15) Physiological Puerperium

Question 1

What’s the Definition of Puerperium?

Answer 1

• The time from Delivery —> 6 Weeks Post-Partum
• It’s the period of adjustment + reversal of anatomy / physiology
• To a Non-Pregnant State

Question 2

What are the Physiological Changes in Puerperium?

Answer 2

1) Uterine Involution (shrinkage)
2) Lochia Discharge

3) Lactation = Prolactin from Anterior PG stimulates Milk Production

Question 3

Describe Uterine Involution

Answer 3

• Where the Uterine Fundus shrinks
• Usually takes around 6 - 8 Weeks to return to normal size
• Breast-Feeding SPEEDS UP the process = Due to Oxytocin Release –> helps contract the myometrium

RIGHT AFTER Birth = Between Navel — Symphysis

AFTER Day 1 = At the Navel
At Day 10 = At the Symphysis

Question 4

Describe Lochia Discharge

Answer 4

• It’s the Vaginal Discharge after birth
• Contains mucous, blood, cellular debris + uterine tissue
• Occurs for 3 - 4 Weeks

NB! FOUL SMELL indicates infection

Question 5

What are the Types of Lochia?

Answer 5

1) Lochia Rubra = 1 - 3 Days

• Blood and Decidua

2) Lochia Serosa = 3rd - 10th Day

• Blood, Mucous and WBCS

3) Lochia Alba = 10th - 15th Day (NO Blood)

Question 6

How’s Pueperium Assessed?

Answer 6

• Check the Post-Partum pressure, HR + temperature
• Check the Fundal Height + Endometrial Lining (restored by 16th Day)
• Checking the Lochia Discharge
• Examine the breasts / breast-feeding
• Check the Vulva + Perineum - in cases of trauma
• Psychiatric State - Post-Partum Depression?

Question 7

What are the IMMEDIATE Post-Partum Findings?

Answer 7

• Fever
• Shivering
• Leukocytosis

Question 8

What are the Stages of Puerperium?

Answer 8

1) IMMEDIATE - Just LESS than 24h after giving birth

2) EARLY = Within 1 Week

3) REMOTE = Period for involution of genital organs

Question 9

What are the Complications during Post-Partum Period?

Answer 9

• Infection
• Thrombosis
• Insufficient recovery from Post-Partum
• Post-Partum Depression

Question 10

What are the Puerperal Complications?

Answer 10

1) Secondary Post-Partum Hemorrhage

• Retained products of pregnancy such as - placenta
• Endometritis
• Abnormal Involution of Placental Attachment Site

2) Deep Vein Thrombosis or Pulmonary Embolism

3) NB! Puerperal Pyrexia - presence of fever, after given birth

• Result of Endometritis (Infection from endometrium –> tubes, ovaries + peritoneum)

Question 11

What are the Clinical Features of Puerperal Pyrexia?

Answer 11

• Abdominal Pain
• Uterine Tenderness
• Fever
• Purulent Lochia
• Mastitis
• UTI