Download - puerperium 安红敏(I)
-
8/14/2019 puerperium I
1/29
1
Normal Puerperium
-
8/14/2019 puerperium I
2/29
Key Words
Puerperium
involution
Lactati
colostrum
lochia
-
8/14/2019 puerperium I
3/29
.Definition
The puerperium is the time following laborduring which the pelvic organs return to
their nonpregnant condition. It is about 6weeks , although it may take much longer
for some of the organs(breast) to return
completely to normal.
-
8/14/2019 puerperium I
4/29
6 weeks periods after birth
the reproductive tract return to itsnormal, non-pregnancy state
-
8/14/2019 puerperium I
5/29
Involution of the uterus
It is the process which the uterus granduallyreturn into the non-pregnant state after
expulsion of the fetus and the placenta.
-
8/14/2019 puerperium I
6/29
Change of corpora uterus
weight and size after delivery
uterine weight : 1kg
size: as the uterus of 20th-week pregnancy
about 1cm below the umbilicus
-
8/14/2019 puerperium I
7/29
one week later:uterine weight : 0.5kg
size: 12th-week of pregnancy to
be just palpable above the
symphysis pubis.
-
8/14/2019 puerperium I
8/29
The height of the fundus diminishes dailyand it cannot normally be felt above the
pubis after the 10th day.
second week:weight: 300g
nearly complete involution of the uterus is
about 6 weeks , weight about 50g.
-
8/14/2019 puerperium I
9/29
Involution of the uterus
1 day
5days
7days---12 week pregnancy
However within twoHowever within twoweeks the uterus can noweeks the uterus can nolonger be palpable abovelonger be palpable abovethe symphysis.the symphysis.
-
8/14/2019 puerperium I
10/29
Involution of the uterus return to the pelvis by about 2 weeks
be at normal size by 6 weeks the weight changes of uterus
1000g immediately after birth
500g 1 weeks after birth300g 2 weeks after birth
50g 6 weeks after birth
-
8/14/2019 puerperium I
11/29
(2) mechanism:decrease of myometrial cell size
the total number of muscle cells does
not decrease.
-
8/14/2019 puerperium I
12/29
(3)prolonged involution :
uterine infection
retention( ) of placental products
fibromyomata( ) in the uterine wall
Ultrasonography can be used to measure length
and width of the uterine cavity.
-
8/14/2019 puerperium I
13/29
Regeneration of endometrium
Decidua ( )
superficial layer: necrotic shed lochia( )
basal layer : glandular epithelium proliferates()
forms a new covering for the
endometrium
-
8/14/2019 puerperium I
14/29
Change of Cervix
After delivery: It has reformed within several hours of
delivery---soft, flabby( )
2~3 days later: admits two fingers
end of the first week: outline and internal os areclosed. It usually admits only one finger by 1 weeks
4 weeks: the cervix is completely recovery
-
8/14/2019 puerperium I
15/29
nulliparous: rounded external os
multiparous: transverse slit due to laceration
at point of 3, 9 o`clock( )
nulliparous multiparousconverted
-
8/14/2019 puerperium I
16/29
Change of other systems
1.cardiovascular change2~3w
blood volume non-pregnancy
72h15~25% heart failure
, fibro 2~3w normally
WBC 15-30109/L
-
8/14/2019 puerperium I
17/29
2.return of menstruation and ovulation
(1)Breast-feed: ovulation : 4~6months
(2)no-breast-feed:
menstrual: 6~10w postpartum
ovulation: 10 weeks
occasionally, a nursing mother will ovulate
and become pregnant again.
-
8/14/2019 puerperium I
18/29
Clinical manifestation
1.Temperature and pulse
The temperature may rise to 37.9 in thefirst 24 hours, but afterwards is should fall
to normal and remain so.
Milk fever( ): Breast engagement in 3~4
days after delivery.
Pulse: first day second daynormal
-
8/14/2019 puerperium I
19/29
2.involution of the uterus
3.After-pains: 1~2 days appear2~3days
multiparous is more common
4.The lochia
the lochia is vaginal discharge due to
sloughing of decidual tissue , mainly from
the placenta site
-
8/14/2019 puerperium I
20/29
the lochia consists of RBC,
WBC, shreds of decidua,
epithelial cell and bacteria.
(1)lochia rubrua: red in color
first 3~4 days (2)lochia serosa: pinkserous
after 3~4 days,last for about 10 days
(3)lochia alba: yellowishwhite2weeks
-
8/14/2019 puerperium I
21/29
-
8/14/2019 puerperium I
22/29
Management of the puerperium
Maternal -infant bonding
rooming in
Uterine complications postpartum hemorrhage, infection,
the amount of lochia
Bowel movement
Urination
Care of the perineum
-
8/14/2019 puerperium I
23/29
Bowel function Constipation is a Common problem in the
puerperium.
This may be due to an interruption in the normal dietand possible dehydration during labour.
Advice on adequate fluid intake and increase in fibreintake may be necessary,
However, constipation may also be the result of fear ofevacuation due to pain from a sutured perineum,
prolapsed haemorrhoids or anal fissures .
Avoidance of constipation, and straining is of utmostimportance in women who have.sustained a third orfourth degree tear.
-
8/14/2019 puerperium I
24/29
Bladder function
undergoing a Caesarean Section under regionalanaesthesia, a urinary catheter may be left in the
bladder for the first 12 to 24 hours.
Voiding( ) difficulty and over distension of the
bladder are not uncommon after childbirth. after epidural anaesthesia the bladder may take up toeight hours to regain normal sensation.
During this time about I L of urine may be produced
if urinary retention occurs, considerabledamage may be inflicted on the detrusor muscle.
Over-stretching of the detrusor muscle can dampenbladder sensation.
We should encourage the mothers topass urine after postpartum in time.
Usually about 1-2hour interval.
As a doctor,
what shouldwe do?
-
8/14/2019 puerperium I
25/29
Breast-feeding1. The advantages of breast-feeding
(1)The most suitable natural food for the growthof infants, beneficial for digestion and absorption.
(2)contain massive immunological substance from
mother (3)economic: sanitary( ), suitable,
temperature, available at any time.
-
8/14/2019 puerperium I
26/29
(4)For mother : promote uterine involution.
(5)enhance materno-infantal affection .(6)beneficial for avoiding pregnancy.
(7)including iron, sodium calcium phosphate
salt, zinc ect which is not only beneficial forthe growth and development of infant, but also
promote the maturation of immuno-system.
-
8/14/2019 puerperium I
27/29
Baby-loving-hospital
(1)early sucking: begin within 30 min after babybirth
(2)mother and baby live in the same room
They are together with 24 hrs. To be divided
-
8/14/2019 puerperium I
28/29
Colostrum
-
8/14/2019 puerperium I
29/29
Summary
Key points
1. Definition of puerperium
2. Involution of the uterus
3. Lochia
4. The advantages of breast-feeding