Professional Documents
Culture Documents
PUERPERIUM
Period of time
encompassing the
first few weeks
(between 4 to 6
weeks) after birth
May be a time o
intense anxiety for
many women
CROSS
SECTIONS
OF UTERI
MADE AT
THE LEVEL
OF THE
INVOLUTING
PLACENTAL
SITE AT
VARYING
TIMES
AFTER
DELIVERY
Sonographic Findings:
SUBINVOLUTION
an arrest or retardation of involution
prolongation of lochial discharge
irregular or excessive uterine bleeding
uterus is larger and softer than would be
expected
due to retention of placental fragments and
pelvic infection
Management of Subinvolution
Chlamydia trachomatis
INCONTINENCE
WEIGHT LOSS
MAMMARY GLANDS
composed of 15 to 25 lobes
arranged radially and are separated from one
another by varying amounts of fat
lobe consists of several lobules, which are
made up of large numbers of alveoli, every
alveolus is provided with a small duct
alveolar secretory epithelium synthesizes the
various milk constituents
BREASTFEEDING
COLOSTRUM- deep lemon-yellow-colored liquid,
expressed from the nipples by the 2nd postpartum day,
contains more minerals and protein, much of which is
globulin, but less sugar and fat
secretion persists for about 5 days, with gradual
conversion to mature milk during the ensuing 4 weeks
content of immunoglobulin A (IgA) may offer protection
for the newborn against enteric pathogens
host resistance factors that are found in colostrum and
milk:
lactoferrin,
HUMAN MILK
IL-6 was associated closely with local IgA production by the breast
ENDOCRINOLOGY OF LACTATION
Progesterone ,estrogen, and placental lactogen, prolactin, cortisol,
and insulin: stimulate the growth and development of the milksecreting apparatus of the mammary gland
Decrease estrogen and progesterone
Removes the inhibitory influence of progesterone on the production of
alpha lactalbumin by the rough endoplasmic reticulum
increased alpha lactalbumin stimulate lactose synthase
increase milk lactose
neurohypophysis secretes oxytocin in pulsatile fashion
stimulates milk expression from a lactating breast by causing
contraction of myoepithelial cells in the alveoli and small milk ducts
IMMUNOLOGICAL CONSEQUENCES OF
BREASTFEEDING
predominant immunoglobulin in milk is secretory IgA
SECRETORY
IgA is secreted across mucous
membranes and has important antimicrobial functions
breast-fed infants are less prone to enteric infections
than bottle-fed infants
human milk also provides protection against rotavirus
infections,Escherichia coli infections
contains both T and B lymphocyte
milk T lymphocytes are almost exclusively composed
of cells that exhibit specific membrane antigens
NURSING
Ideal for neonates
Provides species and age specific nutrients
Promotes cellular growth & differentiation
Decreases incidence of infections
Protective against: SIDS, IDDM, IBD,
Lymphoma, Allergy, Chronic Digestive disease
Enhances Cognitive development
LACTATION INHIBITION
CONTRAINDICATIONS TO BREASTFEEDING
in women who take street drugs or do not control their alcohol use
NIPPLE CARE
Drugs That Have Been Associated with Significant Effects on Some Nursing Infants
BREAST FEVER
breasts become distended, firm, and nodular
a transient elevation of temperature (ranged
from 37.8 to 39)
Treatment: supporting the breasts with a binder
or brassiere, applying an ice bag, an analgesic,
pumping of the breast or manual expression of
milk
MASTITIS
TREATMENT: MASTITIS
clinicians recommend that milk be expressed from the
affected breast onto a swab and cultured
initiate antimicrobial therapy:
staphylococcal infections are usually sensitive to
penicillin or a cephalosporin
BREAST ABSCESS
development is either from failure of defervescence within 48
to 72 hours or development of a palpable mass
TREATMENT: Traditional therapy is surgical drainage less
invasive alternative is ultrasonographic-guided needle
aspiration using local anesthesia
GALACTOCOELE
result of the clogging of a duct by inspissated secretion,milk
may accumulate in one or more lobes of the breast
excess may form a fluctuant mass that may give rise to
pressure symptoms
resolve spontaneously or require aspiration
SUPERNUMERARY BREAST
so small as to be mistaken for pigmented moles, or when without
a nipple, for a lipoma
situated in pairs on either side of the midline of the thoracic or
abdominal walls, usually below the main breasts; also found in
the axillae, and more rarely on other portions of the body, such
as the shoulder, flank, groin, or thigh
no obstetrical significance
ABNORMALITIES OF NIPPLES
Inverted- draw the nipple out, using traction with fingers.
Normal size and shape- may become fissured lesions
provide a convenient portal of entry for pyogenic bacteria effort
should be made to heal such fissures
EARLY AMBULATION
1.
2.
3.
BLADDER FUNCTION
Oxytocin, in doses that have an antidiuretic effect, as a
consequence of infused fluid and the sudden withdrawal of
the antidiuretic effect of oxytocin, rapid bladder filling is
common
BLADDER FUNCTION
SUBSEQUENT DISCOMFORT
DEPRESSION
postpartum blues- degree of depressed mood a few days
after delivery
Anxiety over her capabilities for caring for her infant after
leaving the hospital.
Fears that she has become less attractive
DIET
THROMBOEMBOLIC DISEASE
Half of thromboembolic events associated with
pregnancy develop in the puerperium,
OBSTETRICAL NEUROPATHIES
If the nerve is injured, pain continues after delivery and
may be accompanied by variable degrees of sensory
loss or muscle paralysis supplied by the damaged nerve
IMMUNIZATION
D-negative woman who is not isoimmunized and whose
infant is D-positive is given 300
microgram of anti-D immune globulin shortly after delivery
TIME OF DISCHARGE
Following vaginal delivery, if there are no complications,
hospitalization is seldom warranted for more than 48 hours.
Receive instructions regarding:
EARLY DISCHARGE
The norms are hospital stays of up to 48 hours following
uncomplicated vaginal delivery and up to 96 hours following
uncomplicated cesarean delivery.
American
Academy of Pediatrics, American Academy of
Obstetricians and Gynecologists, 2002
CONTRACEPTION
effort should be made to provide family planning
education
If a woman is not breastfeeding, menses usually
return within 6 to 8 weeks
Ovulation is much less frequent in women who
breast feed compared with those who do not
lactating women, the first period may occur as
early as the second or as late as the 18th month
after delivery
CONTRACEPTION
Clearly, there is delayed resumption of ovulation with
breast feeding, although as already emphasized, early
ovulation is not precluded by persistent lactation.
Other findings included the following:
1.Resumption of ovulation was frequently marked by
return of normal menstrual bleeding
2.Breast feeding episodes lasting 15 minutes seven
times each day delayed resumption of ovulation.
3. Ovulation can occur without bleeding.
4.Bleeding can be anovulatory.
5.The risk of pregnancy in breast feeding women was
approximately 4 percent per year.
HOME CARE
COITUS - no definite time after delivery when coitus should be
resumed
The median interval between delivery and intercourse was 5
weeks range was 1 to 12 weeks
reasons cited for not resuming intercourse included perineal pain,
bleeding, and fatigue
-coitus may be resumed based on the patient's desire and comfort
B. INFANT FOLLOW UP
importance of subsequent neonatal and well-baby care should be
stressed and an emphasis placed on infant immunizations.
Any neonate discharged early should be term, normal, and have
stable vital signs.
Initial hepatitis B vaccine should be administered, and all
screening tests required by law should be performed
2 to 18 months Postpartum
54
Breast Problems
36
20
Anemia
25
Backache
24
20
Hemorrhoids
23
15
Headache
22
15
Tearfullness/depression
21
17
Constipation
20
16
Vaginal discharge
15
Others
2-7
1-8
87
76
Morbidity
Tiredness
FOLLOW UP CARE
Postnatally, most societies did not restrict maternal
work activity, and about half expected a return to full
duties within 2 weeks