NORMAL - PUERPERIUM

 Puerperium:-

“ Period after delivery in which body tissue specially pelvic organs return their pre gravida stage is called as puerpeium period”

Duration:- From expulsion of placenta to 6 week (42 days)

Types:- It is of 3 types (1) Immediate – up to 24 hrs.

       (2) Early – up to 7 days

       (3) Remote – up to 6 weeks

Physiological changes in reproductive system:-

(1) Involution of Uterus:-

Failure to reproductive organs return to their pre-pregnant size position is called sub- involution

In nulli parous women dimensions of uterus are 7.5x5x2.5 w – 60g

In multiparous women dimension of uterus 8.2x6.2x2.5 weight

After the delivery uterus becomes firm attractive & shows alteration  like hardening & softness

Size of uterus is 20x12x7.5 weight of 1000 gm

Fundal height decreases (in to pelvis) about 1 finger breadth (1cm) per day

A flaccid fundus indicates uterine atony and should be massaged until firm,

Tender fundus indicates an infection

Note:- Breast feed may experience a more rapid involution varicose of the release of oxytocin (during breast feeding)

Change occurs in the following component:-

(1) Muscles:-

No of muscle fibers is not but their substance reduction of myometrial cell size

Withdrawal of steroid hormones estrogen & progesterone

In the activity of the uterine capillaries

Release of photolytic enzyme

Autolysis of the protoplasm

Peptones enters the blood stream

Excreted through the kidney

The exertion of product in the puerperium uterine

(2) Blood Vessels:- changes in blood vessels are pronounced at

Placental size

The arteries are contracted by contraction of its wall & thickening of the items

(3) Endometrium:-

Following delivery major part of deciduas is cast off with expulsion of the placenta & the membrane

Endometrial left behind varies in thickness from 2-5 mm entire endometrium is restored by the day 16

Except at the placental size where it takes about 6 weeks

(2) Involution of Lower uterine segment:-

Just after delivery lower uterine segment becomes thin & collapse which we can see on 3rd stage

Time required for involution of lower uterine segment in 3 weeks

(3) Involution of cervix:-

It is slow & gradual process

3rd day Two finger can be passed from external

1st week tip of finger

After delivery external os doesn’t come in mulliparous stage

(4) Vaginal canal:-

The vaginal canal appears swollen & smooth after delivery becomes smaller and firm

Never regains pre-pregnant size

Ragas partially reappear at 3rd week

Never to the same degree as in pregnant size

(5) Perineum:-

Involution is fast by 5th day it returns to normal except in episiotomy & perineal tears

(6) Ovaries:-

- The ovaries are inactive during the last two trimesters of pregnancy recourse of the drop in placental Harmones

- Level and gradually sesames the pre-pregnancy cycle

(7) Lochia:-

It is a vaginal discharge which starts after delivery for first 15 days during puerperium

It originates from the uterine body cervix & vagina

1st week at time of abortion

It contains blood decidual tissue, epithelial cells from the vagina mucosa

Odour – offensive fishy smell

Reaction- Alkaline – 1st week

Acidic – 2nd week

Types:-

(1) Lochia Rubra:- (1 to 4 day)

The first phase of lochia when discharge is red & bloody called lochia rubra means “ Red”

Contain – Few small blood, clots of fetal membrane & deciccus vernix cesareans, lanugo & me conium.

(2) Lochia Serosa (5 to 9 days):-

Pink, pale, brownish & yellow colored

Contains – Less RBC, More WBC (Leucocytes) Mucous from cervix & Micro organism

(3) Lochia Alba: - (10 to 15 days)

White colored

Contains:- Less decidual cell

Mucous

Leukocytes & Micro organism

Amount:- Average amount of discharge 5 to 6 day is – 250 ml

Total 1 to 15 day = 500 ml

Note:- Some time duration of lochia becomes 21 days but if it persist after 21 days than condition is abnormal

Clinical Importance:-

It gives useful information about the abnormal puerperal at

Vulval pads are to be inspected daily to get information

Odor If offensive indicate infection

Amount – Scanty or absent indicate lochiometra

Excessive – Indicate infection

Color:- Persistent of red color beyond the normal limit indicate sub involution

Duration – Duration beyond 5 weeks suggest local genital lesions.

Physiological changes in other system of body:-

(1) Cardiovascular changes:-

(a) Pulse:- 70 to 80 beats/min at delivery

Get slow after delivery becomes normal 2 to 3 day

(b) Temperature:-

Temp. Increase after labour

1st day delivery it reaches 990 F (37.2) become normal at 3 day

If temp rises at 3rd day then only type of infection UTT etc can occur

(c) B.P – No change

(d) Cardiac output:-

Increase in pregnancy period

After delivery it reaches at highest level

Which become normal at 2-3 day due to doses

(e) Weight Loss:-

Total 10 kg wt. loss

4 kg due to fetal & placental

3 kg during puerperium, involution of uterus

3 kg due to women’s daily activities

(f) Urinary tract:-

Diuresis

Dilation of ureter & renal pelvis & involutes at 8th weeks

Bladder tone is gained at 4th week

(g) Blood volume:- Slight decrease of blood volume immediately delivery due to fluid loss return to normal level by 2th week

HB & haemstocrit decrease due to labour

Leukocyte count se 30,000/-

Plasma fibrinogen increase  in 1st week

(h) GI Tract:- Puerperium is due to loss of fluid during labour in the lochia

(1) Fluid Loss:-

2 liters during the first week

1.5 liters during next 5 week

Amount of fluid loss depend on the amount retained during pregnancy Dehydration during labour & blood loss during delivery