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THE PUERPERIUM

DR. K.C. SAMUELSON

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OUTLINE

  • Introduction

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INTRODUCTION

  • The word “puerperium” comes from two latin words “puer” meaning child and “parere” meaning to bear.
  • The puerperium defines the time period between delivery of placenta till 6 weeks after delivery
  • By 6 weeks, most of the changes related to pregnancy, labor and delivery have resolved
  • Vigilance during this period is necessary as complications can arise leading to maternal death

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  • The puerperium is divided into;
    • Immediate (1st 24 hours)
    • Early (2nd to 7th day)
    • Late (2nd to 6th week)

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Management of Normal Puerperium

IMMEDIATE

  • 1 hour after delivery aka 4th stage of labor
    • Repair of perineal tears and episiotomies
    • Administration of oxytocin
    • Monitoring for and prevention of PPH
    • Observe for 1 hour in labor ward and transfer to postnatal ward thereafter

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NEXT 23 HOURS

    • Routine vital signs check
    • Baby’s blood group check
    • Administration of RhoGAM if indicated
    • Analgesia
    • Perineal care
    • Bladder care
    • Initiate breastfeeding
    • Lochia
    • Discharge home

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EARLY AND LATE PUERPERIUM

  • 1st postpartum clinic visit is at 2 weeks
  • Sexual activity
  • Contraception
  • 2nd postpartum clinic visit at 6 weeks

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LACTATION

  • Changes in the breast preparing for lactation occurs during pregnancy under the influences of hormones
  • Prolactin, Chorionic somatotropin and HCG causes ductal sprouting and branching
  • Oestrogen and progesterone stimulate ductal and alveolar growth
  • Prolactin and corticosteroids causes differentiation of ductal end cells to alveoli
  • HPL and prolactin stimulate secretion of colostrum

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  • Lactogenesis is initially stimulated by delivery of placenta, and falling levels of oestrogen and progesterone, with sustenance of prolactin
  • Lactogenesis and breastfeeding is sustained by the suckling reflex
  • Colostrum is the first alkaline rich milk produced in the last month of pregnancy, and released in the first four days of breastfeeding
  • Colostrum is rich in proteins, vitamins,minerals, electrolytes and antibodies
  • Colostrum is low in calories

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  • Transitional milk follows colostrum, and is rich in lactose, fat and calories.
  • This is followed by Mature milk which sets in 1 – 2 weeks after delivery
  • The milk that comes towards the end of the feeding period is higher in fat and calories than at the beginning

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COMPLICATIONS OF PUERPERIUM

  • Primary PPH
  • Secondary PPH
  • Post partum pyrexia
  • Obstetric Neuropathy
  • Deep Vein thrombosis
  • Post partum blues/depression/psychosis

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CONCLUSION

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Video resources

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  • Implantation and early placental development
  • https://www.youtube.com/watch?v=nnWjc34_na4&t=22s