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    The Puerperium

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    Venz
    The document summarizes anatomical, physiological, and clinical aspects of the puerperium, which is the period following childbirth of 4 to 6 weeks. Key points include: - The uterus involutes from 1000g immediately postpartum to 100g or less by 4 weeks as the endometrium regenerates. - Lochia consists of bleeding that changes from red to pale to white over the first 10 days as the uterus involutes. - Breast changes include production of colostrum for the first 5 days, transitioning to mature milk by 4 weeks as regulated by hormones like prolactin. - Care of the mother includes monitoring after delivery, perineal care, diet,

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    The Puerperium

    Uploaded by

    Venz
    74 views42 pages
    The document summarizes anatomical, physiological, and clinical aspects of the puerperium, which is the period following childbirth of 4 to 6 weeks. Key points include: - The uterus involutes from 1000g immediately postpartum to 100g or less by 4 weeks as the endometrium regenerates. - Lochia consists of bleeding that changes from red to pale to white over the first 10 days as the uterus involutes. - Breast changes include production of colostrum for the first 5 days, transitioning to mature milk by 4 weeks as regulated by hormones like prolactin. - Care of the mother includes monitoring after delivery, perineal care, diet,

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    The document summarizes anatomical, physiological, and clinical aspects of the puerperium, which is the period following childbirth of 4 to 6 weeks. Key points include: - The uterus involutes from 1000g immediately postpartum to 100g or less by 4 weeks as the endometrium regenerates. - Lochia consists of bleeding that changes from red to pale to white over the first 10 days as the uterus involutes. - Breast changes include production of colostrum for the first 5 days, transitioning to mature milk by 4 weeks as regulated by hormones like prolactin. - Care of the mother includes monitoring after delivery, perineal care, diet,

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    74 views42 pages

    The Puerperium

    Uploaded by

    Venz
    The document summarizes anatomical, physiological, and clinical aspects of the puerperium, which is the period following childbirth of 4 to 6 weeks. Key points include: - The uterus involutes from 1000g immediately postpartum to 100g or less by 4 weeks as the endometrium regenerates. - Lochia consists of bleeding that changes from red to pale to white over the first 10 days as the uterus involutes. - Breast changes include production of colostrum for the first 5 days, transitioning to mature milk by 4 weeks as regulated by hormones like prolactin. - Care of the mother includes monitoring after delivery, perineal care, diet,

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 42

    The puerperium

    Christiana p. Calagui-damaso, m.d. Ob-gyn

    period of time encompassing the first few weeks following birth between 4 and 6 weeks

    Anatomical, Physiological, and Clinical Aspects

    Vagina and Vaginal Outlet


    Rugae - begin to reappear by the third week but are not as prominent as before Myrtiform caruncles Vaginal epithelium - begins to proliferate by 4 to 6 weeks
    usually coincidental with resumed ovarian estrogen production

    Uterus
    Vessels
    their caliber diminishes to approximately the size of the prepregnant state within the puerperal uterus, larger blood vessels become obliterated by hyaline changes, gradually resorbed, and replaced by smaller ones

    Cervix and Lower Uterine Segment


    end of the first week
    cervical opening narrows, the cervix thickens, and the endocervical canal reforms external os does not completely resume its pregravid appearance

    next few weeks


    lower segment is converted from a clearly distinct substructure large enough to accommodate the fetal head, to a barely discernible uterine isthmus located between the corpus and internal os

    Uterine Involution
    1000 g weight of the uterus immediately postpartum 2 days after delivery, the uterus begins to involute
    1 week - 500 g 2 weeks, 300 g and has descended into the true pelvis 4 weeks - it regains its previous nonpregnant size of 100 g or less

    cells decrease markedly in sizefrom 500-800 m by 5 to 10 m at term to 50-90 m by 2.5-5 m postpartum decidua basalis is not sloughed

    Lochia - consists of erythrocytes, shredded decidua, epithelial cells, and bacteria


    lochia rubra - first few days after delivery; red lochia serosa - 3 or 4 days; progressively pale in color lochia alba - 10th day; admixture of leukocytes and reduced fluid content; white or yellowishwhite color

    Endometrial Regeneration
    superficial layer - becomes necrotic and is sloughed in the lochia basal layer adjacent to the myometrium - remains intact and is the source of new endometrium endometrium arises from proliferation of the endometrial glandular remnants and the stroma of the interglandular connective tissue

    Subinvolution

    arrest or a retardation of involution accompanied by prolongation of lochial discharge and irregular or excessive uterine bleeding, which sometimes may be profuse both retention of placental fragments and pelvic infection may cause subinvolution bimanual examination
    uterus is larger and softer than would be expected.

    Ergonovine or methylergonovine (Methergine), 0.2 mg every 3 to 4 hours for 24 to 48 hours

    Chlamydia trachomatis - azithromycin or doxycycline

    Late Postpartum Hemorrhage


    secondary postpartum hemorrhage - bleeding 24 hours to 12 weeks after delivery
    result of abnormal involution of the placental site occasionally is caused by retention of a placental fragment

    Treatment
    oxytocin, ergonovine, methylergonovine, or a prostaglandin analog Antimicrobials gentle suction curettage curettage

    Urinary Tract
    overdistension, incomplete emptying, and excessive residual urine dilated ureters and renal pelves return to their prepregnant state - 2 to 8 weeks after delivery

    Incontinence
    Urinary incontinence in the first few days postpartum is uncommon

    Peritoneum and Abdominal Wall


    broad and round ligaments require considerable time to recover from the stretching and loosening that occur during pregnancy

    Blood and Fluid Changes


    Marked leukocytosis and thrombocytosis may occur during and after labor white blood cell count - 30,000/uL Relative lymphopenia and an absolute eosinopenia 1 week after delivery - blood volume has nearly returned to its nonpregnant

    Cardiac output
    usually remains elevated for 24 to 48 hours postpartum declines to nonpregnant values by 10 days

    Weight Loss
    5 to 6 kg loss - due to uterine evacuation and normal blood loss 2 to 3 kg loss - diuresis

    2 L - decrease in sodium space during the first week postpartum

    Breasts and Lactation

    Colostrum

    deep lemon-yellow liquid can be expressed from the nipples by the second postpartum day contains more minerals and amino acids has more protein, (globulin), less sugar and fat contains antibodies, and its content of immunoglobulin A (IgA) secretion persists for approximately 5 days, with gradual conversion to mature milk during the ensuing 4 weeks.

    Human milk
    suspension of fat and protein in a carbohydratemineral solution. nursing mother produces 600 mL of milk daily

    isotonic with plasma, and lactose accounts for half of the osmotic pressure.

    Essential amino acids - derived from blood nonessential amino acids - derived in part from blood or synthesized in the mammary gland.

    milk proteins -lactalbumin, -lactoglobulin, and casein

    All vitamins except K are found in human milk


    Vitamin D content is low22 IU/mL

    T and B lymphocytes
    contains factors that act as biological signals for promoting cellular growth and differentiation

    Whey - milk serum which contain large amounts of interleukin-6


    associated closely with local IgA production by the breast.

    Prolactin - actively secreted into breast milk Epidermal growth factor (EGF)
    it may be absorbed to promote growth and maturation of newborn intestinal mucosa

    Endocrinology of Lactation
    Progesterone, estrogen, and placental lactogen, as well as prolactin, cortisol, and insulin
    stimulate the growth and development of the milk-secretion

    Decrease in the level of estrogen and progesterone during delivery


    This decrease removes the inhibitory influence of progesterone on -lactalbumin production by the rough endoplasmic reticulum

    Lactation prolactin secretion is increased by the repeated stimulus of suckling


    Stimulus from the breast triggers the release of dopamine (prolactin-inhibiting factor) from the hypothalamus, and this in turn transiently induces increased prolactin secretion

    Oxytocin secreted by the neurohypophysis


    stimulates milk expression from a lactating breast by causing contraction of myoepithelial cells in the alveoli and small milk ducts Milk ejection or letting down - reflex initiated especially by suckling, which stimulates the neurohypophysis to liberate oxytocin

    Immunological Consequences Of Human Mulk


    1) Secretory IgG - predominant immunoglobulin in colostrum and milk
    Contains antibodies against Escherichia coli, and breast-fed infants are less prone to enteric infections than bottle-fed infants

    2) protection against rotavirus infections 3) reduces the risk of atopic dermatitis and wheezing illnesses in early childhood

    Breast Engorgement/Pain Milk fever - 37.8 to 39 degrees Celsius Contraception

    Contraindications to BF

    women who take street drugs or do not control their alcohol use

    have an infant with galactosemia


    have human immunodeficiency virus (HIV) infection have active, untreated tuberculosis take certain medications undergoing treatment for breast cancer

    Mastitis - Parenchymatous infection of the mammary glands


    Staphylococcus aureus Dicloxacillin, 500 mg orally four times daily Erythromycin is given to women who are penicillin sensitive

    Breast Abscess
    when defervescence does not follow within 48 to 72 hours of mastitis treatment, or when a mass is palpable surgical drainage

    Care of the Mother during the Puerperium

    Hospital Care
    For the first hour after delivery, blood pressure and pulse should be taken every 15 minutes, or more frequently if indicated

    Early Ambulation Perineal Care

    Bladder Function Depression Abdominal wall relaxation Diet

    Neuromuscular and Joint Problems


    Pressure on branches of the lumbosacral nerve plexus during labor may be manifest by complaints of intense neuralgia or cramplike pains extending down one or both legs as soon as the head descends into the pelvis

    Pelvic or hip muscles and tendons can be stretched, torn, or separated during even normal labor Separation of the symphysis pubis or one of the sacroiliac synchondroses during labor may be followed by pain and marked interference with locomotion Time of Discharge

    Home Care

    Coitus Late maternal morbidity Postpartum Care follow up

    Thank you!!

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