6/23/2022
PUERPERIUM
• Period from the end of the 3rd stage of labour up to 6 weeks postpartum/
refers to the time after delivery when maternal physiologic changes
related to pregnancy return to the nonpregnant state
• until most of the patient’s organs have returned to the non-pregnant state
PEUPERIUM • Also called the postpartum or postnatal period
R. NDERITU
PUERPERIUM
The woman recovers from the stresses of pregnancy & delivery,
Physiological changes during the puerperium Occurrence of physiological adaptations facilitating the restoration to
the non pregnant state
Lactation gets established
A time of psychological & social adjustment of the woman & her
family
1
, 6/23/2022
PHYSIOLOGICAL CHANGES DURING PUERPERIUM
PHYSIOLOGICAL CHANGES DURING PUERPERIUM
CONT’
• After expulsion of the placenta, circulating levels of human chorionic Fall in progesterone causes the recovery of normal muscle tone & of the
gonadotrophin, human placental lactogen, oestrogen & progesterone fall
rapidly ligaments of the uterus
• These results to many physiological changes The relaxation effects of progesterone on smooth muscles of the pelvic floor,
Fall in oestrogen reverses the circulatory haemodilution, restoration of normal blood
viscosity & respiration function perineum, vagina & bowel subside
PHYSICAL CHANGES OCCUR DURING PUERPERIUM GENERAL CONDITION
Some women experience shivering, without change in
temparature
• Almost every organ undergoes change during the puerperium period
Pulse rate may be slow, normal or fast but should not go
beyond 100bpm
BP may increase slightly but should be less than 140/90
There is an immediate drop in weight (about 8kgs after
delivery)
Further weight loss follows involution of the uterus and
diuresis and also on whether the mother breastfeeds
2
, 6/23/2022
SKIN ABDOMINAL WALL
• The increased pigmentation of the face, abdominal wall & vulva lightens but • The abdominal wall is flaccid(loose & wrinkled) and some separation
the areola may remain darker than they were before
(divarication) of the abdominal muscles occur
• With onset of diuresis, the general puffiness & oedema may disappear in few
days • Pregnancy marks(striae gravidarum),present during pregnancy do not
dissapear but lighten
• In some women, sweating may occur for some days
GIT URINARY
• Urine TRACT
retention may occur as a result of decreased tone of the
bladder
• Thirst is common • Diuresis usually occurs on the 2nd to 5th day-get rid of excess
• Appetite varies from anorexia to marked hunger fluid accumulated in pregnancy
• may have flatulence (excess wind) • Stress incontinence is common when the woman laughs or coughs.
• Constipation may occur (due to decreased bowel tone, decreased food intake This improves with time & with pelvic floor exercises
during labour,giving an enema and presence of episiotomy or painful
haemorroids) • Epidural analgesia may temporarily impair normal bladder
function
3
, 6/23/2022
BLOOD BREASTS
• Haemoglobin concentation becomes stable around 4th day of puerperium • Usually the breasts are soft on palpation during the first 24 hours post
• Platelet count is raised & the platelets become more sticky from the 4th-10th delivery; there may or may not be any colostrums at this time.
day after delivery.
• This stickiness may predispose mother to thrombo-embolism • by day 3 may become swollen, warm and increased vascularity
GENITAL TRACT
• From Day 2-4, milk secretion is established in most cases. • Very marked changes occur in the genital tract during the puerperium on the
• It is important that the mother is shown the correct technique for Vulva
• proper positioning of the baby and Vagina
• attachment to avoid cracking of the nipples
Cervix
uterus
4
PUERPERIUM
• Period from the end of the 3rd stage of labour up to 6 weeks postpartum/
refers to the time after delivery when maternal physiologic changes
related to pregnancy return to the nonpregnant state
• until most of the patient’s organs have returned to the non-pregnant state
PEUPERIUM • Also called the postpartum or postnatal period
R. NDERITU
PUERPERIUM
The woman recovers from the stresses of pregnancy & delivery,
Physiological changes during the puerperium Occurrence of physiological adaptations facilitating the restoration to
the non pregnant state
Lactation gets established
A time of psychological & social adjustment of the woman & her
family
1
, 6/23/2022
PHYSIOLOGICAL CHANGES DURING PUERPERIUM
PHYSIOLOGICAL CHANGES DURING PUERPERIUM
CONT’
• After expulsion of the placenta, circulating levels of human chorionic Fall in progesterone causes the recovery of normal muscle tone & of the
gonadotrophin, human placental lactogen, oestrogen & progesterone fall
rapidly ligaments of the uterus
• These results to many physiological changes The relaxation effects of progesterone on smooth muscles of the pelvic floor,
Fall in oestrogen reverses the circulatory haemodilution, restoration of normal blood
viscosity & respiration function perineum, vagina & bowel subside
PHYSICAL CHANGES OCCUR DURING PUERPERIUM GENERAL CONDITION
Some women experience shivering, without change in
temparature
• Almost every organ undergoes change during the puerperium period
Pulse rate may be slow, normal or fast but should not go
beyond 100bpm
BP may increase slightly but should be less than 140/90
There is an immediate drop in weight (about 8kgs after
delivery)
Further weight loss follows involution of the uterus and
diuresis and also on whether the mother breastfeeds
2
, 6/23/2022
SKIN ABDOMINAL WALL
• The increased pigmentation of the face, abdominal wall & vulva lightens but • The abdominal wall is flaccid(loose & wrinkled) and some separation
the areola may remain darker than they were before
(divarication) of the abdominal muscles occur
• With onset of diuresis, the general puffiness & oedema may disappear in few
days • Pregnancy marks(striae gravidarum),present during pregnancy do not
dissapear but lighten
• In some women, sweating may occur for some days
GIT URINARY
• Urine TRACT
retention may occur as a result of decreased tone of the
bladder
• Thirst is common • Diuresis usually occurs on the 2nd to 5th day-get rid of excess
• Appetite varies from anorexia to marked hunger fluid accumulated in pregnancy
• may have flatulence (excess wind) • Stress incontinence is common when the woman laughs or coughs.
• Constipation may occur (due to decreased bowel tone, decreased food intake This improves with time & with pelvic floor exercises
during labour,giving an enema and presence of episiotomy or painful
haemorroids) • Epidural analgesia may temporarily impair normal bladder
function
3
, 6/23/2022
BLOOD BREASTS
• Haemoglobin concentation becomes stable around 4th day of puerperium • Usually the breasts are soft on palpation during the first 24 hours post
• Platelet count is raised & the platelets become more sticky from the 4th-10th delivery; there may or may not be any colostrums at this time.
day after delivery.
• This stickiness may predispose mother to thrombo-embolism • by day 3 may become swollen, warm and increased vascularity
GENITAL TRACT
• From Day 2-4, milk secretion is established in most cases. • Very marked changes occur in the genital tract during the puerperium on the
• It is important that the mother is shown the correct technique for Vulva
• proper positioning of the baby and Vagina
• attachment to avoid cracking of the nipples
Cervix
uterus
4
