PRESENTATION ON NORMAL PUERPERIUM Presented by: Ms. Uma - PowerPoint PPT Presentation

• PRESENTATION • ON • NORMAL PUERPERIUM • • Presented by: Ms. Uma Chandel • Nursing Lecturer, NIU • Subject: Obstetrics & Gynecology •

Definition Period following childbirth during which the body tissues ,specially the pelvic organs revert back approximately to the pre-pregnant state both anatomically and physiologically. 

Chapter. 17  Puerperium DURATION Includes 6 subsequent weeks postpartum during which normal pregnancy involution occurs This period is divided into :- Immediate period – within 24hours Early period- upto 7 days Remote period- upto6weeks 

 Chapter. 17 Puerperium Physiological Aspects of the Puerperium Involution of the uterus Lochia Involution of other pelvic structures Breasts Menstruation & ovulation General physiological changes

• INVOLUTION OF THE UTERUS ANATOMICAL CONSIDERATIONS • uterus • lower uterine segment • cervix

Uterus The uterus becomes firm with alternate hardening and softening. The uterus measures about 20 * 12 * 7.5 cm (Length, breadth and thickness) and weighs about 1000 gm. At the end of the 6 weeks it’s measurement is about 60 gm Lower Uterine Segment Immediately following delivery the lower segment become thin, flabby, collapsed structure. It takes few weeks to revert back to the normal shape and size

Cervix It may be bruised and edematous. The cervix contract slowly, the external os admits 2 fingers for few days but by the end of the first week, narrows down to admit the tip of finger only. The Contour of cervix take a longer time to regain 6 week and the external os never revert back to the nulliparous state

Chapter. 17 Puerperium LOCHIA   It is the vaginal discharge of the first fortnight during puerperium  lochia rubra : It is red in colour 1-4 days lochia serosa : yellowish or pale brownish in colour 5-9 days lochia alba : scantier and appears pale white 10-15 days  The average amount of discharge for the first 5 -6 days ,is estimated to be 250ml.

Chapter. 17 Puerperium INVOLUTION OF THE OTHER PELVIC STRUCTURES  VAGINA  The distensible vagina, takes a long time to involute (4-8 weeks). It regain it’s stone but never to the virginal state. Opening remains permanently larger than was prior to the pregnant stage.  BROAD LIGAMENTS & ROUND LIGAMENTS  Require considerable time to recover from the stretching and laxation.  PELVIC FLOOR AND PELVIC FASCIA  Take a long time to involute from the stretching effect during parturition 

• BREASTS The secretion from the breast is thick, sticky & yellowish in colour for the initial 2-3 days and is called colostrum. • MENSTRUATION & OVULATION The onset of the menstrual period following delivery is very variable & depends on lactation. In non-lactating mothers, ovulation may occur as early as possible. In lactating mothers about 10weeks after delivery .

• GENERAL PHYSIOLOGICAL CHANGES PULSE For few hours after normal delivery ,the pulse rate is likely to be raised ,which settles down to normal during the second day. GASTRO- INTESTINAL TRACT Increased thirst Constipation URINARY TRACT The bladder may be over distended without any desire to pass urine. Dilated ureter & renal pelvis return to normal size within 8 weeks.

Weight loss It occurs 5-6 kg with the expulsion of the fetus, a further loss of about 2 kg occur during puerperium Fluidloss Net fluidloss of at least 2 ltr during the first week and additional 1.5 ltr the next 5 week Temperature It should not be above 99 degree F within the first 24 hours. On the 3 rd day there may be slight rise of temperature due to breast engorgement.

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