PUERPERIUM

6/23/2022




PUERPERIUM

• Period from the end of the 3rd stage of labour up to 6 weeks postpartum/
refers to the time after delivery when maternal physiologic changes
related to pregnancy return to the nonpregnant state
• until most of the patient’s organs have returned to the non-pregnant state
PEUPERIUM • Also called the postpartum or postnatal period
R. NDERITU




PUERPERIUM


The woman recovers from the stresses of pregnancy & delivery,
Physiological changes during the puerperium Occurrence of physiological adaptations facilitating the restoration to
the non pregnant state
Lactation gets established
A time of psychological & social adjustment of the woman & her
family




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PHYSIOLOGICAL CHANGES DURING PUERPERIUM
PHYSIOLOGICAL CHANGES DURING PUERPERIUM
CONT’
• After expulsion of the placenta, circulating levels of human chorionic Fall in progesterone causes the recovery of normal muscle tone & of the
gonadotrophin, human placental lactogen, oestrogen & progesterone fall
rapidly ligaments of the uterus


• These results to many physiological changes The relaxation effects of progesterone on smooth muscles of the pelvic floor,
Fall in oestrogen reverses the circulatory haemodilution, restoration of normal blood
viscosity & respiration function perineum, vagina & bowel subside




PHYSICAL CHANGES OCCUR DURING PUERPERIUM GENERAL CONDITION
Some women experience shivering, without change in
temparature
• Almost every organ undergoes change during the puerperium period
Pulse rate may be slow, normal or fast but should not go
beyond 100bpm
BP may increase slightly but should be less than 140/90
There is an immediate drop in weight (about 8kgs after
delivery)
Further weight loss follows involution of the uterus and
diuresis and also on whether the mother breastfeeds




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SKIN ABDOMINAL WALL

• The increased pigmentation of the face, abdominal wall & vulva lightens but • The abdominal wall is flaccid(loose & wrinkled) and some separation
the areola may remain darker than they were before
(divarication) of the abdominal muscles occur

• With onset of diuresis, the general puffiness & oedema may disappear in few
days • Pregnancy marks(striae gravidarum),present during pregnancy do not
dissapear but lighten
• In some women, sweating may occur for some days




GIT URINARY
• Urine TRACT
retention may occur as a result of decreased tone of the
bladder

• Thirst is common • Diuresis usually occurs on the 2nd to 5th day-get rid of excess
• Appetite varies from anorexia to marked hunger fluid accumulated in pregnancy
• may have flatulence (excess wind) • Stress incontinence is common when the woman laughs or coughs.
• Constipation may occur (due to decreased bowel tone, decreased food intake This improves with time & with pelvic floor exercises
during labour,giving an enema and presence of episiotomy or painful
haemorroids) • Epidural analgesia may temporarily impair normal bladder
function




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BLOOD BREASTS

• Haemoglobin concentation becomes stable around 4th day of puerperium • Usually the breasts are soft on palpation during the first 24 hours post
• Platelet count is raised & the platelets become more sticky from the 4th-10th delivery; there may or may not be any colostrums at this time.
day after delivery.
• This stickiness may predispose mother to thrombo-embolism • by day 3 may become swollen, warm and increased vascularity




GENITAL TRACT

• From Day 2-4, milk secretion is established in most cases. • Very marked changes occur in the genital tract during the puerperium on the
• It is important that the mother is shown the correct technique for Vulva
• proper positioning of the baby and Vagina
• attachment to avoid cracking of the nipples
Cervix
uterus




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