼ Definition of puerperal fever and puerperal sepsis
    ◼ Various puerperal abnormalities
    ◼ Causes of puerperal fever
    ◼ Aseptic and antiseptic measures to be adopted for the
    prevention of puerperal sepsis
    ◼ Management of the various abnormalities.
    Abnormal puerperium
    Sepsis is the commonest
    complication during puerperium
    but largely preventable.
    Puerperal Fever/Pyrexia
    Oral temp. 38 degree C or
    more recorded twice in the
    first 10 days after delivery.
    Causes of Puerperal fever

    ◼ Uterine infection
    ◼ Breast infection
    ◼ Urinary infection
    ◼ Thrombophlebitis
    ◼ Other incidental infections
    Puerperal Sepsis
    ◼ Definition
    ◼ Risk Factors for Puerperal Sepsis
    ◼ Diagnosis
    ◼ Management
    ◼ Complication
    Definition

    ◼ Infection of genital tract : Delivery-42 days


    after delivery
    ◼ Two or > features to be present
    pelvic pain, fever 38.50 C, vaginal D/S, smell of D/S,
    sub-involution
    Risk Factors for Puerperal Sepsis
    ◼ Anaemia
    ◼ Malnutrition
    ◼ DM
    ◼ Prolonged labor
    ◼ Obstructed labor
    ◼ Prolonged PPROM
    ◼ Frequent vaginal examinations
    Contd….
    ◼ Operative delivery
    ◼ Un-repaired tears
    ◼ PPH
    ◼ Poor hygiene
    ◼ Poor aseptic technique for delivery
    ◼ Manipulations high in the birth canal
    ◼ Retained bits of placenta or membranes
    ◼ Pre-existing STDs
    Diagnosis
    ◼ Endometritis
    ◼ Subinvolution
    ◼ Pelvic cellulites
    ◼ Salpingitis & peritonitis
    ◼ Pelvic thrombophlebitis
    ◼ Septicaemia
    Management

    Preventive
    ◼ Good antenatal care
    ◼ Proper intra-natal care
    ◼ Post natal care
    Curative
    ◼ General care
    ◼ Antibiotics for infection
    ◼ Local care of various wounds
    Complication
    ◼ Septicaemia
    ◼ Septic shock
    ◼ DIC
    ◼ Pulmonary embolization
    ◼ Distant spread of infection
    ◼ Kidney failure
    ◼ Death
    Contd….
    Late complications:
    ◼ Menstrual problems
    ◼ Chronic pelvic pain
    ◼ Chronic PID
    ◼ Secondary infertility
    Infections Associated with Childbirth
    Process other than Puerperal Sepsis
    ◼ Breast Problems
    ◼ Urinary Problems
    ◼ Venous Thrombosis
    Breast Problems
    ◼ Retracted / cracked nipples
    ◼ Breast engorgement
    ◼ Mastitis
    ◼ Breast abscess
    ◼ Failure of lactation
    Urinary Problems
    ◼ Retention
    ◼ Incontinence
    ◼ Infection
    Venous Thrombosis

    ◼ Due to hypercoagulable state of pregnancy


    ◼ Predisposing factors:
    Increasing maternal age
    Obesity
    Anaemia
    Dehydration
    Trauma
    Infection
    Smoking
    Reduced mobility
    Puerperal Morbidity other than
    infection
    ◼ Secondary Hemorrhage
    ◼ Puerperal Psychosis
    ◼ Obstetric Palsy
    Secondary Hemorrhage

    ◼ Due to:
    Infection
    Retained bits of placenta &
    membranes
    Subinvolution
    Puerperal Psychosis

    ◼ Transient
    ◼ Self limiting
    ◼ Antidepressants & psychological
    counseling
    Obstetric Palsy
    ◼ Severe neuralgia due to pressure on
    lumbo-sacral nerve plexus
    ◼ Foot drop
    ◼ Rarely femoral, obturator or sciatic nerves
    may be involved
    ◼ Spontaneous recovery usually
    ◼ Physiotherapy is helpful
    Conclusions
    ◼ Importance of history
    ◼ Systematic evaluation
    ◼ Proper advise & motivation regarding
    contraception
    ◼ Importance of immunization for new born
    ◼ Stress upon post natal exercises.

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