NORMAL
PUERPERIUM
WHAT IS PUERPERIUM?
Period following childbirth
 Pelvic organs & other body tissues
 Revert to pre-pregnant state
 Anatomically & physiologically




I.
II.
III.
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
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
Physiological Consideration
Autolysis

Muscles:
Steroid
hormones
withdrawn
Myometrial
cell size
reduced
Inc
Collagenase
& Proteolytic
enzymes
Endophlebitis
Thrombosis
Blood Vessels
Fibrinoid end arteritis

Hyalinisation
Endometrium:




regen starts on day 7
from uterine gland mouths and interglandular stromal cells
completed by day 16
except @ placental site
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
4-8 weeks;
Broad/round
ligaments
Vagina
Does not revert
to original state
Long time d/t
stretching
during
parturition
Pelvic floor & Fascia
Involution of other Pelvic structures
Long time d/t
stretching
during
parturition
LOCHIA
• Vaginal discharge for the 1st fortnight during puerperium
●
Odour: offensive fishy smell
●
Colour and composition
Lochia Rubra
•1-4 days
•Blood,fetal memb & decidua
shreds,lanugo,meconium
Lochi Serosa
•5-6 days
•Leucocytes,Cx mucus,wound
exudates,microorganisms
Lochia Alba
•10-15 days
•Decicual
cells,leucocytes,mucus,cholestrin
crystals,fatty epithelial
cells,microorganisms
Clinical importance
Malodorous
Scanty/absent
Excessive
• Puerperal Sepsis d\t E. Coli
• Infection
• Lochiometra
• Infection
Red color persist
• Subinvolution
• Retained conceptus
• Causes secondary PPH
L.Alba beyond 3 wks
• Local genital infection
CHANGES IN BREAST & LACTATION
General Physiological Changes

Pulse:


Temperature:






Pronounced Diuresis on 2nd - 3rd day
over distension
incomplete emptying
presence of residual urine
high risk of infection
GIT:



Any rise above 0.5C suggestive of infection of genito-urinary tract
Urinary Tract:


raises but settles down to normal on 2nd day
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

Blood Values:






Menstruation:


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
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
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

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

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
Abnormal Puerperium
 Puerperal fever/ pyrexia
 Puerperal Sepsis
• Pelvic pain
• Fever
• Foul smelling vaginal discharge
• Subinvolution
 Breast Problems
• Retracted/cracked nipples
• Breast engorgement
• Mastitis
• Breast abscess
• Failure of lactation
 Urinary Problems
• Retention
• Incontinence
• Infection
 Venous thrombosis
 Secondary Hemorrhage
 Puerperal psychosis
 Obstetric palsy
THANQ