The puerperium

Question 1

What is the puerperium?

Answer 1

This is the period of 6-8 weeks after the delivery of the fetus and the placenta
the period taken for the uterus and other body system to return back to pre-pregnancy state

Question 2

Involution of the uterus

Answer 2

Autolysis
• Proteolytic enzymes - Autolysis involves the release of proteolytic enzymes that digest these muscle cells returning them to their pre-pregnancy state.

• Phagocytes (destroy the worn out erythrocytes) - Remove the debris produced by autolysis. This process in incomplete because some elastic tissue remains within the myometrium, preventing the uterus from totally regaining its orginal structure

the increase in white blood cells continues for a few days after delivery. Levels return back to normal within 4-7 days.

Ischaemia - if the uterine contractions occur too frequently, with little time in between for relaxation, the muscles will become starved of oxygen due to hypoxia, resulting in ischaemia which causes increased pain.

Question 3

Contraction and retraction

Answer 3

• Oxytocin - contraction and retraction of muscle fibres occurs under the influence of oxytocin.
• Afterpains - women experience after pains. Breastfeeding encourage oxytocin release and so aids the process of involution ( Involution is the process by which the uterus is transformed from pregnant to non-pregnant state.)

Question 4

Lochia

Answer 4

Lochia Rubra
Discharged from 3-4 days and are red due to the presence of blood from the placental site
Shreds of decidua, vernix & amniotic fluid are passed with this lochia

Lochia serosa
Passed for 5-9 days during the time where they change from pink to brown. They contain less blood and more serum with leucoctyes and organisms

Lochia alba
Lasts from 10-28 days and are yellowish- white. They contain leucocytes, cervical mucus and debris.

Question 5

Midwifery application

Answer 5

6 week period following the birth
• Reproductive system - after delivery the respiratory function rapidly returns to normal. Hormonal levels return to pre-pregnancy levels and the alveoli at the base of the lungs are once again available for respiration

• Ovulation from 21 days following the birth
• Palpation of the fundus - give an indication of the rate of involution within 24hrs of delivery the fundus should be at level of the umbilicus. It should then decrease in size until by day 10 it has usually returned into the pelvis and can no longer be palpated
• Lochia - The quantity, colour, and odour must be noted. Persistent lochia rubra may indicate the uterus has retained products of conception. Scanty or offensive lochia may indicate the presence of infection especially if they are accompanied by pyrexia ( high temp)