Abnormalities in

the Puerperium
AMOSUN DM
MBCHB ife
MPHIL Stell.

Definition
The puerperium is a period of about 6weeks

after birth.
It is characterized by physiological adjustment
to non pregnancy state.

Puerperial abnormalities
Haemorrhage (PPH)
Infections
Septic pelvic thrombophlebitis
Endocrine disorders
Psychiatric disorders

haemorrhage
Postpatum haemorrhage is excessive blood

loss during or after the 3rd stage of labour

usually averaging 500mls following vaginal
delivery or 1000 mls after caesarian section
PPH may be early- occuring within the first
24hours, or late-occuring 1-2 weeks after
delivery & up to 6 weeks postpartum.

Causes of PPH
Early PPH results from;
Uterine atony
Retained products of conception
Uterine rupture
Uterine inversion
Placenta accreta
Lower genital tract lacreation
Coagulopathy & hematoma

Late PPH results from;

Retained products of conception
Infection
Subinvolution of placental site
coagulopathy

infection
results in endometritis.
The commonly implicated organisms includes;
Ecoli
Klebsiella
Proteus species
Chlamydia trachomatis
Bacteroides species

Risk factors for endometritis includes;

Caesarian delivery
Prolonged labour
Prolonged rupture of membranes
Multiple vaginal examinations
Low socioeconomic class
Colonization of the lower genital tract

Septic pelvic
thrombophlebitis
Defined as venous inflammation with

thrombus formation in association with fever

that is unresponsive to antibiotics.
It maybe characterized by painful swollen leg,
and fever.

endocrine
Postpartum thyroid dysfunction can be caused

by primary disorders of the thyroid gland such

as postpartum thyroiditis & graves disease, or
secondary disorder of the hypothalamicpituitary axis such as Sheehans syndrome or
lymphocytic hypophysitis

Psychiatric disorders
Postpartum period is characterised by 3

psychiatric disorders:
Postpartum blue- transient & lasts a few hours
to weeks
Postpartum depression- lasts for weeks to
months
Postpartum psychosis- severe and varied
disorder that elicit psychotic symptoms

finally
Routine postpartum care while still in the

hospital is essential . The mother is monitored

for blood loss, signs of infection, abnormal
blood pressure, contraction and ability to void.

references
Combs CA, Murphy EL, Laros RK Jr. Factors

associated with postpartum hemorrhage with

vaginal birth. Obstet Gynecol. Jan 1991;77(1):6976
Casey BM, Cox SM. Chorioamnionitis and
endometritis. Infect Dis Clin North Am. Mar
1997;11(1):203-22.
Brown CE, Stettler RW, Twickler D, Cunningham
FG. Puerperal septic pelvic thrombophlebitis:
incidence and response to heparin therapy. Am J
Obstet Gynecol. Jul 1999;181(1):143-8

Browne-Martin K, Emerson CH. Postpartum

thyroid dysfunction. Clin Obstet Gynecol. Mar

1997;40(1):90-101
Stowe ZN, Nemeroff CB. Women at risk for
postpartum-onset major depression. Am J
Obstet Gynecol. Aug 1995;173(2):639-45