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Puerperium
Puerperium


more about Puerperium


Description

  • Puerperium is the period from termination of pregnancy to the involution of the uterus, traditionally 6 weeks.


    Involution of reproductive organ

    Uterus:
  • Just after birth: Slightly below umbilicus, weighs about 1000 gm.
  • Day 2: Uterus begins to shrink.
  • 2 weeks: Uterus descends into pelvic cavity; weighs 300 gm.
  • 6 weeks: Uterus returns to normal nonpregnant state; weighs 50-70 gm.

    Placental site involution takes 6 weeks.

    Abdominal wall:
  • Because of rupture of elastic fibers in the skin during pregnancy, abdominal walls remains\ soft and flabby after childbirth.
  • Exercise helps speed recovery of abdominal walls.

    Urinary tract:
  • After birth: over-distention and incomplete emptying occurs.
  • Complete recovery takes 2-8 weeks.
  • About 7% of women develop stress incontinence after delivery; Kegel exercises are helpful.


    Care: immediately after childbirth

  • Bleeding: Vaginal bleeding should be monitored closely.
  • Care of perineum:
  • Mother should be advised to clean the perineum from front to back after bowel movements.
  • Hot sitz bath can reduce discomfort of perineal area and enhance recovery.
  • Early ambulation:
  • Women can get out of bed several hours after childbirth: An attendant should monitor the first ambulation.
  • Early ambulation reduces bladder complications and constipation.


    Care: puerperal period

    After pains:
  • Uterine contractions after birth cause pain.
  • After pains are more common in multiparous women and when the baby suckles.
  • After pains decrease after 3 days after childbirth.

    Lochia:
  • Lochia is red, due to mixture of blood and tissue, for the first few days.
  • After 3-4 days, lochia gradually becomes pale in color.
  • After 10 days lochia, becomes yellowish-white in color.

    Temperature:
  • Physiologic " milk fever" can occur on 3rd or 4th day.
  • Any fever after childbirth should be monitored. It can indicate an infection.

    Bleeding:
  • Any bleeding exceeding 2 times the amount of menstrual blood should be monitored.

    Weight loss:
  • Initially after birth, 10-13 lbs is lost due to uterine evacuation and 4.5-6.5 lbs is lost due to diuresis.
  • Most women approach their prepregnancy weight within 6 months.

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