puerperium Flashcards
Definition and duration
- Pueperium is the period following childbirth, during which the female
undergoes significant physiologic changes that return her to her pre-gravid stage - 3 period
1. immediate : 1st 24hr
2. early : 1st wk
3. late : 6wks - It lasts for 6-8 weeks after delivery
Classification
i) Early pueperium – 24hrs after delievery
ii) Late pueperium – 24hrs till 6-8 weeks
- puerperium may be:
a) normal
b) abnormal
Involution of reproductive tract
i) uterus involution –
-it is the process by which the post partum uterus (1kg) returns almost to its
pre-pregnancy state (≈100g).
-It occurs as a result of autolysis of the excessive cytoplasm of muscle cells
by enzymes (collagenose)….by macrophages in ….withdrawal of steroid
hormones. Thus there is a……………….
in breast feeding women due to the release of oxytocin from post pituitary
due to mammary gland stimulation, It is also decrease in size due to
thrombosis and gyaline degeneration of vessels. However, it never returns
to nulliparous size.
a) 1st day – at umbilical level
b) 2nd day – 2cm below level
c) 3rd day – 4cm below level
d) 5th day – Midpoint …uterus and symphysis
e) 7th day – 4cm above symphysis
f) 10th day – at level of symphysis(so, it is not palpale)
g) 14th days – 6 weeks - not pregnant size
ii) Cervix
- it never returns to immature state, showing signs of parturition (external os is opened).
- After delievery, it becomes flabby and present of cervical lacerations
- During first few days may admit 2 fingers
- In the 2nd week – internal os is closed
iii) Vagina and vulva
- During first few days – stretched vagina is smooth tenderness
- 3rd week – return to pre-gravid size, nugae appear, labia are less prominent state.
- Lochia discharge:
→ Lochia rubra (2-3 days) – blood tinged uterine discharge (shreds of
tissue and deciduas)
→ Lochia serosa – vessels are closed, deciduas, continues in separate –
serous discharge for 6 – 7 days.
→ Lochia alba – 2nd-3rd week, thick, mucoid, yellow white in color.
