NORMAL PUERPERIUM BINZHOU MEDICAL 正常产褥期滨州医疗.pptVIP

* * * * Dr. Madhavi Karki NORMAL PUERPERIUM CHANGES IN UTERUS: INVOLUTION “The process by which the genital organs returns almost to its pre-gravid state is known as involution.” The following changes takes places:- Decrease in size of uterus as a whole. Reduce in the length of muscle fiber. Shrinkage of vessels. Regeneration of normal endometrium. Rate of involution:- -Immediately after delivery till first 24 hours, the uterus will be around 24 weeks size. -Then after there is gradual decrease in size at the rate of 1.25 cm per day. -At 14 days the uterus become pelvic organ and not palpable per abdominally. -By 6 weeks, the uterus become almost normal in size. Weight of uterus:- End of labour:-1kg End of 1st week:-0.5kg End of puerperium:-70gms Traits Lochia rubra Lochia serosa Lochia alba Colour Red Yellow or pale brown Pale white Composition Mainly RBC, leucocytes, decidua, mucus. Mainly mucus and serum, few RBC and leucocytes. Mucus, serous exudates, epithelial cell, leucocytes. Duration 1-4 days 5-9 days 10-15 days. Lochia is 3 types:- Abnormality with lochia:- persistent lochia rubra:- causes secondary PPH due to retained placental tissue and membrane. Offensive lochia:- puerperal sepsis due to E.coli. Scanty serous lochia:- severe streptococcal infection. Suppression of lochia:- obstruction at internal os by clots 2. Changes in abdominal wall Abdominal wall become flat and flabby. Striae gravidarum persist. Proper exercise and massage regain tone 3. Changes in CVS -increased diuresis? 3-4 l loss -rise in hematocrit? 5% -blood volume? reduced by 20% -cardiac output? normalized by 3-4 weeks Child not nursed: 6-8 weeks Lactation amenorrhea: 2-18 m Lack of stimulation by pituitary gonadotropins Ovulation usually regains after 6 weeks? high risk of pregnancy even in lactational amenorrhea. Early ambulation Watch for pain, fever pulse Diet Involution of uterus Lochia Bowel bladder Breast care Perineal care Post natal visit Total Caloric Requireme