8/7/2019 Postpartum final

1/16

8/7/2019 Postpartum final

2/16

Puerperium

Puer child, parere- to bring

forth

6 weeks period after the deliveryof the baby.

8/7/2019 Postpartum final

3/16

Involution

the return of the reproductive

organs to their non-pregnant

state.

8/7/2019 Postpartum final

4/16

Phases of the Puerperium:

Taking In occurs during the first 2 3 dayspostpartum. The womans attention is focusedon her own needs for sleep and rest and she isdependent on others.

Taking Hold extends from the 3rd day to 2weeks postpartum. the woman begins to initiateaction. The concern of the mother at this time is

focused on her ability to control body functionand her ability to assume the mothering role.

y the client can already start to do her usualactivities and touches the baby slowly

8/7/2019 Postpartum final

5/16

Contn

Letting Go the woman finally redefines her

new role. The mother realizes the

individuality of her baby. She gives up her

role of being childless and she now adjustsherself to meet the needs of her child

y the client already assumes the

responsibility of being a mother. The

client holds her baby with a happy face.

8/7/2019 Postpartum final

6/16

Involution

Cardiovascular system

Blood loss in normal delivery is 300-500ml. c/s(500-1000ml)

Blood loss and diuresis in the postpartumperiod contribute to reduction in blood

volume. 1st to 2nd week after birthIntegumentary system

Chloasma, palmar erythema, linea nigragradually disappear during the postpartumperiod. Striae gravidarum do notdisappear and assumes a silvery whiteappearance.

8/7/2019 Postpartum final

7/16

Uterine Involution the decrease of theuterine size is due to the decrease in

myometrial size and not to their number. Thesudden decrease in estrogen andProgesterone now causes atrophy ofmyometrial cells and consequently, a decreasein uterine weight.1000g to 500g after a week

and after 6 weeks it return to prepregnantstate(50g)

Fundus - is assessed for firmness, positionand height. Measure the position or height ofthe fundus by using the umbilicus as the

landmark. Immediately after delivery, thefundus is located midway between theumbilicus and the symphisis pubis then it risesto the level of the umbilicus. It then descendsinto the pelvic cavity by one fingerbreadth a

day.

8/7/2019 Postpartum final

8/16

Afterpains is due to the strong uterinecontractions. Afterpains are more common to

multiparas, women treated with oxytocin andbreastfeeding mothers. These afterpains arepresent 2 to 3 days after childbirth.

Management:

Explain to the woman the cause and purposeof afterpains.

Keep bladder empty by regularly voiding, adistended bladder increases afterpains.

Instruct woman to assume prone position.

Massage uterus gently. Never apply heat

Administer Analgesics as ordered.

8/7/2019 Postpartum final

9/16

Lochia is the uterine discharge after delivery. It consists of blood,mucus, epithelial cells, leukocytes and bacteria.

Type of Lochia Color Postpartal day Composition

Rubra Red 1 3 lood,Fragments of

deciduas andmucus

Serosa Pink 3 10 lood, mucusand invading

leukocytesAlba White 10 14 (6

Weeks)Largely mucus,leukocyte counthigh.

8/7/2019 Postpartum final

10/16

Signs of abnormal ochia

Signs Possible Cause

Foul smell Infection

Large clots Retained placental fragments

Excessive amount withcontracted uterus

Lacerations of birth canal

Return to rubra after serosa or

alba

Retained fragments, infection

Persistent bleeding after 6 weeks Subinvolution of the uterus,

8/7/2019 Postpartum final

11/16

Bladder

Trauma to the bladder results in loss ofbladder tone. Loss of bladder tone results inincreased capacity of the bladder anddecreased sensation to void.

Effects of bladder distention Hemorrhage

Infection

increase discomfort

Atony of the bladder wall

overflow incontinence

8/7/2019 Postpartum final

12/16

Measures to induce voiding

provide privacy open faucet and let woman listen to running

water

pour warm water over the perineum

encourage the woman to practice kegel

exercise several times a day.

liberal fluid intake

8/7/2019 Postpartum final

13/16

Vagina immediately after delivery the

vagina is smooth and swollen. After 2 to 3weeks,

Rugae reappears, but not as numerous as

before pregnancy. The vagina returns to itsprepregnant condition after 6 to 8 weeks but

does not regain its virginal state.

8/7/2019 Postpartum final

14/16

Cervix is soft, edematous and relaxedright after delivery. It regains itsprepregnant firmness after the first week

postpartum. but the external os does notreturn to its original prepregnant conditionas it is lacerated during delivery.

Perineum The discomfort of episiotomydoes not last for more than a week.Perineal care must be done and perilighttherapy after.

8/7/2019 Postpartum final

15/16

COMPLICATIONS OF THE POST PARTUM PERIOD

Uterine atony

Lacerations

Retained placental fragments

Subinvolution Hematomas

Puerperial infection

Urinary tract infection

Mastitis thrombophlebitis

8/7/2019 Postpartum final

16/16

Thank you!