Puerperium Flashcards
What is puerperium
Period of 6 weeks in which reproductive organs return to a non-pregnant state.
What happens to the Uterus in puerperium?
1kg -> 100g
Endometrial lining regenerates (16 days)
Fundal height rapidly declines (Fundal Involution)
What happens to the cervix in puerperium?
Reverts, but not same as nulliparous state
External os closed - finger cant be introduced
What happens to the vagina in puerperium ?
Shrinks- does not fully return to normal state
On smear - appears atrophic - resolves
What happens to the ovaries during Puerperium?
Non - breast feeding women - early as 27 days. Most ovulate 12 weeks after delivery.
Breast-feeding - 36 weeks
What happens to the breasts during Puerperium?
Delivery of placenta triggers Lactogenesis (decreased Progesterone) -> swelling of breasts
In first 2-4 days produce CLOSTRUM (high protein, rich in antibodies) -> protects newborn.
What are the CVS changes in puerperium?
After delivery, CO increases. Takes 2 days to return to late pregnancy levels. Fully resolves in 2-6 weeks.
What is Lochia and what are the types?
Vaginal discharge after birth. Contains blood, mucous and uterine tissue.
Lochia Rubra - 3-4 days after birth. Bright Red. Blood clots are normal
Lochia Serosa - Days 4-10 - Brownish red, more watery, no clots
Lochia Alba - lasts 2-4 weeks - yellow/white. reduced amount and colour
What are the most common complications of Puerperium?
Hemorrhage
Infections
Mastitis
What is puerperal infection? Common pathogens?
Any genital infection after delivery.
Streptococci A, B, D
E. Coli, Klebsiella
S. Aureus
What is puerperal pyrexia? What is it caused by?
A rise in temperature >38 degrees for 2 days within first 10 days after birth.
Caused by:
PUMP
Pulmonary infection
UTI
Mastitis
Puerperal sepsis
What is the pathogenesis of puerperal sepsis?
Infection of the genital tract - occurs due to a complication of delivery.
Separation of placenta leaves an open wound -> blood clots formed in uterus -> excellent media for bacterial infection.
What causes Mastits in puerperium?
poor nursing, maternal fatigue, cracked nipple. Source of infection is infants nose/mouth. S. Aureus most common
Symptoms of mastitis?
Engorgement of breasts + fever. chills, malaise
Hard, tender area on breast
Pathogenies of Venous stasis in Puerperium?
Gravid uterus presses against the IVC -> venous stasis -> hypercoagulable state.
