8. Puerperium Flashcards
(20 cards)
What is the puerperium?
The period immediately after childbirth when the womb is returning to its normal size, lasting approximately six weeks.
What normal changes occur during puerperium?
- Reproductive organs changes
2. Systemic changes
Which reproductive organs change during puerperium?
Perineum Uterus Cervix Ovaries Breasts
Describe the changes in perineum the during puerperium?
Swelling and engorgement resolved within 2 weeks
Perineal injury: heals by first intention (wound closure)
Integrity and strength recovered by 6 weeks
Pelvic floor strength recovered by 6 weeks
Kegel exercises
Describe the changes in the uterus during puerperium?
Reduces to the level of the Umbilicus - immediately following delivery
1cm/day
Midway between umbilicus and symphysis by 2 weeks
Pelvis by 4 weeks
1000g to 100 - 200g by 6 weeks
What is Lochia?
Lochia
- Vaginal discharge along with decidua, clots and membrane after delivery of the placenta during the puerperium
- Fishy in odour
- Continues for up to 6 weeks but continually reducing
Describe the changes in the cervix during puerperium?
Histological changes
Closed by 2 weeks
Multips os (always 1 cm dilated)
Describe the changes in the ovaries during puerperium?
Ovulation may return within 6 - 8 weeks in nonbreatsfeeding mothers with likely return of menstruation
Suppression of lactation due to pulsatile nature of prolactin release
Ovulation will return even if mothers continue to breastfeed – cave
Describe the changes in the breasts during puerperium?
Breasts
- Lactational function of breasts triggered by decrease in hormones (oestrogen) after the delivery of the placenta and an increase prolactin levels.
Colostrum
- Secreted for 2-3 fays (protein, fat, minerals, IgA and IgG)
Milk
- Protein, lactose, water, fat, IgG, IgA and IgM
What normal systemic changes occur in puerperium?
Cardiovascular
- Increase in CO immediately following delivery but returned to normal by 2 - 6 weeks
- Circulating volumes returned to prepregnancy levels by 2 weeks (7.5 – 5l)
Haematological
- Hb and Hct after delivery (dilutional)
- Coagulation factors remain elevated for up to 6 weeks after delivery ( VTE disease).
What are the abnormal changes in puerperium studied?
Post Partum Haemorrhage
Puerperal Fever and Sepsis
Endocrine Disorders
Psychiatric Disorders
What is PPH? What are the categories?
> 500ml from the genital tract
- Primary (immediate)
- In hospital within 24 hours
- 4 Ts: tone, tissue, trauma, thrombin
- Ix and management - secondary (delayed)
- May occur postdischarge
- Another institution
- Ix and management
What is puerperal Fever and Sepsis?
Temp > 38 degrees in first 10 days
What is endometritis?
Foul smelling lochia
Tender uterus
Increase in vaginal bleeding
Systemic manifestations
Risk factors (4Ps, 3Ms, 1C)
- Caesarean section
- Prolonged labour
- Preexisting lower genital tract infection
- Placement of IDC
- Prolonged ROM
- Multiple Ves
- MROP
- Multiple pregnancy
What are the potential causes of puerperal sepsis?
Wound Infection UTI Mastitis Thrombophlebitis Other
What common endocrine disorder manifests in puerperium?
PP thyroiditis
- Transient autoimmune destructive lymphocytic thyroiditis
- 1 - 4 months; thyrotoxic (reduced TSH)
- ß blocker if severe
- 4 - 8 months; hypothyroid (Incresed TSH)
- Eltroxin if required
What are the main psychiatric disorders postpartum?
PP Blues
PP Depression
PP Psychosis
What is the PP blues ?
50 - 70%
Mild, self limiting arising in first 2 weeks
Tx = Emotional support
What is PP Depression?
10 - 15%
Lasts up to 6 months
Support +/- antidepressant
Psychiatric services
What is PP Psychosis?
0.1 - 0.25%
Lasts up to 3 months
Psychiatric services
