Complication of puerperium

Complication & minor ailments Complication & minor ailments of puerperiumof puerperium

Complication & minor ailments Complication & minor ailments of puerperiumof puerperium

PRESENTED BY:-PRESENTED BY:- Balkeej kaurBalkeej kaur M.Sc (N) Ist yrM.Sc (N) Ist yr Roll no- 08Roll no- 08

INTRODUCTION:• Puerperium,  the period of adjustment

after childbirth during which the mother’s reproductive system returns to its normal prepregnant state. triggered by a sharp drop in the levels of estrogen and progesterone produced by the placenta during pregnancy. The uterus shrinks back to its normal size and resumes its prebirth position by the sixth week.

DEFINITION• It is the period following child birth

during which all the body tissue especially pelvic organs revert back to their pre pregnant stage both anatomically and physiologically.

• It has 3 types:• Immediate- within 24 hrs• Recent- within 7 days• Remote- up to the end of 6 weeks

MINOR AILMENETS OF PUERPERIUM

• AFTER PAIN:- it is infrequent, spasmodic pain felt

in the lower abdomen after delivery for a variable period of 2-4 days. presence of blood clots or bits after birth leads to hypertonic contraction of the uterus in an attempt to expel them out.

NURSING MANAGEMENT

it includes in massaging the uterus with expulsion of clots followed by administration of analgesics & antispasmodics.

cont..• Effective relief from pain by emptying

bladder.• Provide a prone position with pillow

under her lower abdomen.( it provides a constant pressure against her uterus ,which keeps it contracted thus eliminates after birth pains)

• PAIN ON THE PERINEUM Never forget to examine the perineum

when analgesic is given to relieve pain.- Early detection of vulvo- vaginal

heamtoma can thus be made.

Signs and Symptoms.

• Severe, sharp perineal pain. • (2) Appearance of a tense, sensitive

mass of varying size covered by discolored skin.

• (3) Swelling in the perineal wall. • (4) Often seen on the opposite side

of the episiotomy.

• (5) Inability to void due to pressure/edema on or around the urethra.

• (6) Complaint of fullness or pressure in the vagina.

Medical Treatment. This is consists of analgesics given for discomfort, opening the hematoma so blood clots can be evacuated and the bleeders can be ligated, and packing for pressure

• Nursing Interventions. • Apply ice to area of hematoma. • Observe for evidence of enlarged

hematoma. • Flag the patient's chart if packing was

inserted.• Sitz baths (hot or cold ) can give

additional relief.

DEFINITION

PREDISPOSING FACTORS

ANTEPARTUM FACTORS:-

Malnutrition & anemia

Pre-eclampsia

Pre mature rupture of membranes

Chronic debilitating illness

Sexual intercourse

INTRAPARTUM FACTORS• Sepsis during internal

examination• Dehydration & keto-acidosis• Traumatic operative delivery• Hemorrhage• Placenta praevia

INVESTIGATIONSCollect the history

Clinical examination

Investigations include-

Urine culture

Blood culture

Vaginal swabs for culture

MEDICAL TREATMENT:•Ampicillin 500 mg,I/M •Gentamycin 3-5 mg/kg body weight,•Cefuroxime 750 mg,I/V•Metronidazole 0.5 gm,I/V

PROPHYLAXIS

NURSING MANAGEMENT

Certain measures are undertaken before,

during and postpartum period.

Antenatal period-

To detect and eradicate the septic focus.

To maintain or improve the health status like hemoglobin level, prevent preeclampsia.

Should take care about personal hygiene.

Contd…..INTRANATAL PERIOD

The delivery should be conducted taking full surgical asepsis.

The patient is instructed not to touch the vulva during labour.

Excessive blood loss should be replaced promptly.

Prophylactic antibiotics.

•Use caps, mask, gowns, and gloves when working in delivery rooms. • Use sterilized equipment within control dates.•Wash hands meticulously (staff). •Correct breaks in sterile techniques immediately.•Limit unnecessary vaginal exams duringlabor which increases the chances of introducingorganisms from the rectum and vagina into the uterus

POSTPARTUM PERIOD• Aseptic precautions should be taken during perineal

care.• Too many visitors should not be allowed.• Sterilized pads should be used and changed.• Instruct the patient on hand washing and

cleansing her perineum from front to back.• Restrict personnel with respiratory infections

from working with patients.• Early ambulation postpartum.• Daily evaluation of fundal height to document

involution•

Nursing Care of Puerperal Infection. -Isolation, if possible, the removal of the patient from the maternity ward. -Meticulous hand washing. -Patient placed in Fowler's position to facilitate drainage. -Reeducation of the patient on -handwashing and peri-care.

Emotional support since the patient may be prevented from rooming in with her infant while her temperature is elevated. -Check the vital signs.-Maintain the fluid intake and output.-Anemia should be corrected by blood transfusion.-Sufficient rest is enforced by analgesics and sedatives.

PUERPERAL PYREXIA

Definition An elevation of temperature to 38˚c

(100.4˚f) or more occurring on two separate occasions at 24 hours apart (excluding the first 24 days ) following delivery is called puerperal sepsis.

CAUSES• Puerperal sepsis• Urinary tract infection: cystitis, pyelonephritis.• Breast infection• Infection of laparotomy wound (caesarean

section)• Intercurrent infection : acute bronchitis,

pneumonia, influenza, acute appendicitis & enteric fever

NURSING MANAGEMENT

• Isolation,. • -hand washing. • - Patient placed in Fowler's

position to facilitate drainage. • - education of the patient on

handwashing and peri-care.

• - Emotional support• Check the vital signs.• -Maintain the fluid intake and

output.• Sufficient rest is enforced by

analgesics and sedatives.

Sub involution Sub involution of uterusof uterus

Sub involution Sub involution of uterusof uterus

Definition

• Sub involution of uterus is impaired and deficient involution of the uterus following delivery

• when the uterus is not reverted back to the pre-pregnant both anatomically & physiology.

Causes • Predisposing factors• Grand multiparity• over-distention of uterus as in twins & hydromnios• Maternal ill health• Cesarean section• Prolapse of the uterus • Uterine fibroids • No sucking of the baby

Clinical features• Excessive or prolonged discharge of lochia • Irregular or excessive uterine bleeding• Irregular cramp like pain• Uterine height more than normal for the

particular day of post partum

Management• Sub involution is managed by treating the

causes.• Antibiotics for sepsis.• Exploration of the uterus for retained products.• pessary in prolapse or retroversion.• Early ambulation postpartum. • Daily evaluation of fundal height to

document involution.

BREAST DISORDERSBREAST DISORDERSBREAST DISORDERSBREAST DISORDERS

CLASSIFICATION BREAST DISORDERS

IN FEMALES

NIPPLEDISORDERS

BRESTINFECTIONS

NIPPLE DISORDERS CLASSIFICATION

INVERTED NIPPLE

RETRACTED NIPPLE

ACCESSORY NIPPLES

INVERTED NIPPLES DEFINITION-

It is a condition in which nipple instead of pointing outwards get retracted into the breast.

METHODS-• Use of breast pump.• Hospital grade electric pump.• Use of nipple shield.• Frequent stimulation

Breast pump

Nipple shield

Cont..OTHER METHODS-• Plastic surgery• Nipple piercing• Regular stimulation• Suction cups or clamps• Homemade nipple protractor.

Suction cups

Clamp, piercing, shells…

CRACKED NIPPLESDEFINITION- it is a condition in which there is loss

of surface epithelium with the formation of raw area on the nipple along with fissure situated either at the tip or of the base of nipple

CAUSE-improper hygiene resulting in crust formation,

Retracted nipples, Trauma Due to incorrect breast feeding.

Cont…

Cont…SYMPTOMS- painful breast feeding, it may

progress to mastitis.

PROPHYLAXIS-maintaining hygiene.

TREATMENT-correct attachment of infant, purified lanonin application(3-4 times), usage of breast pump and shields(if severe), application of miconazole lotion, biopsy.

BREAST INFECTIONSCLASSIFICATION

MASTITISSUBAREOLAR

ABCESS

MASTITIS DEFINITION- It is the inflammation of parenchyma of

the mammary gland TYPES-

PATHOGENS-staphylococcus, streptococcus, gram negative bacilli such as escherichia coli,

salmonella, mycobacterium, candida, cryptococcus (rarely)

PUERPERAL MASTITIS

NON PUERPERAL MASTITIS

Mastitis

Cont…CAUSES-

PUERPERAL MASTITIS Blocked milk ducts Milk excess Cracked nipples Tight clothing Microorganism

transference by patient and infant.

CAUSES-NON PUERPERAL

MASTITIS Hyperprolactinemia Thyroid disorders Breast trauma,

surgery Nipple piercing Medications .

Cont…SYMPTOMS

PUERPERAL MASTITIS

Tough, doughy texture

Dull to severe painFlu-like symptomsAbscess (rare)

SYMPTOMS

NON PUERPERAL MASTITIS

Redness, swellingDiffused tenderness,

painHot sportsAbscessNipple discharge.

TREATMENTPUERPERAL

MASTITIS Breast feeding. Use of suction

devices Heat application (prior

to feeding) Cold compresses

(severe) Antibiotics

TREATMENT

NON PUERPERAL MASTITIS

Symptomatic management

Broad spectrum antibiotics.

BREAST ENGORGEMENTDEFINITION-it is a condition which occurs

in mammary glands by expanding viens and the pressure of new breast milk contained with in them.

CAUSE-It is due to exaggerated normal venous and lymphatic engorgement of breasts which precedes lactation.it involves primiparous women and women with inelastic breast.

Breast engorgement

Cont….SYMPTOMS-Pain, feeling of heaviness,

generalized malaise, transient rise of temperature, painful breast feeding.

PREVENTION-to avoid prelacteal feeds, to initiate early and unrestricted breast feeding, exclusive breast feeding on demand, feeding in correct position.

Cont…MANAGEMENT

-To support the breast with brassiere

-Mannual expression of any remainaing milk after each feed

-To administer analgesics for pain

-Put baby on breast feed regularly and at frequent intervals

-Gentle use of breast pump (if severe)

Failing lactation

CAUSES:-• Debilitating state of the mother• Early primigravidae• Failure to suckle the baby regularly• Depression or anxiety state in the puerperium• Apprehension to nursing• Premature baby, who is too weak to suck• Painful breast lesions

MANAGEMENTANTENATAL• Education regarding the advantages of

breast feeding• Correction of abnormalities like retracted

nipples• Breast hygiene

• Improving the general health status of mother

Cont…POSTNATAL• Encourage adequate fluid intake• Nurse the baby regularly• Treat painful lesions promptly• Express residual milk after each feeding• Drugs like thyroid extract or prolactin are

useful.

Summarization

ANY QUERY

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