puerperium (1).pdf

PUERPERIUM Dr. Ahmed Reda NORMAL PUERPERIUM  Definition The time from the delivery of the placenta through the first few weeks after the delivery (6 weeks postpartum). Importance By 6 weeks after delivery, most of the changes of pregnancy, labor, and delivery have resolved and...

PUERPERIUM Dr. Ahmed Reda NORMAL PUERPERIUM  Definition The time from the delivery of the placenta through the first few weeks after the delivery (6 weeks postpartum). Importance By 6 weeks after delivery, most of the changes of pregnancy, labor, and delivery have resolved and the body has reverted to the non-pregnant state. The uterus Size Immediately after the delivery, the uterus can be palpated at or near the umbilicus 2 weeks postpartum, the uterus should be located in the true pelvis Weight Most of the reduction in size and weight occurs in the first 2 immediately postpartum = 1000g weeks After 1 week = 500g At the end of 2nd week = 300g Thereafter = 100g or less.  Tissues revert to a non-pregnant The cervix state but never return to the nulliparous state The external os is closed to the extent that a finger could not be easily introduced. The external os never resumes its pre- gravid shape; the small, smooth, regular circular opening of the nulligravida becomes a large, transverse, stellate slit after childbirth The vagina shrinks to a non pregnant state resolution of the increased vascularity and edema occurs by 3 weeks the vaginal epithelium appears atrophic on smear. This is restored by weeks 6-10. Tissues revert to a non-pregnant state but never return to the nulliparous state The perineum swelling and engorgement are completely gone within 1-2 weeks. The gapping of the vulva that occur during vaginal delivery remains for 2-3 weeks then gradually disappear but never returns to the pre- pregnancy state. the muscle tone may or may not return to normal, depending on the extent of injury. Afterpain Duration Moderate pain for 2 days Mild pain by the 3rd day postpartum  Occasionally severe enough to require an analgesic Causes Multipara: The uterus contracts vigorously at interval  afterpain Primiparas: The uterus tonically contracts  mild pain Infant suckling (breast feeding): oxytocin release  uterine contraction  afterpain Lochia Duration Variable Lasts about 5 weeks At week 6 postpartum only 15% of women have lochia Types Lochia rubra: Color  Red Duration  variable Lochia serosa Color  Brownish red, more watery consistency  Continues to decrease in amount Lochia alba Color  Yellow Ovulation and menstruation There is no ovulation immediately postpartum Cause: Prolactin hormone inhibits gonadotrophin releasing hormone (GnRH) release from the hypothalamus. Ovulation is restored after a duration depending on whether the woman is breastfeeding or not Menstrual cycles is resumed when ovulation is restored Not Breast feeding Breastfeeding Variable duration Ovulation may be as early as Have longer period of anovulation 27 days after delivery and amenorrhea Most have a menstrual period 50-75% return to periods within by 12 weeks 36 weeks The rest return to periods may not have periods until stopping breastfeeding The breasts Changes to the breast that prepare for breastfeeding occur throughout pregnancy Lactation can occur by 16 weeks’ gestation Colostrum: Mature milk continues to – 1st 2-4 days after delivery change throughout the – High in protein and immune factors period of breastfeeding Milk: to meet the changing – The milk marures over the first week demands of the baby – Contains all the nutrients necessary Breastfeeding Intiation Breastfeeding is neither easy nor automatic Should be initiated as soon as possible after delivery Feed the baby every 2-3 hrs to stimulate milk production Contraindications Alcohol use and street drugs With certain medications Active untreated tuberculosis (TB) Infections: HIV, Cytomegalovirus and hepatitis B virus Women with active herpes simplex virus An infant with galactosemia Mother is undergoing breast cancer treatment Physiologic weight loss The mean weight loss from delivery of the fetus, placenta, and amniotic fluid is 6 kg. Contraction of the uterus, loss of lochial fluid, and loss of excess intra- and extracellular fluid leads to an additional loss of 2 to 7 kg during the puerperium. Approximately one-half of gestational weight gain is lost in the first six weeks after delivery, with a slower rate of loss through the first six months postpartum Abdominal Wall Remains soft with poor tone for many weeks Return to a pre-pregnant state depends greatly on exercise Sexual intercourse May resume when… – Red bleeding ceases – Vagina and vulva are healed – Physically comfortable – Emotionally ready  Physical readiness usually takes ~3 weeks Concerns - Puerperal Period Physical activity and exercise during the postpartum period Physical activity and exercise during the postpartum period Moderate-intensity exercise of 20 to 30 minutes per day on most or all days of the week. Pelvic floor rehabilitation: ◦ Prevent and manage pelvic organ prolapse ◦ Prevent and manage urinary incontinence ◦ Improve sexual function Benefits of Postnatal Exercise Restores physical health ◦ Improves blood circulation ◦ Improves cardiovascular and bone health ◦ Strengthens abdominal and spinal muscles Improves sleep quality Relieves stress Prevention of depressive disorders such as postnatal depression Reduced body weight Stimulates lactation Alleviates postnatal issues such as diastasis recti, urinary incontinence, pelvic organ prolapse and pelvic girdle pain ROLE OF WOMEN’S HEALTH PHYSIOTHERAPIST Physical therapy can improve health outcomes for new mothers in the postnatal period  through a combination of  manual therapies  specific treatments (such as pelvic floor muscle training)  therapeutic exercise Benefits 1. Improve mood 2. Improve cardio-respiratory fitness 3. Promote weight loss 4. Reduce the risk of postpartum depression and anxiety 5. Enhance psychological well‐being 6. Improve sexual health and sexual dysfunction 7. Lead to better outcomes assessing quality of life Thank You