16) Pathological 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 Pathologies in Puerperium?

Answer 2

• Puerperal Infections
• Post-Partum Endometritis
• Thrombophlebitis-septic pelvis
• Puerperal Sepsis
• Sub-involution
• Post-Partum Depression / Psychosis

Question 3

Describe Puerperal Infections

Answer 3

• They’re infections of the genitourinary tract, during Post-Partum Period
• Presented with *fever MORE than 38D

** DUE to:**

• Prolonged Rupture of Membranes
• Multiple Vaginal Exams, during Labor
• E.Coli, Klebsiella, GAS, Pseudomonas

(A) LOCAL = Endometritis
(B) DISSEMINATED = Puerperal Sepsis, Thrombophlebitis

Question 4

Describe Post-Partum Endometritis

Answer 4

• Inflammation of the Endometrium, as a result of Lochia retention-induced infection

DUE to:

• C-Section
• Retained POC after delivery, miscarriage, abortion
• Multiple Cervical Exams

CFs = Fever, Chills, Uterine Tenderness, Foul-Smelling Lochia

Treatment = Antibiotics Clindamycin, Gentamycin

Question 5

Describe Thrombophlebitis-Septic Pelvis

Answer 5

• The inflammation + thrombosis of Pelvic Veins

DUE to:

• C-Section
• Pelvic Infections
• Abortions
• Post-Partum Venous Stasis

CFs = Fever, Abdominal Pain, Tenderness of Affected Pelvis Vein, Palpable Cord

Diagnosis = CT / MRI Scan shows Ovarian Vein Thrombosis

Treatment = Antibiotics and Anticoagulants (Low-Molecular Weight Heparin)

Question 6

Describe Puerperal Sepsis

Answer 6

• It’s Maternal Sepsis which develops from birth — 6 Weeks Post-Partum

CFs = Fever, Tachycardia, Pelvic Pain, Abnormal Smelling Discharge

NB! DELAYS Uterine Involution

Treatment = Broad-Spectrum Antibiotics

Question 7

Describe Sub-involution

Answer 7

• When involution stops / arrests, as a result of DILATED Uteroplacental Vessels

CFs

• Prolonged Lochial Discharge
• Excess Uterine bleeding
• Enlargement + Softening of Uterus

Question 8

Describe - Post-Partum Depression / Psychosis

Answer 8

DEPRESSION - Symptoms starts during pregnancy, or 4 weeks of delivery

PSYCHOSIS - During 2 weeks of delivery

• Delusions / Hallucinations
• Persistent Insomnia
• Mood Changes - Mania / Depression