Description
This academic presentation on Normal Puerperium and Postnatal Care is authored by Dr Kenneth Chanda, a specialist with a Bachelor of Science in Human Biology, Bachelor of Medicine and Bachelor of Surgery, and a Master of Medicine in Obstetrics and Gynaecology from the University of Zambia. Designed for a BSc in Clinical Medicine program, the material defines the puerperium as the six-week period following childbirth and details the physiological reversal of pregnancy changes. It systematically covers uterine involution, including fundal height regression, lochia types, and cervical transformation. The presentation also explains anatomical changes in the vagina and ligaments, cardiovascular adjustments like elevated cardiac output, renal diuresis, haematological shifts such as leukocytosis, and weight loss patterns. A significant portion is dedicated to breast changes, colostrum and mature milk composition, and the milk let-down reflex, alongside guidance on postnatal exercise and diet. Finally, it differentiates puerperal sepsis from pyrexia and lists differential diagnoses for postpartum fever. This resource is a vital tertiary-level guide for medical and clinical officer students in Zambia, providing essential knowledge for exams and clinical management of the postnatal period. Download these notes to consolidate your understanding of postpartum care.
What's inside
Normal Puerperium & Postnatal Care BSc. Clinical Medicine Dr Kenneth Chanda BScHB, MBChB, MMed (MMOG)-[UNZA] Last updated: 04-02-18 Ecclesiastes 1:18; ‘For in much wisdom is much grief: and he that increaseth knowledge increaseth sorrow’ Definition of Puerperium Period confined to the time after child birth Usually includes six subsequent weeks Changes are a reversal of the physiological changes in pregnancy Normal Puerperium Uterine Changes Just after placenta expulsion, fundus is slightly below the umbilicus Anterior and posterior walls are in close apposition each measuring about 4-5cm Uterus begin to shrink after 2 days (Involution) Descends into pelvis after 2 weeks and regains a non pregnant state after 4 weeks Weighs 1000g just after delivery Normal Puerperium Uterine Changes (Cont’d) Weighs 500g after 1 week, 300g by 2nd week and to less than 100g there after Tends to contract tonically in prime paras and contracts vigorous at intervals in multiparas giving rise to the after pains Normal Puerperium Uterine Changes (Cont’d) Calibre of extra uterine vessels decrease to equal to or approximate the none pregnant state Large vessels within the uterus are obliterated by uterine changes, gradually reabsorbed and replace by small ones Cervical opening contracts with a few days leaving a parous cervix (see next slide) Normal Puerperium Uterine Changes (Cont’d) Normal Puerperium Uterine Changes (Cont’d) Lochia Is vaginal discharge of variable quantity originating from sloughing of the decidual Components of lochia are; Erythrocytes, decidual, epithelial cells, bacteria Types of lochia Lochia rubra (0-3 days); red Lochia serosa (4-10 days); pale Lochia alba (> 10 days); white Normal Puerperium Other Anatomic Changes Vagina Rugae appear by the 3rd week The hymen is represented by several small tags of tissue called myrtiform caruncles Broad/Round ligaments Require considerable time to recover from the stretching and the loosening that occurred in pregnancy Normal Puerperium Other Anatomic Changes (Cont’d) Normal Puerperium Cardiac output Remains elevated for at least 48hours after delivery Contraction of uterus pushes 500-700 of blood into maternal circulation Normal Puerperium Renal Changes Normal pregnancy is associated with associated with an appreciable increase of extracellular water Diuresis occurs from 2nd to 5th day and corresponds to the loss this water Puerperal bladder has increased capacity and a relative insensitivity to intravesical fluid pressure Dilated renal pelvis/ ureters resolve over 2-8 weeks Normal Puerperium Haematology There is marked leukocytosis and thrombocytosis Leukocyte count may reach as high as 30,000/µL There is relative lymphopenia and absolute eosinophilia HB and HCT fluctuate moderately Normal Puerperium Weight Women lose 5-6 kg from uterine evacuation They lose 2-3 kg from uterine diuresis Most women approach their self reported prepregnant weight 6 months after delivery but still retain some surplus weight Normal Puerperium Breast Changes Each mature mammary gland contains 15-25 lobes Each lobe contains several lobules that contain alveoli Alveoli secretory epithelium synthesises the various components of milk Colostrum is deep lemon-yellow coloured liquid secreted by the breast after delivery and can be expressed from nipple by 2nd day Normal Puerperium Breast Changes (Cont’d) Mature milk contains more minerals and protein much of which is globulin and less of fat Colostrum secretion persists for about 5days with gradual conversion to mature milk during the ensuing 4 weeks Host resistance factors found in colostrum and milk include: IgA, complement, Macrophages, lymphocytes, lactoferin, lysosomes etc Normal Puerperium Breast Changes (Cont’d) Human milk is a suspension of fat and protein in a carbohydrate mineral solution A nursing mother can produce up to 600cc of milk/day Milk is isotonic with plasma with lactose accounting for half of the osmotic pressure Other nutrients present include; Major proteins including α lactoalbumin, β lactoalbumin and casein All vitamins except vitamin K are found in human milk Normal Puerperium Milk let down reflex Normal Puerperium Exercise & Diet Exercise to restore abdominal wall tone may be started anytime after vaginal delivery and as soon as abdominal sore diminishes in caesarean section (6-8 weeks) No dietary restrictions for women who delivery vaginally Women may be allowed to eat 2 hours after delivery Puerperal Infection/ Pyrexia Puerperal sepsis; A general term used to describe any bacteria infection of the genital tract after delivery Puerperal Pyrexia; A temperature of 38.0 ⁰ C or higher which occurs on any …
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