Puerperium and Postpartum Care

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Questions and Answers

What is the primary objective of the lecture on puerperium?

To classify the stages of puerperium

To recognize the difference between normal and abnormal puerperium (correct)

To diagnose abnormalities in puerperium

To plan a physical therapy program for postpartum women

How long does the immediate puerperium period last?

First 24 hours (correct)

First week postpartum

Through 6 weeks postpartum

First 48 hours

What is the primary cause of postpartum chills?

Sudden drop in hormones

Fluid loss during delivery

Release of endorphins

All of the above (correct)

What is the maximum temperature rise during the first day postpartum?

38.5 °C Signup and view all the answers

What is the duration of postpartum chills?

1-2 hours Signup and view all the answers

What is the primary focus of a physical therapy program for postpartum women?

Addressing problems of the woman postpartum Signup and view all the answers

What is the duration of the remote puerperium period?

Through 6 weeks postpartum Signup and view all the answers

What is the primary goal of assessing the problems of the woman postpartum?

To plan a physical therapy program Signup and view all the answers

What hormone is released during suckling, which accentuates afterpains?

Oxytocin Signup and view all the answers

What is the purpose of daily time rest?

To help with involution of the uterus Signup and view all the answers

How many fingers can the os admit up to 48 hours postpartum?

1-2 fingers Signup and view all the answers

By the end of the 1st week, how many fingers should the os admit?

Less than 1 finger Signup and view all the answers

How long does it take for abdominal muscles to regain their tone after childbirth?

6-7 weeks Signup and view all the answers

What type of hormone initiates milk secretion?

Prolactin Signup and view all the answers

What is the composition of colostrum?

High protein, high vitamins, low fat, and low carbohydrates Signup and view all the answers

What is the purpose of TENS in managing afterpains?

To relieve pain Signup and view all the answers

What is the main purpose of mobilization in manual therapy techniques?

To correct alignment and alleviate pain with high amplitude and low velocity motion of the spine Signup and view all the answers

What is the main benefit of kinesio-taping in managing back pain?

To deactivate pain by decreasing the nociceptive stimuli Signup and view all the answers

What is diastasis recti?

A natural separation of rectus abdominis muscle during pregnancy Signup and view all the answers

What is the primary goal of core stability exercises?

To train the muscles supporting the trunk in a balanced manner Signup and view all the answers

What is the correct setting for ultrasound therapy?

Continous, 1.5 w/cm2, 1 MHz, 10 minutes, 3 times/week Signup and view all the answers

What is manipulation in manual therapy techniques?

Low amplitude and high velocity motion of the spine Signup and view all the answers

What is the primary function of kinesio-taping in managing back pain?

To support muscles and joints Signup and view all the answers

When is diastasis recti considered abnormal?

When the gap between the two recti exceeds 2.5 fingers Signup and view all the answers

What is the primary reason for promoting bonding between the mother and baby through breastfeeding?

To stimulate the release of hormones that promote bonding Signup and view all the answers

Which of the following is a common cause of constipation in postpartum women?

All of the above Signup and view all the answers

What is the primary cause of urinary retention in postpartum women?

Trauma to the sphincter Signup and view all the answers

What is the term used to describe the mild degree of depression and emotional liability that is common in postpartum women?

Baby blues Signup and view all the answers

What is the primary cause of perineal pain in postpartum women?

Perineal laceration Signup and view all the answers

What is the recommended treatment for acute perineal pain in postpartum women?

All of the above Signup and view all the answers

What is the primary mechanism of action of pulsed electromagnetic energy in managing perineal pain?

Collagen and fibrin deposition Signup and view all the answers

What is the recommended duration of ultrasound therapy for managing perineal pain?

5 minutes Signup and view all the answers

What is the primary cause of spinal headaches?

Puncture of the dura resulting in leakage of CSF into the epidural space Signup and view all the answers

What is the recommended management for thrombosed hemorrhoids?

PEME when the hemorrhoids are thrombosed Signup and view all the answers

What is the primary cause of carpal tunnel syndrome in postpartum women?

Fluid retention and edema Signup and view all the answers

What is the recommended management for epidural site pain?

Electrotherapy modalities Signup and view all the answers

What is the primary cause of paralytic ileus?

Unknown etiology Signup and view all the answers

What is the recommended management for De Quervain's tendonitis?

Resting of the wrist Signup and view all the answers

What is the recommended management for spinal headaches to decrease risk of circulatory and pulmonary complications?

Breathing and circulatory exercises Signup and view all the answers

What is the recommended management to return bowel sounds in a shorter time for paralytic ileus?

Short wave diathermy for one hour twice a day Signup and view all the answers

Study Notes

Normal Puerperium

The period of adjustment after pregnancy and delivery where anatomical and physiological changes of pregnancy are reversed, and the body returns to the non-pregnant state.
Classified into three stages: • Immediate puerperium (first 24 hours) • Early puerperium (till 1st week postpartum) • Remote puerperium (through 6 weeks postpartum)

Postpartum Changes

Postpartum chills: normal response of the body due to sudden drop in hormones, fluid loss, and endorphins release.
Temperature: reactionary rise of body temperature not exceeding 38.5°C during the first day postpartum, accentuated during suckling due to oxytocin hormone release.

Pain Management

Analgesics
Hot packs
TENS (V-shaped over the lower abdomen with the same parameters as in normal labor)
Frequent urination every 2 hours
Daily time rest (relaxation on the face, 10-30 minutes, twice daily for the first 3 days)

Cervix and Vagina

Bruised and swollen with minor lacerations
The os admits 1-2 fingers up to 48 hours postpartum, and by the end of the 1st week, it should not pass 1 finger through the internal os
Vaginal wall regains its tone, and minor lacerations heal rapidly

Muscular Wall of Pelvic Organs

Abdominal and pelvic floor muscles regain their tone by the end of puerperium
Involution of abdominal muscles may require 6-7 weeks

Breast and Lactation

Prolactin hormone initiates milk secretion
First three days postpartum, breast secretes colostrum (high protein and vitamins, less fat and carbohydrates)

Excretory Function

Constipation is common due to dehydration during labor, laxity of abdominal muscles, immobility, and hormonal effects (relaxin and progesterone)
Urinary retention is common due to immobility, trauma to the sphincter from perineal trauma, and hormonal effects

Psychological Changes

Postpartum depression (baby blues) is mild and usually lasts for a few days
It requires only reassurance

Abnormal Puerperium and Postnatal Problems

Perineal pain: associated with episiotomy and perineal laceration, and can last till 3 months postpartum
Management: analgesics, cryotherapy, ultrasound, and pulsed electromagnetic energy (PEME)

Back Pain

Causes: postural, hormonal, and ligamentous changes, and referred pain from uterine contractions
Management: hot packs, ultrasound, gentle massage, TENS, manual therapy techniques, core stability exercises, and kinesio-taping

Diastasis Recti (Divarication)

Natural separation of rectus abdominis muscle during pregnancy
Considered abnormal when the gap between the two recti exceeds 2.5 fingers, indicating weakness of abdominal muscles

Hemorrhoids

Varicose veins in and around the anus and anal canal, often prolapsing after labor
Management: ice packs, PEME when thrombosed

Epidural Site Pain

Produces small hematoma in supraspinous ligament following injection
Management: mobilization exercises, electrotherapy modalities

Spinal Headaches

Caused by puncture of dura, resulting in leakage of CSF into epidural space
Management: breathing and circulatory exercises, strengthening program while lying in bed

Paralytic Ileus

Management: early ambulation, passive exercise of lower limbs and trunk, static abdominal exercise, thermotherapy, and short wave diathermy

Carpal Tunnel Syndrome

Result of fluid retention and edema
Management: refraining from sleeping on the affected side, wearing a night splint, exercising the wrist and hand, and electrotherapy (laser, ultrasound, hot packs)

De Quervain Tendonitis

Pain over the styloid process of the radius
Management: resting the wrist, wearing a night splint, and electrotherapy (laser, ultrasound, hot packs)

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Description

This quiz covers the normal and abnormal puerperium, assessing postpartum problems, and planning physical therapy programs. Understand the importance of physical therapy for women postpartum.