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Puerperium
Puerperium
Objectives
Anatomical and physiological changes in pregnancy that led to normal lactation Understand the physiology and advantages of normal lactation Available methods of lactation suppression Prevent, recognize and manage breast-feeding complications Diffrentiate the causes of puerperal pyrexia Recognize the postpartum mental illnesses
Puerperium
Puerperium It is the time from the delivery of the placenta through the first 6 weeks after the delivery Why?? Anatomical and physiological changes of pregnancy return to pre-pregnancy state
Puerperium
Examples Uterus
Weight Cervix Lochia (rubra, serosa then alba)
Vagina
Pelvic floor Vaginal vs. C/S Episiotomy
Menstruation
Breast feeding Ovulation
Postpartum Care
Discharge time Rh immunoglobulin Vaginal (episiotomy, pain and hemorrhoids) C/S (ambulation, eating and voiding) Sexual intercourse Education and discharge instruction Contraception
Breast Feeding
Physiology Lactation can occur by 16 weeks' gestation Lactogenesis is initially triggered by the delivery of the placenta, which results in falling levels of estrogen and progesterone, with the continued presence of prolactin Suckling stimulates the release of prolactin and oxytocin secondly If the mother is not breastfeeding, the prolactin levels decrease and return to normal within 2-3 weeks
Breast Feeding
Physiology Colostrum is the liquid that is initially released by the breasts during the first 2-4 days after delivery High in protein, lactose and water This liquid is very protective for the newborn
Breast Feeding
1. 2. 3. 4. 5. Infants Maternal Delays fertility Decrease cancers (breast, uterine, ovarian) Emotional health Promote wt loss Decrease osteoporosis Society
Recurrent mastitis
Methods
Mechanical Medical (e.g. bormocryptin)
Puerperal Pyrexia
It is a temperature of 38C, maintained for or recurring within 24 hours, within 2-3 weeks of childbirth or abortion Causes
Womb Wound Water Walk Wind Wondering drugs Others Local infection Vaginal Vs. C/S UTI DVT RTI Meds Breast, IV
Womb
Puerperal Pyrexia
History & Examination Investigations complete septic work up Treatment broad spectrum antibiotics wait for cultures
Mental illnesses
Post-partum 'Blues' This occurs in around 50% of women within 4 to 5 days of delivery It is usually a self limiting condition Rarely progress
Mental illnesses
Postnatal Depression It is a relatively common disorder Onset between 1-6 months after delivery May last 6 moths or longer Clinical features sleep disturbance depressed mood social withdrawal lack of worthiness about being a mother Suicidal thoughts
Mental illnesses
Management Social support Psychiatric or psychological care Medications
Mental illnesses
Puerperal Psychosis Psychotic illness occurs in 0.2% of mothers and the onset is earlier than postnatal depression. This is a serious condition and requires expert psychiatric evaluation and treatment