Physiology Of The Puerperium Flashcards
During the puerperium what areas can cause infection?
Raw placental site Breasts Lochia Wounds and trauma to the perineum Ragged membranes
Name eight signs of sepsis?
Very high temp over 38 degrees Very low temp below 36 degrees Shivering and chills Tachycardia Tachypnoea Headache and confusion Severe abdominal pain Extreme fatigue
Post birth there are dramatic haemodynamic alterations, what impact does this have on the heart?
Stroke volume and cardiac output
In the puerperium, due to the withdrawal of oestrogen, diuresis occurs. Where does this fluid volume come from and how long does it occur and how much fluid is lost?
It comes from plasma volume, lasts up to one weeks and possible loss of 2 litres
How many days does it usually take the uterus to return to the pelvis?
10 days
How much does the uterus approx weigh at 6 weeks post partum?
60g
What is the definition of ischaemia?
Myometrium constricts the blood vessels so the blood circulating in the uterus is reduced
Define autolysis
Muscle fibres are digested by proteolytic enzymes and macrophages. The waste produces then pass into the blood stream and are eliminated by the kidneys
Define phagcoytosis
Removes excess fibrous and elastic tissue however some remains so uterus will never go back to complete pre pregnancy state
Why might the uterus be slow to involute
Large baby Multiple pregnancy Polyhydramnios Retained placenta Infection Blood clot
What happens to the placenta after birth?
When the placenta is born, upper portion of spongy endometrial layer is sloughed off
Remaining decidua is organised into basal and superficial layers
Superficial layers contain granulation tissue becomes invaded by leukocytes and acts as a barrier. This layer then becomes necrotic and is sloughed off.
Basal layer remains intact and sources regeneration
Healing of placental site complete by 6 weeks
Describe the colour and content of the three stages of lochia and which days they are present?
Lochia rubra- red blood, 1-3 days
Lochia serosa- pink blood, 4-10 days
Lochia Alba- white blood, 11-21 days
What might a heavy or profuse red lochia be a sign of?
Retained placenta
When can ovulation start if a woman is not breast feeding?
5 weeks
Can ovulation start before menstruation?
Yes
