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NORMAL PUERPERIUM

NORMAL PUERPERIUM
DEFINITION

  1. period of adjustment after pregnancy when anatomic and physiologic changes are reversed
  2. immediate - first 24 hours after delivery
  3. early - first week
  4. traditionally, puerperium lasts 6 weeks
POST-DELIVERY EXAMINATION

The 8 B’s:
Blues (post-partum), Breathing (DVT/PE), Breast, Belly, Bowels, Bladder, Bleeding, Baby

BREAST

  1. 2 events stimulate lactation
    • sudden drop in placental hormones (especially estrogen)
    • suckling stimulates release of prolactin and oxytocin
  2. colostrum secreted for ~ 2 days (contains protein, fat, minerals, IgA and IgG)
    • replaced by milk after ~ 3-6 days (contains protein, lactose, water, fat)
  3. breast feeding encouraged
UTERUS

  1. through process of catabolism, uterus weight rapidly diminishes
  2. cervix loses its elasticity and regains firmness
  3. start oxytocin drip or give oxytocin 10 U IM after 3rd stage (i.e. after delivery of placenta; some give IM dose after delivery of head)
  4. generally should involute ~ 1 cm (1 finger breadth) below umbilicus per day in first 4-5 days
  5. involution then slows down; reaches non-pregnant state in 4-6 weeks postpartum
LOCHIA

  1. normal vaginal discharge postpartum
  2. monitored for signs of infection or bleeding
  3. normally decreases and changes colour from red (lochia rubra; due to presence of erythrocytes) to yellow (lochia serosa) to white (lochia alba; residual leukorrhea)over 3-6 weeks
  4. foul smelling lochia suggests endometritis
NORMAL PUERPERIUM NORMAL PUERPERIUM Reviewed by Radiology Madeeasy on September 08, 2010 Rating: 5
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