Puerperium Flashcards
Definition of puerperium
Time from the delivery of the placenta till 6 weeks after delivery
- Body reverts to non-pregnant state
Physiology changes in puerperium
Uterus
1. Uterine involution
- immediately after delivery, uterine fundus is felt at the level of umbilicus
- 2-3 weeks later, it is felt below pubic symphysis
- Lochia (vaginal discharge after birth: mixture of blood leukocytes and shred off decidua)
- initially dusky red then cleared by 4 weeks
Other system
1. CVS
- levels of blood clotting factors and platelet rise after delivery
Management of normal puerperium
- Vitals
- temp, RR, BP, HR, O2 sat - Level of uterine fundus (umbilicus level after delivery)
- If high level, consider:
a. Uterus filled with blood
b. Full bladder
c. Pelvic hematoma - Amount of vaginal bleed using pad chart TRO PPH
- Bladder -> encourage urination to reduce cx
- Breast
- Suitable for breastfeeding
- Encourage breastfeeding
- Refer to lactation consultant - Check wound
- Ambulation
- Reduce DVT risk
- If high risk:
a. DVT prophylaxis
b. TED stocking
c. Clexane - Analgesia
- Mood disorders
- Emotional support - Contraceptive advice
- PAP/HPV Screening
If uterus fundus level is higher than expected (umbilicus) post delivery, suspect:
a. Uterus filled with blood
b. Full bladder
c. Pelvic hematoma
Complications of puerperium to elicit in history
Major cx
- Thromboembolism (DVT)
- Infection of wound
- PPH (1’ vs 2’)
Others
- Urinary/bowel cx
- Mental disorder
- Breast feeding cx
Other points to ask for:
- Discharge
- Screening (PAP, HPV)
- Contraception
Risk factors of thromboembolism in puerperium
- Past hx of thromboembolic disease
- Obesity
- C-sect
- Prolonged bed rest for any obstetric cx
- > 30yo
- Heavy smokers
- Presence of lupus anticoagulant in pregnancy
- Deficiency of natural anticoagulant (AT3, protein S and C)
Puerperal infection
Temperature 38 degrees or more within 10 days of post partum
Common infection sites in puerperal infection
Pelvic organs (endocervical swab)
Urinary tract (urine culture)
Respiratory (sputum culture)
Breasts
Surgical wound (wound culture)
Legs
-> Blood cultures
Urinary complications
- Urinary retention
- Prolonged labour
- Epidural analgesia
- Instrumental delivery: bruising/edema/hematoma around bladder - Urinary incontinence
- Stress
- Urge
- If continuous leakage -> examine to exclude fistula
Breastfeeding complications
- Painful breasts
a. Engorgement
- Painful breasts
- Low grade fever
- Management: encourage breastfeeding, use breast pump
b. Sore/Cracked nipples
- Due to poor positioning of baby
- Management: Teach mother, ointments, use of breast pump until nipple has healed
c. Mastitis
- Fever
- Tender breast
- Erythema over breast
- Management: Antibiotic, continue breastfeeding, use breast pump
d. Abscess
- Management: Drainage + Abx cover
Mental disorder
- Post-natal blues
- Transient self limiting condition
- Lasts for <2 weeks
- Anxious, irritable, tearful
- Reassurance, social & family support - Postnatal depression
- Refer to psychiatry - Postnatal psychosis
- Refer to psychiatry
