the puerperium

Question 1

What is the puerperium

Answer 1

The period commencing from delivery of the placenta until 6-8weeks after birth , considered to be complete with the first ovulation and the return of normal menstruation.

Question 2

what is the top to toe check

Answer 2

· Emotional wellbeing , bonding and headaches
· Breasts - feeding , engorgement , nipples and lactation
· Bowels - constipation and movement
· Uterus - involution
· Bladder - frequency amount , UTI , retention
· lochia - colour , amount , odour
· Legs - signs of DVT ,mobility

Question 3

what are the vital signs

Answer 3

· Bp
· Pulse
· Temperature
· Respirations
· Saturations
· Alertness
· Pain

Question 4

what happens to the hormones once pregnancy is over

Answer 4

· Oestrogen - reduced to pre pregnancy level by day 7
· Progesterone - reduces similar to luteal phase by 48 hours - similar to follicular phase by day 7
· Prolactin - increases to support lactation
Thyroid - organ reduces back to normal size - hormone levels normal by 4 weeks

Question 5

cardiovascular and respiratory

Answer 5

Diuresis within 48hr to reduce circulating volume
Reduced progesterone - removal of excess tissue fluid
Bp returns to non pregnant level
Lungs able to fully inflate
Oxygen demands return to normal

Question 6

postpartum psychosis

Answer 6

Severe depressive illness
Rapid
Within 1 month
Hallucinations , thought disturbances , insomnia

Question 7

breasts

Answer 7

oxytocin is high immediately after birth encouraging instinctive feeding
Prolactin increases to increase lactation and milk secretion
Nipples
breastfeeding should be comfortable and pain free
May be tender or some sort of discomfort in first few days
Attachment issues cause soreness

Question 8

mastitis

Answer 8

Area of inflammation following engorgement or a blocked duct
If breastfeeding continue to feed offering infected breast first - warm compresses possible antibiotics

Question 9

uterus

Answer 9

Return of gravid uterus to its original position size and shape
Vagina and pelvic floor muscles also return to pre pregnant state
Rate of involution varies

Question 10

Muscle layer returns to normal thickness by three processes

Answer 10

· Ischaemia - decreased blood supply
· Autolysis - enzymes break down excess muscle fibres and cytoplasm
Phagocytosis - products of autolysis engulfed by macrophages

Question 11

Afterpains

Answer 11

· Oxytocin causes further uterine contractions for up to 24hours
· Stronger in multips
· Usually settled by 4-7 days
Can be associated with breastfeeding

Question 12

lochia

Answer 12

Lochia
· Vaginal blood loss during the puerperium
Varies in content - volume and colour

Question 13

rubra red

Answer 13

day 1-3

Question 14

serosa pink

Answer 14

4 - 10

Question 15

alba white

Answer 15

11-21 days

Question 16

cervix

Answer 16

Change from soft and highly vascular to reduced vascularity and normal consistency
Within a few days
If laboured will return to slit appearance

Question 17

Ovaries and fallopian tubes

Answer 17

Displaced during pregnancy as uterus distends , returns to pelvic cavity

Question 18

Vagina , vulva and pelvic floor

Answer 18

Reducing progesterone results in normalising tone

Question 19

Perinium

Answer 19

Perineal trauma usually heals rapidly
Oedema usually reabsorbed within 3 - 4 days

Vital assessments
* Good perineal hygiene
* Handwashing
* Showers
* Simple analgesia
* Pelvic floor exercises
Maternity pads

Question 20

Bowels

Answer 20

• Gastric motility reduced during labour
  
  • Reduced progesterone = smooth muscle tone gradually normalises
  • Minor pregnancy ailment such as heartburn and constipation
  • First movement 2-3 days
    Links between severe perineal trauma and incontinence

Question 21

possible delay in bowels

Answer 21

Fear
Reduced diet and fluid in labour
Pain
Medications

Question 22

bladder

Answer 22

uring labour , bladder displaced into abdomen and urethra stretches
May be loss of tone in bladder and bruising to the urethra
Marked diuresis for 2-3 days
Overdistension and retention may occur
Mobilisation and frequent urination

Question 23

infection sites include

Answer 23

• Breasts
  
  • Epithelial lining of veins
  • Genital tract
  • Urinary tract
  • Wound
  • Upper respiratory tract