MINOR AILMENTS OF PERPUERUIM:

MINOR AILMENTS OF PERPUERUIM SUPERVISED BY : Mrs. P.VADIIVUKKARASI, Asst. Professor, Dept. of OBG
(N), MSKCON, Balongi. 1 Mata Sahib Kaur College Of Nursing Bbalongi ,Mohali , Punjab PREPARED AND
PRESENTED BY: Ms. MANPREET KAUR BHANGU, M.Sc.(N) I year, Dept. of OBG (N), MSKCON, Balongi.
INTRODUCTION:
INTRODUCTION 2 Mata Sahib Kaur College Of Nursing Bbalongi ,Mohali , Punjab
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Puerperuim is the period following child birth during which the body tissue, specially the pelvic organs revert back
approximately to the pre pregnant state both anatomically and physiologically. 3 Mata Sahib Kaur College Of Nursing
Bbalongi ,Mohali , Punjab
MEANING :
Meaning From Latin puerperium (" childbed , child -birth ") noun form of puerperus ("of a woman in labour"),
MEANING 4 Mata Sahib Kaur College Of Nursing Bbalongi ,Mohali , Punjab
DEFINITION :
Puerperuim is defined as the time from the delivery of the placenta through the first few weeks after the delivery . The
period is usually considered to be 6 weeks in duration . DEFINITION 5 Mata Sahib Kaur College Of Nursing
Bbalongi ,Mohali , Punjab
PHYSIOLOGICAL CHANGES :
BREASTS The changes to the breasts that prepare the body for breastfeeding occur throughout pregnancy. If
delivery ensues, lactation can be established as early as16 weeks' gestation. Lactogenesis is initially triggered by the
delivery of the placenta, which results in falling levels of estrogen and progesterone, with the continued presence of
prolactin. If the mother is not breastfeeding, the prolactin levels decrease and return to normal within 2-3 weeks .
PHYSIOLOGICAL CHANGES 6 Mata Sahib Kaur College Of Nursing Bbalongi ,Mohali , Punjab
CONT:
The colostrum is the liquid that is initially released by the breasts during the first 2-4 days after delivery. High in
protein content, this liquid is protective for the newborn. The colostrum, which the baby receives in the first few days
postpartum is already present in the breasts, and suckling by the newborn triggers its release. The process, which
begins as an endocrine process, switches to an autocrine process; the removal of milk from the breast stimulates
more milk production . CONT 7 Mata Sahib Kaur College Of Nursing Bbalongi ,Mohali , Punjab
CONT..:
Over the first 7 days, the milk matures and contains all necessary nutrients in the neonatal period. The milk continues
to change throughout the period of breast feeding to meet the changing demands of the baby. CONT.. 8 Mata Sahib
Kaur College Of Nursing Bbalongi ,Mohali , Punjab
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ABDOMINAL WALL The abdominal wall remains soft and poorly toned for many weeks. The return to a pre pregnant
state depends greatly on maternal exercise . OVARIES The resumption of normal function by the ovaries is highly
variable and is greatly influenced by breastfeeding the infant. The woman who breastfeeds her infant has a longer
period of amenorrhea and an ovulation than the mother who chooses to bottle-feed. The mother who does not
breastfeed may ovulate as early as 27 days after delivery. 9 Mata Sahib Kaur College Of Nursing Bbalongi ,Mohali ,
Punjab
CONT :
Most women have a menstrual period by 12 weeks; the mean time to first menses is 7-9 weeks .In the breastfeeding
woman, the resumption of menses is highly variable and whether the baby's food is supplemented with formula.. The
delay in the return to normal ovarian function in the lactating mother is caused by the suppression of ovulation due to
the elevation in prolactin. Half to three fourths of women who breastfeed return to periods within 36 weeks of delivery
CONT 10 Mata Sahib Kaur College Of Nursing Bbalongi ,Mohali , Punjab
CONT :
UTERUS The pregnant term uterus (not including baby, placenta, fluids, etc) weighs approximately 1000 g. In the 6
weeks following delivery, the uterus recedes to a weight of 50-100 g .Immediately postpartum, the uterine fundus is

palpable at or near the level of the maternal umbilicus. Thereafter, most of the reduction in size and weight occurs in
the first 2 weeks, at which time the uterus has shrunk enough to return to the true pelvis. Over the next several
weeks, the uterus slowly returns to its non pregnant state, although the overall uterine size remains larger than prior
to gestation the endometrial lining rapidly regenerates, so that by the seventh day endometrial glands are already
evident. CONT 11 Mata Sahib Kaur College Of Nursing Bbalongi ,Mohali , Punjab
CONT..:
Immediately after delivery, the contractions of the arterial smooth muscle and compression of the vessels by
contraction of the myometrium ("physiologic ligatures") result in hemostasis . The size of the placental bed decreases
by half, and the changes in the placental bed result in the quantity and quality of the lochia that is experienced.
Immediately after delivery, a large amount of red blood flows from the uterus until the contraction phase occurs.
Thereafter, the volume of vaginal discharge ( lochia ) rapidly decreases. The duration of this discharge, known as
lochia rubra , is variable. The red discharge progressively changes to brownish red, with a more watery consistency
( lochia serosa ). Over a period of weeks, the discharge continues to decrease in amount and color and eventually
changes to yellow ( lochia alba ). The period of time the lochia can last varies, although it averages approximately 5
weeks. CONT.. 12 Mata Sahib Kaur College Of Nursing Bbalongi ,Mohali , Punjab
CERVIX :
The cervix also begins to rapidly revert to a non pregnant state, but it never returns to the nulliparous state. By the
end of the first week, the external os closes such that a finger cannot be easily introduced. CERVIX 13 Mata Sahib
Kaur College Of Nursing Bbalongi ,Mohali , Punjab
VAGINA :
The vagina also regresses but it does not completely return to its pre pregnant size. Resolution of the increased
vascularity and edema occurs by 3 weeks, and the rugae of the vagina begin to reappear in women who are not
breastfeeding. At this time, the vaginal epithelium appears atrophic on smear. This is restored by weeks6-10;
however, it is further delayed in breastfeeding mothers because of persistently decreased estrogen levels. VAGINA
14 Mata Sahib Kaur College Of Nursing Bbalongi ,Mohali , Punjab
PERINEUM :
The perineum has been stretched and traumatized, and sometimes torn or cut, during the process of labor and
delivery. The swollen and engorged vulva rapidly resolves within 1-2 weeks. Most of the muscle tone is regained by
6 weeks. PERINEUM 15 Mata Sahib Kaur College Of Nursing Bbalongi ,Mohali , Punjab
Enlist of minor ailments of Puerperuim :
Enlist of minor ailments of Puerperuim 16 Mata Sahib Kaur College Of Nursing Bbalongi ,Mohali , Punjab
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After pains Pain on the perineum Breast engorgement Postnatal diuresis Constipation lactation supression 17 Mata
Sahib Kaur College Of Nursing Bbalongi ,Mohali , Punjab
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AFTER PAINS It is the spasmodic, intermittent pain felt in the back and lower abdomen after delivery for a variable
period of 2-4 days. It is often felt more frequently while breast-feeding. Presence of blood clots or bits of the after the
birth leads to spasmodic hypertonic contractions of the uterus in an attempt to expel them out. MANGEMENT:
Massage the uterus with expulsion of the clot. Administer analgesics (ibuprofen) and antispasmodics. 18 Mata Sahib
Kaur College Of Nursing Bbalongi ,Mohali , Punjab
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PAIN IN PERINEUM Some degree of pain is felt in the stitches. Abnormal pain should be investigated to diagnose
vulvo -vaginal hematoma or infection is developing . RELIEVING MEASURES After using the bathroom, spray or
pour warm water over the entire vaginal area. Encourage mother to pat the area dry, making sure to start at the front
and end at the back to avoid spreading germs from the rectum to the vagina. To reduce the swelling Apply Ice packs
Wrap the ice pack in a washcloth or other soft or absorbent material. Do not directly apply the ice. Sitz bath
Encourage the mother to sit in a tub with 2-3 inches of warm water for about 15 minutes. 19 Mata Sahib Kaur College
Of Nursing Bbalongi ,Mohali , Punjab
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Care of Perineal stitches Clean and dress the perineal area daily and cover with sterile pad. Swabbing should be
done from above downwards. Advice the mother to use topical anaesthetic spray or ointment according to
the prescription. BREAST ENGORGEMENT May occur about the third day postpartum and is often regarded by
mothers as the result of the milk coming in. 20 Mata Sahib Kaur College Of Nursing Bbalongi ,Mohali , Punjab
CONT:
It is due to exaggerated normal venous and lymphatic engorgement of the breasts which precedes lactation. The
mother approaches with pain and tense feeling of the breasts, generalized malaise and painful breast feeding.
MANAGEMENT: Encourage the mother to consume lots of fluids. Support the breasts with a binder or brassiere.
Apply hot bags on breast before nursing and ice bags after. Express the milk manually. The baby should be put to
breast regularly after the expression of milk. Analgesics may also be prescribed to relieve pain CONT 21 Mata
Sahib Kaur College Of Nursing Bbalongi ,Mohali , Punjab
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POSTNATAL DIURESIS Within 12hrs of the birth the women begins to lose excess tissue fluid accumulated during
pregnancy. The profuse diaphoresis occurs especially at night for the first 2-3 days after childbirth. CAUSES
Decreased estrogen levels Removal of increased venous pressure in the lower extremities Loss of the remaining
pregnancy induced increase in blood volume. By the above mechanisms the body rids itself of excess fluid in the
body MANAGEMENT Keep the mother clean and dry Change her dress frequently Change the bed sheets frequently
Care must be taken to ensure that the mother is well hydrated. 22 Mata Sahib Kaur College Of Nursing Bbalongi
,Mohali , Punjab
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CONSTIPATION The problem is much less because of early ambulation and liberalization of dietary intake.
Encourage the mother to take a diet containing sufficient amount of roughage and fluids is enough to move the
bowel. If necessary mild laxative such as Isvgol 2 tea spoons may be adviced at bed time. LACTATION
SUPRESSION this is necessary when the women has decided not to breast feed or incase of neonatal death. 23
Mata Sahib Kaur College Of Nursing Bbalongi ,Mohali , Punjab
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MANAGEMENT Advice the mother to wear well fitted supportive brassier or breast binder continuously atleast the
first 72 hrs.after giving birth. Avoid breast stimulation. Eg: Running warm water over the breasts,newborn sucking or
pumping of the breasts Bromocriptine was often prescribed in olden days. But recent days it is not practiced much as
it causes the seizures, strokes and MI. 24 Mata Sahib Kaur College Of Nursing Bbalongi ,Mohali , Punjab
NURSING MANAGEMENT :
NURSING MANAGEMENT 25 Mata Sahib Kaur College Of Nursing Bbalongi ,Mohali , Punjab
ASSESSMANT :
Take complete history: of past and present obstetrical history and also identify the risk factors of hemorrhage.
Physical examination especially the vital signs signs of blood loss to be assessed. Assess the amount of blood loss
its nature, consistency, abdominal pain Assess for signs of shock. ASSESSMANT 26 Mata Sahib Kaur College Of
Nursing Bbalongi ,Mohali , Punjab
NURSING DIAGNOSIS :
Decreased cardiac output related to hypovolemia Fluid volume deficit related to excessive blood loss Altered tissue
perfusion related to hypovolemia Pain related to procedures and treatment Anxiety related to separation from
newborn long term impact on self care and infant care, need for blood transfusion. Risk for injury related to
changes in cerebral tissue perfusion. Risk for altered parent/infant attachment related to to complication and need for
separation from newborn during treatment. NURSING DIAGNOSIS 27 Mata Sahib Kaur College Of Nursing
Bbalongi ,Mohali , Punjab
INTERVENTIONS: :
Administer IV fluids as quickly as possible. Administer oxytocics to help contract the uterus. Administer oxygen
therapy. Place the client in a trndlenburg position to increase venous return to the heart. Monitor vital signs every 510min,, and observe the clients color, oxygen saturation by pulse oxymetry and skin temperature. Palpate the fundus
for firmness and massage to restore the tone. Evaluate the vaginal bleeding, extent of perineal pad saturation, colour
INTERVENTIONS: 28 Mata Sahib Kaur College Of Nursing Bbalongi ,Mohali , Punjab

CONT..:
Consistency of bleeding clots and pooling on the under pad. Prepare for blood transfusions and administer blood
transfusions. Reassure the mother and family. Allow the family members to involve in the care. Explain the
physiological process of hemorrhage and interpret medical treatments and procedures. Once the bleeding controlled
assist the mother and family what happened to understand and why to anticipate what impact this complication will
have on the post partum while care taking and self care activities and to plan for special needs at home CONT.. 29
Mata Sahib Kaur College Of Nursing Bbalongi ,Mohali , Punjab
CONCLUSION :
Postnatal period is the most crucial period during which mother face many discomfort. If the mother has the
knowledge of those minor ailments & their measures she can manage the problem very easily. As a student nurse we
should possess the knowledge of it & should care the mother to come out of this problem . CONCLUSION 30 Mata
Sahib Kaur College Of Nursing Bbalongi ,Mohali , Punjab
REFERENCES :
1.Jacob Annamma;A Comprehensive Textbook Of Midwifery And Gynecological Nursing;jaypee publishers 2.Dutta
D.C ;Text Book Of Obstertrics ; New Central Book Agency Ltd.Sixth Edition 2004.page no.-145-147 3.Inderani T.K ;
Domicillary Care In Midwifery; 4.Sisirk Chattopadhyay,Narayunaswamy M.Text Book Of Midwifery: B1
Publishers;page no.280 5. http://www.scribd.com/doc/77178401/Seminar-on-Minor-Ailments-and-Complications-ofPuerperium 6. www.the free dictionary.com 7.http/www.netplaces.com REFERENCES 31 Mata Sahib Kaur College
Of Nursing Bbalongi ,Mohali , Punjab
Thank you :