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.