puerperium Flashcards
define puerperium
Time from delivery until the anatomic and physiologic changes of pregnancy have resolved
Approximately 6 weeks
Period of major physical, social, & emotional change and adaptation
what are the three physiological changes seen in puerperium
Lochia and Uterine Involution
2- Lactation
3- Menstruation and resumption of ovulation
what is lochia
passage of blood, mucus and uterine tissue that occurs during the puerperium*
bleeding after delivery of baby and placenta
bloody for 1st few days
Sero-sanguinous for up to 7-10 days
becomes clearer for 6 weeks
should be expected to cease after 4-6 weeks.
what is uterine involution
At umbilicus after delivery
Becomes a pelvic organ by 10 days
Os closed by 3 weeks
what is lactation
- Oestrogen stimulates duct growth
- Progesterone stimulates alveolar growth
- Placental lactogen affects growth of epithelium in alveoli
- Initiation of lactation is dependent on fall in oestrogen after delivering baby which stimulates release of prolactin from hypothalamus
- Milk ejection needs oxytocin from posterior pituitary
- Colostrum produced for first 3 days
Followed by establishment of milk secretion
Continued lactation dependant on suckling
what is colostrum
first secretion of the breast
when does menstruation occur in non lactating women
- resumption of menstruation approximately 8 weeks
first ovulation approximately 10 weeks
About 40% of first cycles are ovulatory
when does menstruation occur in lactating women
if for < 1 month: menstruation resumes in approximately 10 weeks
if breast feed after the first month: the average interval to first ovulation is 16 weeks
breast feeding does not offer secure contraception beyond the ninth week postpartum
management of puerperium at discharge
At discharge
- Inform GP and arrange for midwife and health visitor
- Anti-D if indicated
- Discuss contraception
- Discuss breast feeding
- Perineal care and postnatal exercise
- Vaginal loss / Hb check
At postnatal visit in 6 weeks
Discuss problems and assessment of faecal or urinary incontinence
examination of puerperium
Temperature, BP, pulse, RR, SATS Uterine size and involution Vaginal bleeding Lochia/discharge Abdominal wound (if CS) Perineum and para-vaginal tissue Breast - mastitis signs Lower limbs for DVT Enquire about bladder function Enquire about bowel function
contraception use during puerperium
- Barrier
- IUCD
PERMANENT CONTRACEPTION
- Tubal ligation: mini-laparotomy, laparoscopy 3 months after delivery
Hormonal: Minipill/Depot Injections Combined oral contraception: Reduces breast milk Excreted in milk If not breast feeding: start COP 3 weeks postpartum – increased risk of thrombosis if started earlier
advantages of breast feeding to newborn
- Easily digested nutrients
- Antibodies in colostrum:
lower incidence of gastro-enteritis
respiratory infection
otitis media
PREVENTS narcotising enterocolitis(as lysozyme, lactoferrin and IgA are present).
Avoid milk allergies (1% for cow’s milk)
Good source of nutrition except Vit C, D and iron.
Cannot overfeed
Lower risk of hypocalcaemia
advantages of breast feeding to mother
To Mother Promotes bonding Improves uterine involution ? Reduced risk of breast cancer. Contraception Safe and cheap can lose 500 calories
difficulties of breastfeeding
- Nipple inversion: correct by Waller shields in late pregnancy
- Maternal fatigue
- Emotional stress
what breast feeding advice will one give
Babies sleeping in same room as mothers encourages breast feeding
If still hungry, weigh before and after feeding:
can be fed more often, or supplements added
Check if mother on medication
Contraindicated if active TB/ HIV
Sore nipples are corrected by correcting baby’s position at breast
Express milk for babies in Special Care Units
