NormalandAbnormalPuerperium
Normal and Abnormal Puerperium
NormalPuerperiumDefinition1. The time from the delivery of the placentathrough the first few weeks after the delivery.2. 6 weeks in duration3. By 6 weeks after delivery, most of the changesofpregnancy,laborand deliveryhaveresolved and the body has reverted to thenonpregnant state
Normal Puerperium • Definition 1. The time from the delivery of the placenta through the first few weeks after the delivery. 2. 6 weeks in duration. 3. By 6 weeks after delivery, most of the changes of pregnancy, labor, and delivery have resolved and the body has reverted to the nonpregnant state
Normal PuerperiumThe relevant anatomy and physiology in thepuerperiumReproductive organsUterus1000g→50-100gThe endometrial lining rapidly regenerates(16days)The placental site undergoes a series ofchanges in the postpartum period
Normal Puerperium • The relevant anatomy and physiology in the puerperium 1. Reproductive organs 1) Uterus ✓ 1000g → 50-100g ✓ The endometrial lining rapidly regenerates (16 days) ✓ The placental site undergoes a series of changes in the postpartum period
Normal Puerperium2)Cervixit never returns to the nulliparous statethe external os is closed to the extent that afinger could not be easily introduced3)Vaginashrinks to a nonpregnant stateresolution of the increased vascularity andedema occurs by3weeksthe vaginal epithelium appears atrophic onsmear. This is restored by weeks 6-10
Normal Puerperium 2) Cervix ✓ it never returns to the nulliparous state. ✓ the external os is closed to the extent that a finger could not be easily introduced. 3) Vagina ✓ shrinks to a nonpregnant state ✓ resolution of the increased vascularity and edema occurs by 3 weeks ✓ the vaginal epithelium appears atrophic on smear. This is restored by weeks 6-10
Normal PuerperiumPerineumswelling and engorgement are completelygone within 1-2 weeksthe muscle tone may or may not return tonormal, depending on the extent of injury5）Ovariesovulate as early as 27 days after delivery (notbreastfeed);12weeks (most);7-9weeks(mean).the suppression of ovulation due to theelevation inprolactin
Normal Puerperium 4) Perineum ✓ swelling and engorgement are completely gone within 1-2 weeks ✓ the muscle tone may or may not return to normal, depending on the extent of injury. 5) Ovaries ✓ ovulate as early as 27 days after delivery (not breastfeed ); 12 weeks (most); 7-9 weeks (mean). ✓ the suppression of ovulation due to the elevation in prolactin
NormalPuerperium6BreastsLactation can occur by 16 weeks'gestationLactogenesis is initially triggered by thedelivery of theplacenta (EPand prolactin)the prolactin levels decrease and return tonormal within 2-3 weeks (not breastfeeding)The colostrum初乳（thefirst2-4days)The milk continues to change throughout theperiod of breastfeeding to meet the changingdemands of the baby
Normal Puerperium 6) Breasts ✓ Lactation can occur by 16 weeks' gestation. ✓ Lactogenesis is initially triggered by the delivery of the placenta (E↓P↓and prolactin). ✓ the prolactin levels decrease and return to normal within 2-3 weeks (not breastfeeding) ✓ The colostrum初乳(the first 2-4 days) ✓ The milk continues to change throughout the period of breastfeeding to meet the changing demands of the baby
Normal Puerperium2Systemic changeCardiovascular systemBlood volume returns to nonpregnant levelsby the tenth days of puerperiumCardiac output ↑ (immediately after delivery)→ slowly declines-→reach latepregnancylevels 2days postpartum- normal 2-6 weeks.2）Hematologic changesHemoglobin concentration on the firstpostpartum daysSeveral clotting factors (fibrinogen) fon thefirst days
Normal Puerperium 2. Systemic change 1) Cardiovascular system ✓ Blood volume returns to nonpregnant levels by the tenth days of puerperium ✓ Cardiac output ↑(immediately after delivery) → slowly declines→ reach late pregnancy levels 2 days postpartum→ normal 2-6 weeks. 2) Hematologic changes ✓ Hemoglobin concentration↑on the first postpartum days ✓ Several clotting factors (fibrinogen) ↑on the first days
Normal PuerperiumManifestation1Fever (24 hours)2.Pain (uterine contraction)3.Sweat4.Lochia恶露a large amount of red blood initially flowsfrom the uterus as the contraction phaserapidly occurs. (5 weeks)lochia rubra; lochia serosa (brownish red,with a more watery consistency); lochia alba(yellow)
Normal Puerperium • Manifestation 1. Fever (24 hours) 2. Pain (uterine contraction) 3. Sweat 4. Lochia 恶露 ✓ a large amount of red blood initially flows from the uterus as the contraction phase rapidly occurs. (5 weeks) ✓ lochia rubra; lochia serosa (brownish red, with a more watery consistency); lochia alba (yellow)
Normal PuerperiumManagement2 hours after deliveryBleedingUterine contractionHR and Bp and R andT2. 1 weeks after deliveryBleeding
Normal Puerperium • Management 1. 2 hours after delivery ✓ Bleeding ✓ Uterine contraction ✓ HR and Bp and R and T 2. 1 weeks after delivery ✓ Bleeding
Normal Puerperium3.Emiction and defecate4.Lochia5.Episiotomy and Laceration6.Breast
Normal Puerperium 3. Emiction and defecate 4. Lochia 5. Episiotomy and Laceration 6. Breast