Changes of the Puerperium Flashcards
What is the Puerperium?
The postpartum period, expulsion of placenta, to complete physiological recovery.
Acute: 24 hrs after placenta delivery.
Early: up to 7 days.
Late: up to 6wks and 6mnths.
Involution of the Uterus:
Returning the uterus to its non-pregnant state.
Contraction continue, and restrict blood vessels.
After birth palpation: 2cm above umbilicus (26). Firm, globular, 1kg.
24Hrs: 1-2cm below umbilicus.
2Wks: non-palpable (below symphysis pubis) 300g.
6Wks: Complete recovery (50g).
Breastmilk and establishing breastfeeding:
Oestrogen and Progesterone drop, Prolactin surge.
Prolactin: suckling, hypothalamus, An.P gland, lactocytrophs,
Oxytocin: secretion, Po. P gland. Myoepithelial cells.
Lactogenesis 1: colostrum @16 wks.
Lactogenesis 2: milk supply established. 3 days.
Galactopoesis: maintenance of lactation. (Lactogenesis 3).
Endocrinology:
Drop in placental hormones: (HCG, HPL, Oestrogen, Progesterone.)
Removed from 1) maternal blood. 2)tissues.
Oestrogen: pre-pregnancy level by day 7.
Progesterone: sim to luteal phase day 1/2.
Oxytocin: surge, Po. p gland, milk secretion.
Prolactin: surge, An. p gland, milk prod.
Haemostasis: Think of the 4 stages.
Control of bleeding.
Compression of blood vessels in uterine walls.
“Tying off” of BV in myometrium.
Increase in clotting factors (Fibrinogen) (DVT risk).
Ischaemia: blood volume in uterus reduces.
Autolysis/ fibrinolysis.
Phagocytosis: removal of extra fibrous/elastic tissue. (Some remain - multiparous).
Cervix:
Rapidly looses vascularity.
Pre-pregnancy state in a few days.
Nulliparous vs Multiparous:
“Multips Os”: external os remains slightly open. (internal os closes).
Vagina:
Oedema: reabsorbed within 3/4 days.
Quick healing: elasticity, wounds, bruising.
Parity displaced as more fleshy labia.
Oestrogen: Drops, thinner vag. epithelium (lubrication issues).
Progesterone: Drops, so muscle tone is restored. (V,V and PV).
Cardiovascular System:
Clotting factors: inc imm. after birth . Normal in few weeks. (Thrombosis risk).
Prevention: Early mobilisation.
Blood vol inc. during preg for PP BL (3-500ml)/
Respiratory System:
Breathing becomes easier. (Diaphragm goes up, lungs decompress, Hyperventilation goes away).
02 demands become normal.
Urinary System:
Kidneys excrete excess body fluid (oedema reduces). Diuresis (excessive micturition).
Progesterone drops: pre-pregnancy state (renal organs).
Swollen ankles/feet. Night sweats.
Urinary retention? UTI? incontinence?
GI system:
Should be back to normal, 6Wks PP.
Bloating/constipation . BO 2/3d PP.
Progesterone normal day1/2. Motility/movement incs.
Muscular System:
Abd. wall soft for months PP.
DRAM (Divarification of Rectus Abdominus Muscles).
Divide in midline. (linea nigra).
Progesterone goes back up to normal: Ligaments/ joints.
Striae gravidarum. Excess pregnancy hair falls out.
Nervous System:
Poor sleep PP: infant feeding,.
Carpal tunnel dec. in few weeks.
Mental Health (Psychological):
Baby blues: 2 wks.
Postnatal depression: 1yr. (10-15% of women).
Puerperal Psychosis: rare/severe PND.
Oxytocin:
Encourages involution.
Natural: Po. p gland. Breastfeeding and Skin to Skin.
Artificial: active management of 3rd Stage. (Syntocinon).
