Introduction to Puerperium PDF

Introduction to Puerperium DR: AYMAN MOHAMED, ASSISTANT PROFESSOR OF PHYSICAL THERAPY FOR WOMAN HEALTH. NADEEN AL -RAMAHI , AND JOUD AL-GAGHBIER, MSC. Puerperium Puerperium is defined as the time from the delivery of the placenta through the first few weeks after the delivery. This period is usua...

Introduction to Puerperium DR: AYMAN MOHAMED, ASSISTANT PROFESSOR OF PHYSICAL THERAPY FOR WOMAN HEALTH. NADEEN AL -RAMAHI , AND JOUD AL-GAGHBIER, MSC. Puerperium Puerperium is defined as the time from the delivery of the placenta through the first few weeks after the delivery. This period is usually considered to be 6 weeks in duration. By 6 weeks after delivery, most of the changes of pregnancy, labor, and delivery have resolved and the body has reverted to the nonpregnant state. Stages of Puerperium 1. The immediate puerperium: the first 24 hours after parturition, when a post-anesthetic or postdelivery complication may occur. 2. The early puerperium: extends until the first week postpartum. 3. The remote puerperium: Include the period required for the involution of the genital organs through the sixth week postpartum. Anatomical and physiological changes General changes: A. Immediately: ◦ Shivering. ◦ Muscular tremors. ◦ Chattering of teeth for 10–15 m. B. Temperature: ◦ Slight rise not exceeding 38°. ◦ If it rises more than 38° or persists (peripheral pyrexia), she needs medical care. Anatomical and physiological changes, cont. Specific changes: Uterine involution: ◦ The uterus can return to its normal size, site, and weight before pregnancy. Non- pregnant uterus Full term uterus After involution Size 1*2*3 inches (thickness 1.5*2.5*3.5 inches wall, width, long) (thickness wall, width, long) Site Pelvic organ Abdominal organ Pelvic organ Weight 50 gm 1000 gm Less than 100 gm Anatomical and physiological changes, cont. Sub-involution of the uterus: is a medical condition in which, after childbirth, the uterus does not return to its normal size. Causes of subinvolution of the uterus: ◦ Retained placenta fragment. ◦ Infection. ◦ Overdistention of the uterine as in cases of twins. ◦ Bad general health condition (anemia). ◦ Multiparty. Anatomical and physiological changes, cont. The muscular walls of the pelvic organs: ◦ The voluntary muscles gradually regain their tone during the puerperium. ◦ Tearing or overstretching of the musculature or fascia at the time of delivery predisposes to genital hernias. ◦ Involution of the abdominal musculature may require 6-7 weeks. Vigorous exercises are not recommended until after that time. Anatomical and physiological changes, cont. Psychological changes: ◦ Mild degrees of depression and emotional disturbance are almost in the puerperium, in some cases, and require psychiatric support. ◦ Psychiatric illness may present as severe depression, disorientation in time, and space, and a complete loss of interest in the child. Anatomical and physiological changes, cont. Urination: ◦There is diuresis in the 1st to 2nd days of puerperium. ◦Retention of urine may occur either due to trauma to the sphincter or reflexes from perineal trauma. Anatomical and physiological changes, cont. Skin and body weight: ◦ There is a tendency to sweat, and the body weight is slightly lost during the 1st to 10th days. Anatomical and physiological changes, cont. Cardiovascular system: ◦ Cardiac output and plasma volume return within the 1st week postpartum. ◦ During the 1st to 10th days after delivery, there is an increase in the clotting factors that are associated with a higher risk of deep venous thrombosis. Thank you