Puerperium and Postpartum Period

Puerperium
• The puerperium, or postpartum period is the
time from the delivery of the placenta until 6
weeks after delivery.
• By 6 weeks after delivery, most of the
anatomic and physiologic changes of
pregnancy, labour, and delivery are reversed,
and the body returns to the normal, non-
pregnant state.
2

Puerperium
The postpartum period divided into:
1. The immediate puerperium (first 24 hours):
where the acute post-anesthetic or post-
delivery complications may occur.
2. The early puerperium (first week)
3. The remote puerperium (after 1st week until
6th week): includes the period of time
required for the genital organs to revert back
to the state before pregnancy (Involution),
and return of menstruation. 3

Normal Puerperium
The Normal Anatomical Involution:
• Uterus:
The uterus weight during pregnancy (not including
baby, placenta, fluids, etc) about 1000 grams. The
uterus will weight 50-100 grams, during the 6 weeks
after delivery.
Myometrial contractions help in involution. These
contractions occur during the first 2–3 days of the
puerperium.
4

Cross Section of uterus after delivery and postpartum (P.P)

Normal Puerperium
• Cervix:
The cervix begins to rapidly change back to a non-
pregnant state, but it never returns to the
nulliparous state. After the end of the 1st week; we
can hardly enter one finger.
• Vagina:
The vagina; which was enlarge to accommodate the
baby, will diminishes in size to a non-pregnant state,
but it does not completely the same size before
pregnancy. 7

Nulliparous Cervix 8
Parous Cervix

Normal Puerperium
• Changes in the Placental Implantation Site:
The uterus continues to contract, which closes off
those blood vessels where the placenta was
attached, to reduce the bleeding.
Breastfeeding, will help the body to release natural
oxytocin, which helps in uterus contract.
Initially postpartum, a large amount of red blood
(Lochia Discharge) comes from the uterus as the
contraction phase rapidly occurs. The volume
rapidly decreases. 9

Normal Puerperium
• Changes in the Placental Implantation Site:
Lochia; is vaginal discharge during the postpartum
period. It consists of blood, tissue from the lining of
the uterus, and bacteria.
1. Lochia Rubra (1 – 4 days) consists of blood so it is RED.
2. Lochia Serosa (5 – 9 days) consists of less blood cells and more
water and mucous; so it is pink or pale brownish.
3. Lochia Alba (after 10 days) consists mostly of white blood cells,
fats and microorganisms; so it is yellow or pale white.
Sometimes it lasts from the 2nd week to 6th week after delivery.
10

Normal Puerperium
• Abdominal wall:
The abdominal wall remains soft and poorly toned
for many weeks. The return to a pre-pregnant state
depends greatly on exercise.
• Ovaries:
The woman who decides to breastfeed has a longer
period of amenorrhea and anovulation than non-
breastfeeding mother due to the elevation in
prolactin. 11

Routine Postpartum Care
• Vaginal Care:
After a vaginal delivery, most women experience
swelling of their perineum and pain.
Routine care of this area includes ice applied to the
perineum to reduce the swelling and help with pain
relief (the first 24 hours) and then switch to warm
baths.
Pain medications and anti-inflammatories are very
helpful.
12

Routine Postpartum Care
• Cesarean Section:
The woman who has had a cesarean section does
not have the pain in her perineum, but from her
abdominal incision. This, too, can be treated with
ice to the incision, as well as with the use of
systemic pain medication.
13

Abnormal Puerperium
1.PPH
2.Infections
3.Psychiatric disorders
14

Abnormal Puerperium
2. Infection
• Postpartum infections, also known as childbed fever and
puerperal fever, are any bacterial infections of the female
reproductive tract following childbirth or miscarriage.
• Infection may attack the cavity and wall of the uterus, or
may spread more to cause septicaemia (blood
poisoning) and septic shock.
• It usually occurs after the first 24 hours and within the
first ten days following delivery.
15

Abnormal Puerperium
2. Infection
Most common types include:
• Endometritis; an infection of the endometrium (uterine
lining).
• Mastitis; a breast infection
• Urinary tract infection
• Wound Infection
• Septic pelvic thrombophlebitis; venous inflammation
with clot formation that’s unresponsive to antibiotic
therapy.
16

Septic Pelvic
Thrombophlebitis
17

Abnormal Puerperium
2. Infection
Signs & Symptoms:
• A fever greater than 38°C
• Lower abdominal pain
• Chills
• Bad-smelling vaginal discharge
• Painful urination
• Breast tenderness
• Tachycardia
18

Abnormal Puerperium
2. Infection
Causes:
• Anemia
• Caesarean section (C-section)
• The presence of certain bacteria in the vagina
• Premature rupture of membranes
• Multiple vaginal and cervix exams
• Manual removal of the placenta
• Episiotomy and laceration
• Induced labor
• A part of the placenta remains in the uterus after delivery
19

Abnormal Puerperium
2. Infection
Management:
• Sterilization
• Drinking plenty of water and fluid.
• Caesarean section; all women receive a preventive dose of
antibiotics such as ampicillin and gentamicin.
• In with mild disease, we use oral antibiotics otherwise we will
use intravenous antibiotics.
• We should know if the mother is breastfeeding or no before
prescribing any drugs
• Antibiotics will be prescribed according to the type of bacteria
• Septic pelvic thrombophlebitis treatment should includes
anticoagulation with broad-spectrum antibiotic as penicillin.

Abnormal Puerperium
3. Psychiatric disorders
Three psychiatric disorders may arise:
1. Postpartum blues: is a transient disorder the lasts hours to
weeks and is characterized by crying and sadness.
2. Postpartum depression (PPD): is a more prolonged affective
disorder that lasts for weeks to months.
3. Postpartum psychosis: occurs in the first postpartum year and
refers to a group of severe and varied disorders with psychotic
symptoms.
21

Abnormal Puerperium
Causes:
• The specific cause of these disorders is unknown.
• Result from the stress of pregnancy and labor.
• Sudden fall in estrogen and progesterone levels that
occur after delivery.
• Postpartum thyroid dysfunction.
22

Abnormal Puerperium
Treatment:
• Providing support particularly from the family
• Pharmacological treatment
• Electroconvulsive therapy
• Increase Dopamine level by:
1. Exercises
2. Foods like; Green tea, Nuts, Dark Chocolate,
Banana, and Omega 3
3. Exposing to Sunlight
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Puerperium and Postpartum Period

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Puerperium and Postpartum Period