Puerperium and Postpartum Period

what is the Puerperium and Postpartum Period
what's the normal?
what's the abnormal Puerperium?
and what are the most common complications and how to manage it?

1. Puerperium

2. Puerperium The puerperium, or postpartum period is the time from the delivery of the placenta until 6 weeks after delivery. By 6 weeks after delivery, most of the anatomic and physiologic changes of pregnancy, labour, and delivery are reversed, and the body returns to the normal, non-pregnant state. 2

3. Puerperium The postpartum period divided into: The immediate puerperium (first 24 hours): where the acute post- anesthetic or post-delivery complications may occur. T he early puerperium (first week) The remote puerperium (after 1 st week until 6 th week): includes the period of time required for the genital organs to revert back to the state before pregnancy ( Involution), and return of menstruation. 3

4. Normal Puerperium The Normal Anatomical Involution: Uterus: The uterus weight during pregnancy (not including baby, placenta, fluids, etc ) about 1000 grams. The uterus will weight 50-100 grams, during the 6 weeks after delivery. Myometrial contractions help in involution. These contractions occur during the first 2–3 days of the puerperium. 4

5. Uterus Involution 5

6. Cross Section of uterus after delivery and postpartum (P.P)

7. Normal Puerperium Cervix: The cervix begins to rapidly change back to a non-pregnant state, but it never returns to the nulliparous state . After the end of the 1 st week; we can hardly enter one finger. Vagina: T he vagina; which was enlarge to accommodate the baby, will diminishes in size to a non-pregnant state, but it does not completely the same size before pregnancy. 7

8. Nulliparous Cervix 8 Parous Cervix

9. Normal Puerperium Changes in the Placental Implantation Site: The uterus continues to contract, which closes off those blood vessels where the placenta was attached, to reduce the bleeding . Breastfeeding, will help the body to release natural oxytocin, which helps in uterus contract. Initially postpartum, a large amount of red blood (Lochia Discharge) comes from the uterus as the contraction phase rapidly occurs. The volume rapidly decreases. 9

10. Normal Puerperium Changes in the Placental Implantation Site: Lochia ; is vaginal discharge during the postpartum period. It consists of blood, tissue from the lining of the uterus, and bacteria. Lochia Rubra (1 – 4 days) consists of blood so it is RED. Lochia Serosa (5 – 9 days) consists of less blood cells and more water and mucous; so it is pink or pale brownish. Lochia Alba (after 10 days ) consists mostly of white blood cells, fats and microorganisms; so it is yellow or pale white . Sometimes it lasts from the 2 nd week to 6 th week after delivery. 10

11. Normal Puerperium Abdominal wall: The abdominal wall remains soft and poorly toned for many weeks. The return to a pre-pregnant state depends greatly on exercise. Ovaries: The woman who decides to breastfeed has a longer period of amenorrhea and anovulation than non-breastfeeding mother due to the elevation in prolactin. 11

12. Routine Postpartum Care Vaginal Care: After a vaginal delivery, most women experience swelling of their perineum and pain . Routine care of this area includes ice applied to the perineum to reduce the swelling and help with pain relief (the first 24 hours) and then switch to warm baths . Pain medications and anti-inflammatories are very helpful. 12

13. Routine Postpartum Care Cesarean Section : The woman who has had a cesarean section does not have the pain in her perineum, but from her abdominal incision. This, too, can be treated with ice to the incision, as well as with the use of systemic pain medication. 13

14. Abnormal Puerperium PPH Infections Psychiatric disorders 14

15. Abnormal Puerperium Infection Postpartum infections, also known as childbed fever and puerperal fever, are any bacterial infections of the female reproductive tract following childbirth or miscarriage. Infection may attack the cavity and wall of the uterus, or may spread more to cause septicaemia (blood poisoning) and septic shock. It usually occurs after the first 24 hours and within the first ten days following delivery . 15

16. Abnormal Puerperium Infection Most common types include : Endometritis; an infection of the endometrium (uterine lining ). Mastitis; a breast infection Urinary tract infection Wound Infection Septic pelvic thrombophlebitis; venous inflammation with clot formation that’s unresponsive to antibiotic therapy. 16

17. Septic Pelvic Thrombophlebitis 17

18. Abnormal Puerperium Infection Signs & Symptoms: A fever greater than 38°C Lower abdominal pain Chills Bad-smelling vaginal discharge Painful urination Breast tenderness Tachycardia 18

19. Abnormal Puerperium Infection Causes: Anemia Caesarean section (C-section ) The presence of certain bacteria in the vagina Premature rupture of membranes Multiple vaginal and cervix exams Manual removal of the placenta Episiotomy and laceration Induced labor A part of the placenta remains in the uterus after delivery 19

20. Abnormal Puerperium Infection Management: Sterilization Drinking plenty of water and fluid. Caesarean section; all women receive a preventive dose of antibiotics such as ampicillin and gentamicin. In with mild disease, we use oral antibiotics otherwise we will use intravenous antibiotics. We should know if the mother is breastfeeding or no before prescribing any drugs Antibiotics will be prescribed according to the type of bacteria Septic pelvic thrombophlebitis treatment should includes anticoagulation with broad-spectrum antibiotic as penicillin.

21. Abnormal Puerperium Psychiatric disorders Three psychiatric disorders may arise: Postpartum blues: is a transient disorder the lasts hours to weeks and is characterized by crying and sadness . Postpartum depression (PPD ): is a more prolonged affective disorder that lasts for weeks to months. Postpartum psychosis: occurs in the first postpartum year and refers to a group of severe and varied disorders with psychotic symptoms. 21

22. Abnormal Puerperium Psychiatric disorders Causes: The specific cause of these disorders is unknown . Result from the stress of pregnancy and labor. Sudden fall in estrogen and progesterone levels that occur after delivery. Postpartum thyroid dysfunction. 22

23. Abnormal Puerperium Psychiatric disorders Treatment: Providing support particularly from the family Pharmacological treatment Electroconvulsive therapy Increase Dopamine level by: Exercises Foods like; Green tea, Nuts, Dark Chocolate, Banana, and Omega 3 Exposing to Sunlight 23