| ID | 344 |
|---|---|
| Name | THE PUERPERIUM |
| Cause | Bacterial on the genital tract occurring after the birth of the baby. Some of the common bacterial problems you will face are- streptococci, staphylococci, Escherichia coli (E. coli), clostridium tetani, clostridium welchii, chlamydia, and gonococci |
| Signs Symptoms | Vaginal bleeding (lochia) Postpartum bleeding is a normal part of the delivery process. ... Abdominal cramps. ... Sore perineum. ... Trouble urinating. ... Constipation. ... Hemorrhoids. ... Fatigue. ... Body aches. |
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| Management | Management of puerperium: A. Prevention of infection: 1. The vulva and perineum should be kept clean and as dry as possible. 2. The vulva is simply kept covered with a dry sterile pad, which is changed whenever it is soaked or soiled. 3. The patient should be kept in a well-venti-lated small wards. 4. Attendants for persons with a septic focus are not allowed in the labour room or in ward. 5. Patients who develop signs indicative of sepsis must at once fee isolated form the normal cases and treated immediately. B. Rest and exercise: 1. A patient needs a period of rest from hard work and mental worry of at least 14 days. Now a day early ambulation is favoured. 2. Patients who are confined to bed are given breathing exercise, exercises for the abdom-inal and pelvic muscles and exercises to the legs to reduce the risk of thrombosis. C. Onset of lactation and breast care: 1. After delivery,if the baby is healthy, he should be put to breast immediately 1-2 minute on each side. 2. If the baby cannot suck properly,the breast may become painful and tender, then milk should be expressed by squeezing the breast. D. Constipation: Constipation may need to be overcome by laxa-tives, suppositories or even an enema. E. Retention of urine: Retention is liable to occur after a difficult labour which causes bruising or lacerations in the vulva or when perineal stitches have been inserted. In these situation bladder should be emptied by simple or self retaining catheter. F. Cystitis and pyelonephritis: Urinary tract infection may arise in the 1st week of the puerperium with high rise of temperature, tenderness over the renal angle. It should be treated by adequate quantities of fluid and antibiotics (e.g. ampicillin, cotrimoxazole, nalidixic acid, cephalosporin etc). G Thelochia: For the first 3 or 4 days the lochial discharges are red in colour and it disappears usually by the 14th day. Excessive and offensive lochia may indicate infection of uterus or retained piece of placenta in the uterus. If so, after diagnosis it should be removed by curettage and antibiotics given. H. Diet: 1. The day after a normal delivery the patient should be given a normal diet. 2. During lactation- some increase in protein and fat. 3. Fluid intake should be increased. I. Sleep and avoidance of anxiety: If she is excited and sleeping badly- nitrazepam 5mg should be given for the first few nights. J. Perineal stitches: Each day the perineum should be washed with soap and water and dired. A dry sterile vulva pad is then applied and changed frequently. K. Postnatal examination: This should be carried out at the end of the sixth week. The doctor enquires about her general health, whether the lochia have ceased, about bladder function,and about any feeding problems. The abdomen is examined and the state of the musculature is noted. Pelvic examination is performed to check that any lacerations have healed normally, that there is no prolapse of the vaginal walls and that the uterus has involuted normally. By speculum examination cervix is seen to find out any erosion or laceration. |
| Introduction | Puerperium is the period following childbirth during which the body tissue specially the pelvic organs return back approximately to the pre-pregnant state both anatomically & physiologically. Duration: puerperium starts as soon as placenta is expelled & lasts for 6 weeks. |
| History | |
| Etiology | see under cause |
| Clinical Features | see under sign and symptoms |
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