8. Puerperium Flashcards
What is the puerperium?
The period immediately after childbirth when the womb is returning to its normal size, lasting approximately six weeks.
What normal changes occur during puerperium?
- Reproductive organs changes
2. Systemic changes
Which reproductive organs change during puerperium?
Perineum Uterus Cervix Ovaries Breasts
Describe the changes in perineum the during puerperium?
Swelling and engorgement resolved within 2 weeks
Perineal injury: heals by first intention (wound closure)
Integrity and strength recovered by 6 weeks
Pelvic floor strength recovered by 6 weeks
Kegel exercises
Describe the changes in the uterus during puerperium?
Reduces to the level of the Umbilicus - immediately following delivery
1cm/day
Midway between umbilicus and symphysis by 2 weeks
Pelvis by 4 weeks
1000g to 100 - 200g by 6 weeks
What is Lochia?
Lochia
- Vaginal discharge along with decidua, clots and membrane after delivery of the placenta during the puerperium
- Fishy in odour
- Continues for up to 6 weeks but continually reducing
Describe the changes in the cervix during puerperium?
Histological changes
Closed by 2 weeks
Multips os (always 1 cm dilated)
Describe the changes in the ovaries during puerperium?
Ovulation may return within 6 - 8 weeks in nonbreatsfeeding mothers with likely return of menstruation
Suppression of lactation due to pulsatile nature of prolactin release
Ovulation will return even if mothers continue to breastfeed – cave
Describe the changes in the breasts during puerperium?
Breasts
- Lactational function of breasts triggered by decrease in hormones (oestrogen) after the delivery of the placenta and an increase prolactin levels.
Colostrum
- Secreted for 2-3 fays (protein, fat, minerals, IgA and IgG)
Milk
- Protein, lactose, water, fat, IgG, IgA and IgM
What normal systemic changes occur in puerperium?
Cardiovascular
- Increase in CO immediately following delivery but returned to normal by 2 - 6 weeks
- Circulating volumes returned to prepregnancy levels by 2 weeks (7.5 – 5l)
Haematological
- Hb and Hct after delivery (dilutional)
- Coagulation factors remain elevated for up to 6 weeks after delivery ( VTE disease).
What are the abnormal changes in puerperium studied?
Post Partum Haemorrhage
Puerperal Fever and Sepsis
Endocrine Disorders
Psychiatric Disorders
What is PPH? What are the categories?
> 500ml from the genital tract
- Primary (immediate)
- In hospital within 24 hours
- 4 Ts: tone, tissue, trauma, thrombin
- Ix and management - secondary (delayed)
- May occur postdischarge
- Another institution
- Ix and management
What is puerperal Fever and Sepsis?
Temp > 38 degrees in first 10 days
What is endometritis?
Foul smelling lochia
Tender uterus
Increase in vaginal bleeding
Systemic manifestations
Risk factors (4Ps, 3Ms, 1C)
- Caesarean section
- Prolonged labour
- Preexisting lower genital tract infection
- Placement of IDC
- Prolonged ROM
- Multiple Ves
- MROP
- Multiple pregnancy
What are the potential causes of puerperal sepsis?
Wound Infection UTI Mastitis Thrombophlebitis Other
