The Puerperium (suite de couche normale). Plan: Definition. Objectives:-Monitor physiological changes of the puerperium. -Diagnose and treat postpartum omplications. -Discuss breast feeding. -Provide emotional support. -Disacuss family planning and contraception.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
The Puerperium (suite de couche normale).
Plan:
Definition.
Objectives:-Monitor physiological changes of
the puerperium.
-Diagnose and treat postpartum omplications.
-Discuss breast feeding.
-Provide emotional support.
-Disacuss family planning and contraception.
-Postpartum consultation.
Physiological Changes.• Involution of the Genital and Urinary tracts.
I- Uterus, Uterine height 30-35cm, 1-1.5kgs, involutes by 1-2cm dailly,
10-14 days becomes a pelvic organ.
By 4 weeks non gravid size(50-70gms).
3wks <100gms, 2wks 300gms, 1wk 500gms.
Uterine involution occurs by reduction in the size of individual
cells(autolysis).
Lower segment disappears(junction between cervix and body of uterus).
Dr. Nana
Physiological Changes(1).
Cervix regresses, internal OS is closed, infra vaginal1.5-2cm,by a
week, external OS remains dehiscent.
Ectropion, endocervical mucosa may remain visible for a long
period.
• Regeneration of the Endometrium.
Separation of placenta / membranes involves only spongy layer.
2-3 days later basal portion differentiates into superficial layer,
becomes necrotic and basal layer, regenerates the new
endometrium. Dr. Nana
Physiological Changes(2).• Involution of the Placenta site.
At delivery, size of a palm, 2 weeks 3-4cm in diameter, complete
extrusion <6 weeks.
Involution of endometrium and placenta site can be summarised into
four stages:
1. Regression delivery to day five.
2. Scarring of placenta site day five to 25 without hormonal stimulation.
3. Proliferation of endometrium day 25-45 influenced by oestrogens.
Dr:Nana
Physiological Changes(3).4 Resumption of menses triggered by ovulation by 40th day.
Sometimes ovulation doesnot occur,bleeding is withdrawal in
origin, ovulation usually occurs by the 60th day.
• Vagina,vaginal outlet.
Sperficial erosion scar quickly, some degree of colpocele
occurs at delivery , regresses quick, myrtiforme caruncles
may be seen, intriotus closes with time, perineum regains ist
tonicity but must be reinforced with appropriate gymnastics.
Dr.Nana
Physiological Changes(4).
• Abdomen. Rupture of elastic fibers, diastases of the rectus
abdominus muscle.
• A slow regression of other changes, biliary and urinary
tracts(cholecystography and IVP interpretation difficult).
• Relative insensitivity to intravesical pressure, Retention.
• Biochemistry: several modifications progressively regress to
normal, tolerance to glucose or carbohydrates, changes in lipid