The document defines the puerperium period as the 6 weeks following childbirth when the body reverts from its pregnant state. It has 3 stages: immediate (24 hours), early (up to 7 days), and remote (up to 6 weeks). During this time, the uterus involutes from 1000g to 60g, the cervix regains its shape by 6 weeks, and other pelvic structures like the vagina and ligaments take longer to revert due to stretching during birth. Women experience lochia discharge, breast and lactation changes, as well as general physiological changes like increased urination and weight loss. Proper management focuses on rest, hygiene and infection prevention. Abnormalities can include puer

1. NORMAL
PUERPERIUM

2. WHAT IS PUERPERIUM?
 Period following childbirth
 Pelvic organs & other body tissues
 Revert to pre-pregnant state
 Anatomically & physiologically

3.  Begins as soon as placenta is
expelled
 lasts for appx 6 weeks(42 days)
 3 stages
I. Immediate-within 24hrs
II. Early -upto 7 days
III. Remote – upto 6wks

4. INVOLUTION OF THE UTERUS
Anatomical consideration
● At delivery-20 x 12 x 7.5cm and appox. 1000g
● After involution-reverted to non-preg size of
appox. 60g
● Lower uterine segment isthmus in a few weeks
● Contour of cervix regained in 6 wks
● External os never reverts back to nulliparous state

6. Physiological Consideration
 Muscles:
 Endometrium:
 regen starts on day 7
 from uterine gland mouths and interglandular stromal cells
 completed by day 16
 except @ placental site
Steroid
hormones
withdrawn
Inc
Collagenase
& Proteolytic
enzymes
Autolysis
Myometrial
cell size
reduced
Endophlebitis Thrombosis
Fibrinoid end arteritis Hyalinisation
Blood Vessels

7. Clinical assessment of Involution of uterus
• Fundus lies 13.5cm above sypmphysis pubis
for the 1st 24hrs following delivery
• Steady decrease by 0.5'' in nxt 24 hrs
• Day 14- not palpable- pelvic organ
• Completed by 6 wks

8. Vagina
4-8 weeks;
Does not revert
to original state
Broad/round
ligaments
Long time d/t
stretching
during
parturition
Pelvicfloor&Fascia
Long time d/t
stretching
during
parturition
Involution of other Pelvic structures

9. LOCHIA
• Vaginal discharge for the 1st fortnight during puerperium
● Odour: offensive fishy smell
● Colour and composition
Lochia Rubra
Lochi Serosa
Lochia Alba
•1-4 days
•Blood,fetal memb & decidua
shreds,lanugo,meconium
•5-6 days
•Leucocytes,Cx mucus,wound
exudates,microorganisms
•10-15 days
•Decicual
cells,leucocytes,mucus,cholestrin
crystals,fatty epithelial
cells,microorganisms

10. •Puerperal Sepsis dt E. ColiMalodorous
•Infection
•Lochiometra
Scanty/absent
•InfectionExcessive
•Subinvolution
•Retained conceptus
•Causes secondary PPH
Red color persist
•Local genital infectionL.Alba beyond 3 wks
Clinical importance

11. CHANGES IN BREAST & LACTATION

12. General Physiological Changes
 Pulse:
 raises but settles down to normal on 2nd day
 Temperature:
 Any rise above 0.5C suggestive of infection of genito-urinary tract
 Urinary Tract:
 Pronounced Diuresis on 2nd - 3rd day
 over distension
 incomplete emptying
 presence of residual urine
 high risk of infection
 GIT:
 increased thirst
 constipation
 Weight Loss:
 5-6kg expulsion of fetus placenta, liqour, blood
 2kg- during puerperium dt diuresis
 Continued upto 6 months of delivery

13.  Blood Values:
 immediate-reduced blood volume; Normal in 2 weeks
 rise in cardiac output; Normal in 1 week
 leuycocyotsis dt stress
 Hypercoagulable state for 48 hrs
 Fibrinolytic activity enhanced in 4 days
 Menstruation:
 if not breast feeding- resumes in 6 to 8 wks
 Ovulation:
 non-lactating mother- 4 wks
 lactating mother- 10 weeks
 Exclusive Breastfeeding- 98% contraception up 6 months

14. Management of normal Puerperium
 To restore health of Mother
 Rest and Early ambulation
 Emotional support
 Diet of patients choice
 Sleep
 Immunization- anti-D- Gamma globulin
 Maternal-infant Bonding
 Postnatal exercise

15. To prevent infection
Care of bladder & Vulva
Care of episiotomy wound
Maintenance of asepsis and proper hygiene
Immunization- Rubella vaccine, TT
To take care of the Breasts & promote breast
feeding
To motivate mother for contraception

16. • After pains
• Uterus massage
• Ibuprofen
• Anti-spasmodic
• Pain at site of perineum
• Sitz bath
• analgesics
• Treatment of Anaemia
• Supplementary Iron therapy
Treatment of minor ailments

17. Abnormal Puerperium
 Puerperal fever/ pyrexia
 Puerperal Sepsis
• Pelvic pain
• Fever
• Foul smelling vaginal discharge
• Subinvolution

18.  Breast Problems
• Retracted/cracked nipples
• Breast engorgement
• Mastitis
• Breast abscess
• Failure of lactation

19.  Urinary Problems
• Retention
• Incontinence
• Infection
 Venous thrombosis
 Secondary Hemorrhage
 Puerperal psychosis
 Obstetric palsy

20. THANQ