Puerperium Flashcards
What is puerperium?
The 6 week period following completion of labour
What physiological changes occur in puerperium?
Uterine involution
Genital tract changes
What is uterine involution?
The process by which the post partum uterus of 1kg returns to its pre pregnancy stage of 100g
The fundus moves from 12 cm above pubic symphysis to being no longer palpablee
What causes involution in labour?
AUTOLYSIS (muscle cells diminish in size due to enzymatic degradation of the cytoplasm, as excess protein is absorbed and excreeted in the urine)
What are signs of delayed involution
Full bladder, full rectum
Retained products / clots - opalpable iuterus, artefact on IUSS
What are changes to the genital tract?
Thickening of the cervix
Should take about 2 weeks to close again
In some people the eexternal os reemains open permanently
Becomes funnel shaped
What is LOCHIA?
The blood. stained uterine discharge that comes out of the vagina after birth n
Made up of blood and necrotic decidua
What are the three types of lochia?
RSA
Lochia Rubra - red, during first few days
Lçochia Serosa - pink/brown, two weeks
Lçochia alba _ yellow white discharge, one month
How do you manage perineal tears?
Change sanitary pads frequently + good hygene (wash and change sanitary pads frequently)
Medical mx:
- Analgesia
- Lactulose + bulking agent
- Antibiotics
What is common as bladder dysfunction in puerperium=?
Voiding difficulty + bladder overdistension
Blòadder takes 8 h to regain normal sensation after epidural
THis can damage the detrusor, leading to hypocontractivle bladdert
Leads to overflow incontinence
IWhat do you do to minimise risk of bladder distension=
Insert catheter for at least 12 h after spinal anaesthesia until woman is mobvinle
What kind of. bowel abnormality is normal after birth?
CONSTIPATION
Due to interruption of normal diet, intrapartum dehydration, opiate. use, fear. of opening bowels due to pain
What are three things that are a higher risk with C. secion?
infection
Anaemia
VTE
What do you do for anaemia’
Give iron supplement
OR
Transfusion
Depending on Hb
What is the most important obs to monitor Post partum?
BP
What is secondary post partum haemorrhage?
Bleeding from or into the genital tract 24 h to 6 weeks after birth
What are the two main causes of. secondary PPH?
Endometritis
Retained placenta
What is endometritis?
Inflammation of the endometrium
What are sx of endometritis?
Lower abdominal pain
Tender uterus with closed internal os
What are sx of retained placent?
Crampy lower abdo pain
Large uterus
Open internal os
Prolonged third stage of labour
How do you manage secondary PPH?
IV fluids / blood as required
Uterotonics
Uterine evacuation
Antibiotics (
What is obstetric palsy?
Development of maternal motor / sensory neuropathy following delivery
What are preseenting featueres of obstetric palsy?
Sciatic pain Foot drop Parasthesia Hypoaesthesia Muscle wsting
What causes obstetric palsy?
Nerve damage
Because the lumbosacral plexus and nerve tracks are stretched and compressed by the foetal head
What is the biggest RF for obstetric palsy?
Prolonged/obstructed labour
What is pubic symphisis diastasis?
Spontaneous separation of the pubic symphisis
What are features of pubic symphisis diastasis
Symphiseal pain aggravated by weight bearing and walking
Waddling gait
Pubic. tenderness
palpable interpubic gap
How do you manage pubic symphisis diastasis
Rest
Anti inflammatories
Physio
Pelvic corset
What causes puerperal sepsis?
Genital ttact infection following delivery
How do you prevent puerperal sepsis?
Increased hygiene awareness
Good aseptic technique
Prophylactic antibiotics for CS patients
What form of antibiotics is given to CS patients?
Single intraoperative dose (Co-amoxiclav + metronidazole) before the skin incision
What is treatment once puerperal sepsis is identified
Further antibiootics (broad spectrum)
What is a rare complication that can occur?
Necrotising fascitiis
Due. to clostridium perfingens
What is colostrum
Yellow fluid secreted by breast from 16 weeks to 2nd post partum day
Contains antibodies and WBC
Aims to priotect baby from infection
When is breast milk produced?
From 2nd post partum day
What are major constituents of breast milk=?
lactose, protein, fat, water, all vitamins EXCEPT vit K
What hormones induce lactation and how?
PROLACTIN stimulates milk synthesis
OXYTOCIN stimulates milk release
What is the rooting reflex?
Baby’s mouth gapes when the skin around it is touched
What are advantages of breastfeediung?
Readiliy available
Free
Contraceptive effect
Reduces diseases in babY: necrotising enterocolitis, childhood infective illnesses, atopic illnesses, T1DM; childhoow cancer, premenopausal preast ancer
