puerperium 安红敏（I）

8/14/2019 puerperium I

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Normal Puerperium


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Key Words

Puerperium

involution

Lactati

colostrum

lochia


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.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.


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6 weeks periods after birth

the reproductive tract return to itsnormal, non-pregnancy state


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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.


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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


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one week later:uterine weight : 0.5kg

size: 12th-week of pregnancy to

be just palpable above the

symphysis pubis.


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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.


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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.


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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


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(2) mechanism:decrease of myometrial cell size

the total number of muscle cells does

not decrease.


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(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.


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Regeneration of endometrium

Decidua ( )

superficial layer: necrotic shed lochia( )

basal layer : glandular epithelium proliferates()

forms a new covering for the

endometrium


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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


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nulliparous: rounded external os

multiparous: transverse slit due to laceration

at point of 3, 9 o`clock( )

nulliparous multiparousconverted


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Change of other systems

1.cardiovascular change2~3w

blood volume non-pregnancy

72h15~25% heart failure

, fibro 2~3w normally

WBC 15-30109/L


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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.


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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


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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


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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


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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


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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.


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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?


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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.


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(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.


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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


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Colostrum


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Summary

Key points

1. Definition of puerperium

2. Involution of the uterus

3. Lochia

4. The advantages of breast-feeding

Documents

puerperium 安红敏（I）