Puerperium

Question 1

What is the normal puerperium?

Answer 1

Postpartum period
It is the time following childbirth when a woman’s body returns to the pre-pregnant state
(From child birth to 6 weeks)(42 day)

Question 2

General changes in the normal puerperium:

Answer 2

Temp: + but exeed 38°
Pulse: + if there is hge or infection
Breast : colostrum in the first 3 days and milk after 3-4 days with breast engorged tender relived by sukling
Urine: diuresis by 2-4 day
Loss of weight
Bowel: tendency to constipation
Blood: ++ coagulability during 1st two week and -HG

Question 3

Changes in genital tract (puerperium)

Answer 3

Involution of the uterus
Lochia
Involution of other pelvic organs
Menstruation

Question 4

Types of lochia in the order

Answer 4

lochia rubra (1st few days) : bloody discharge
lochia serosa (3-4 days): pink (become lighter)
lochia alba (10th day): white or yellow-white

Question 5

Foul-smelling lochia suggests:

Answer 5

Endometritis

Question 6

Return kf menstruation
Nursing vs. non-nursing mothers

Answer 6

Non-n : return by 6-8 weeks
Nursing : may develop lactating amenorrhea

Question 7

T or F
CO use should be advised during the puerperium

Answer 7

T
although ovulation may not occur for several months

Question 8

Woman who deliver vaginally should be taught & encouraged to perform:

Answer 8

Kegel exercises

Question 9

Changes in breast and lactation:

Answer 9

Mamogenesis
Lactogenesis
Galactopoiesis
Galactokinesis

Question 10

Abnormal puerperium:

Answer 10

Puerperal fever/pyrxia
Puerperal sepsis
Breast problems
Perineal Complications
Bladder and bowel dysfunction
Venous thrombosis
Puerperal psychosis
Obstetric palsy

Question 11

Causes of Puerperal fever:

Answer 11

Uterine, breast, and urinary infections
Thrombophlebitis
Other incidental infections

Question 12

Features of puerperal sepsis

Answer 12

Pelvic pain
Fever 38.5°
Offensive Vaginal DS
Sub-involution

Question 13

RF for puerperal sepsis:

Answer 13

Anemia
Malnutrition
DM
Prolonged and obstructed labor
Prolonged PPROM
Frequent vaginal examination
Poor hygiene
Pre-existing STDs
Operative delivery

Question 14

S&S of P sepsis

Answer 14

Fahm, N&V, offensive 2ry PPH
Signs: pyrexia, tachycardia, uterusis large tender
Infected wound may present

Question 15

P sepsis investi:

Answer 15

1. FBC: anemia, leukocytosis
2. ABG: acidosis&hypoxia
3. High vaginal swab: infection
4. Pelvic USS: retained products, adnexal mass or pelvic abscess
5. Coagulation profile: DIC
6. RFT&Electrolyte: Imbalance

Question 16

Complications of P infection:

Answer 16

septicemia&septic shock
DIC
Pulmonary embolization
Distant spread of infection
Kidney failure
Death

Question 17

Late Complications of P sepsis

Answer 17

Mensis problems
Chronic pevic pain
Chronic PID
2ry infertility

Question 18

Breast problems:

Answer 18

Retracted/ cracked nipples
Breast engorgement
Mastitis
Breast abscess
Failure of lactation

Question 19

Talk about mastitis:

Answer 19

After 2 -4 weeks
Caused by staph aureus bacteria from the infant’s oral pharynx
If a breast abscess develops, it should be surgically drained

Question 20

Perineal Complications:

Answer 20

Perineal discomfort: it is ++ in episiotomy
Local cooling by crushed ice or topical Anasthetics.
perineal infection: (uncommon but serious)
Caused by bacterial contamination during delivery
Antibiotics and drainage of pus if presence

Question 21

Bladder problems:

Answer 21

Bladder dysfunction:
Voiding difficulty and over-distension

Question 22

Bowel problems:

Answer 22

constipation is common
Adivece on adequate fluid & fiber intake is necessary

Question 23

Venous thrombosis

Answer 23

Dt to **hypercoagulable state of pregnancy

Question 24

Predisposing factors of venous thrombosis:

Answer 24

++ maternal age
Obesity
Anemia
Dehydration
Trauma
Infection
Smoking
Reduced mobility

Question 25

Puerperal psychosis

Answer 25

Transient
Self limiting
Antidepressants & psychological counseling

Question 26

Obstetric palsy

Answer 26

severe neuralgia dt pressure on lumbo-sacral nerve plexus
Foot drop
Spontaneous recovery usually
Physiotherapy