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Normal Puerperium

正常产褥

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Key Words
• Puerperium 产褥期
• involution 复旧
• Lactati 哺乳
• colostrum 初乳
• lochia 恶露
Ⅰ.Definition
• The puerperium is the time following labor
during which the pelvic organs return to
their nonpregnant condition. It is about 6
weeks , although it may take much longer
for some of the organs(breast) to return
completely to normal.
 6 weeks periods after birth
 the reproductive tract return to its
normal, non-pregnancy state
Involution of the uterus
• It is the process which the uterus grandually
return into the non-pregnant state after
expulsion of the fetus and the placenta.
Change of corpora uterus
• ①weight and size after delivery
uterine weight : 1kg
size: as the uterus of 20th-week pregnancy
about 1cm below the umbilicus
• ② one week later:
uterine weight : 0.5kg
size: 12th-week of pregnancy to
be just palpable above the

symphysis pubis.
• ③The height of the fundus diminishes daily
and it cannot normally be felt above the
pubis after the 10th day.
• ④second week:
weight: 300g
• nearly complete involution of the uterus is
about 6 weeks , weight about 50g.
Involution of the uterus
However within two
weeks the uterus can no
longer be palpable above
the symphysis.

• 1 day
• 5days
• 7days---12 week pregnancy
Involution of the uterus
 return to the pelvis by about 2 weeks
 be at normal size by 6 weeks
 the weight changes of uterus
1000g immediately after birth
500g 1 weeks after birth
300g 2 weeks after birth
50g 6 weeks after birth
• (2) mechanism:
decrease of myometrial cell size
the total number of muscle cells does
not decrease.
• (3)prolonged involution :

①uterine infection
②retention( 留滞 ) of placental products
③fibromyomata( 纤维瘤 ) in the uterine wall

Ultrasonography can be used to measure length


and width of the uterine cavity.
Regeneration of endometrium
• Decidua ( 蜕膜 )
• superficial layer: necrotic shed lochia( 恶露 )
basal layer : glandular epithelium proliferates( 增生
)
forms a new covering for the

endometrium
Change of Cervix
• After delivery: It has reformed within several hours of
delivery---soft, flabby( 松弛 )
• 2~3 days later: admits two fingers
• end of the first week: outline and internal os are
closed. It usually admits only one finger by 1 weeks
• 4 weeks: the cervix is completely recovery
• nulliparous: rounded external os
• multiparous: transverse slit due to laceration
at point of 3, 9 o`clock( 如图所示 )

converted
nulliparous multiparous
Change of other systems
1.cardiovascular change
2~3w
①blood volume non-pregnancy

72h↑15~25% heart failure

② , fibro → 2~3w normally

③WBC ↑ 15-30×109/L
2.return of menstruation and ovulation

• (1)Breast-feed: ovulation : 4~6months

• (2)no-breast-feed:
menstrual: 6~10w postpartum
ovulation: 10 weeks
※occasionally, a nursing mother will ovulate
and become pregnant again.
Clinical manifestation
1.Temperature and pulse
• The temperature may rise to 37.9℃ in the
first 24 hours, but afterwards is should fall
to normal and remain so.
• Milk fever( 生乳热 ): Breast engagement in 3~4
days after delivery.
• Pulse: first day↑ second day→normal
• 2.involution of the uterus
• 3.After-pains: 1~2 days appear
2~3days↓
multiparous is more common
• 4.The lochia
the lochia is vaginal discharge due to
sloughing of decidual tissue , mainly from
the placenta site
• the lochia consists of RBC,
WBC, shreds of decidua,
epithelial cell and bacteria.
• (1)lochia rubrua: red in color
first 3~4 days
• (2)lochia serosa: pink→serous
after 3~4 days,last for about 10 days
• (3)lochia alba: yellowish→white
2weeks
Management of the puerperium
• Daily maternal observations include temperature,
pulse, blood pressure, urinary function, howel
fuction, breast examination and feeding, assessment
of uterine involution, appearance of lochia, perineal
inspection, examination of legs and pelvic floor
exerises.
• These observations should be made more frequently
in high-risk women or if an abnormality has been
detected, e.g. Caesarean Section, raised blood
pressure, perineal infection, etc.
• check haemoglobin( 血红蛋白 ) levels on day 3
• Transfusion if the haemoglobin level was less than 8
g/dL. ( gram/diciliter )
Management of the puerperium
 Maternal -infant bonding
rooming in
 Uterine complications
postpartum hemorrhage, infection,
the amount of lochia
 Bowel movement
 Urination
 Care of the perineum
Bowel function
• Constipation (便秘) is a Common problem in the
puerperium.
• This may be due to an interruption in the normal diet
and possible dehydration during labour.
• Advice on adequate fluid intake and increase in fibre
intake may be necessary,
• However, constipation may also be the result of fear of
evacuation (排泄) due to pain from a sutured perineum,
prolapsed haemorrhoids (痔疮) or anal fissures (肛裂)
.
• Avoidance of constipation, and straining is of utmost
importance in women who have.sustained a third or
fourth degree tear.
Bladder function
As a
• undergoing a doctor,
Caesarean Section under regional
what
anaesthesia, should catheter may be left in the
a urinary
we do?
bladder for the first 12 to 24 hours.
• Voiding( 排泄 ) difficulty and over distension of the
bladder are not uncommon after childbirth.
We should encourage the mothers to
• pass urinethe
after epidural anaesthesia after postpartum
bladder mayintake
time.up to
eight hours to regainUsually
normal about 1-2hour interval.
sensation.
• During this time about I L of urine may be produced
if urinary retention (尿潴留) occurs, considerable
damage may be inflicted on the detrusor muscle.
• Over-stretching of the detrusor muscle can dampen
bladder sensation.
Breast-feeding
1. The advantages of breast-feeding
• (1)The most suitable natural food for the growth
of infants, beneficial for digestion and absorption.
• (2)contain massive immunological substance from
mother
• (3)economic: sanitary( 卫生 ), suitable,
temperature, available at any time.
• (4)For mother : promote uterine involution.
(5)enhance materno-infantal affection .
(6)beneficial for avoiding pregnancy.
(7)including iron, sodium calcium phosphate
salt, zinc ect which is not only beneficial for
the growth and development of infant, but also
promote the maturation of immuno-system.
Baby-loving-hospital 爱婴医院

• (1)early sucking: begin within 30 min after baby


birth
(2)mother and baby live in the same room
They are together with 24 hrs. To be divided
<1h/day. Include bath and medical treatment.
• (3)pure breast-feed
the infant eat only maternal milk within 4~6
months after birth .
• (4) breast-feeding according to need 按需哺乳
• Colostrum 初乳
①<7days of the postpartum
②sticky, yellowish fluid.
Rich in protein globulin and minerals
less sugar and fat
easy to digest
③IgA ( Immunoglobulin A )→ prevent diarrhea
Summary
Key points
• 1. Definition of puerperium
• 2. Involution of the uterus
• 3. Lochia
• 4. The advantages of breast-feeding