8/14/2019 puerperium v2

1/16

PUERPERIUMUERPERIUM

RACHEL P. FUENTES, RNRACHEL P. FUENTES, RN

Ateneo de Davao UniversityAteneo de Davao University

8/14/2019 puerperium v2

2/16

PUERPERIUMUERPERIUM

PUERPERIUM/POSTPARTUMPUERPERIUM/POSTPARTUM6-week period after delivery6-week period after delivery

INVOLUTIONINVOLUTIONreturn of reproductive organs to their pre-return of reproductive organs to their pre-

pregnancy statepregnancy state

8/14/2019 puerperium v2

3/16

PRINCIPLES OFRINCIPLES OF

POSTPARTUM CAREOSTPARTUM CARE

A.A. Promote healing & return to normal of Promote healing & return to normal of the different parts of the bodythe different parts of the body

1.1. Vascular changesVascular changesa.a. The 30-50% in bld vol is reabsorbed intoThe 30-50% in bld vol is reabsorbed intogeneral circulation w/in 5-10 minsgeneral circulation w/in 5-10 mins

b.b. WBCWBCc.c. Risk for thrombo-embolismRisk for thrombo-embolism

- Early ambulation after 4-8 postpartumEarly ambulation after 4-8 postpartum

d. 3 4 wks postpartum all bldd. 3 4 wks postpartum all bldvalues return to normalvalues return to normal

8/14/2019 puerperium v2

4/16

PRINCIPLES OFRINCIPLES OF

POSTPARTUM CAREOSTPARTUM CARE

2.2. Genital changesGenital changesa.a. Uterine involution measured byUterine involution measured by

fingerbreaths (=1cm)fingerbreaths (=1cm)b.b. Knee-chest position for return of Knee-chest position for return of

uterus in its normal anteflexed positionuterus in its normal anteflexed positionc.c. Afterpains strong uterine contractionsAfterpains strong uterine contractions

feltfeltNsg mgt: analgesicNsg mgt: analgesic

8/14/2019 puerperium v2

5/16

PRINCIPLES OFRINCIPLES OF

POSTPARTUM CAREOSTPARTUM CARE

d.d. Lochia uterine discharge consisting of Lochia uterine discharge consisting of bld, decidua, WBC, mucusbld, decidua, WBC, mucus

1.1. Rubra 1Rubra 1stst

3 days; red, mod in amt3 days; red, mod in amt2.2. Serosa next 4-9 days; pink or Serosa next 4-9 days; pink or

brownish &brownish & amtamt3.3. Alba from 10Alba from 10 thth day up to 3-6 wks;day up to 3-6 wks;

colorless, minimal amtcolorless, minimal amt

8/14/2019 puerperium v2

6/16

PRINCIPLES OFRINCIPLES OF

POSTPARTUM CAREOSTPARTUM CARE

e.e. Pain in perineal regionPain in perineal region

Relieved by:Relieved by:1.1. Sims positionSims position2.2. Perineal heat lampPerineal heat lamp3.3. Warm Sitz bath BIDWarm Sitz bath BID

4.4. Topical or oral analgesicsTopical or oral analgesics

8/14/2019 puerperium v2

7/16

PRINCIPLES OFRINCIPLES OF

POSTPARTUM CAREOSTPARTUM CARE

f.f. Sexual activity 3-4 wks postpartum if Sexual activity 3-4 wks postpartum if bleeding has stopped & episiorrhaphy hasbleeding has stopped & episiorrhaphy has

healed.healed.g.g. MenstruationMenstruation1.1. Breastfeeding 3-4 monsBreastfeeding 3-4 mons2.2. Not breastfeeding w/in 8 wksNot breastfeeding w/in 8 wks

f.f. Postpartum check-up 6Postpartum check-up 6 thth wkwk

8/14/2019 puerperium v2

8/16

PRINCIPLES OFRINCIPLES OF

POSTPARTUM CAREOSTPARTUM CARE

3.3. Urinary changesUrinary changesa.a. Diuresis w/in 12Diuresis w/in 12

b.b. Frequent urination in small amtsFrequent urination in small amts3.3. GI changes GI changes delayed bowel evacuation due to:delayed bowel evacuation due to:

. . muscle tonemuscle toneb.b. Lack of food + enema during labor Lack of food + enema during labor

c.c. DehydrationDehydrationd.d. Fear of pain from perineal tendernessFear of pain from perineal tenderness

8/14/2019 puerperium v2

9/16

PRINCIPLES OFRINCIPLES OF

POSTPARTUM CAREOSTPARTUM CARE

5.5. VSVSa.a. T may T may

b.b. Bradycardia common for 6-8 days postpartumBradycardia common for 6-8 days postpartumc.c. RR no changeRR no change

5.5. WeightWeight- 10-12 lbs immediate wt loss10-12 lbs immediate wt loss- Further wt loss next daysFurther wt loss next days

8/14/2019 puerperium v2

10/16

PRINCIPLES OFRINCIPLES OF

POSTPARTUM CAREOSTPARTUM CARE

Provide emotional supportProvide emotional supportTaking In PhaseTaking In Phase

11 stst 1-2 days. Mother is passive & dependent on others;1-2 days. Mother is passive & dependent on others;keeps on verbalizing about recent delivery.keeps on verbalizing about recent delivery.

Taking Hold PhaseTaking Hold PhaseAfter she has rested and recovered from stress of After she has rested and recovered from stress of delivery, the new mother begins to initiate & take axn,delivery, the new mother begins to initiate & take axn,has energy for the infant. Lasts 2 days to several weeks.has energy for the infant. Lasts 2 days to several weeks.

Letting Go PhaseLetting Go Phase

Family relationships are adjusted to accommodate theFamily relationships are adjusted to accommodate theinfant. Give up the fantasy child and gets to know theinfant. Give up the fantasy child and gets to know thereal child.real child.

8/14/2019 puerperium v2

11/16

8/14/2019 puerperium v2

12/16

PRINCIPLES OFRINCIPLES OF

POSTPARTUM CAREOSTPARTUM CARE

Prevent postpartumPrevent postpartum complicationscomplications

http://c/Users/User/Desktop/MCN/repro%20inver.ppt#Slide%2014http://c/Users/User/Desktop/MCN/repro%20inver.ppt#Slide%2014http://c/Users/User/Desktop/MCN/repro%20inver.ppt#Slide%2014

8/14/2019 puerperium v2

13/16

PRINCIPLES OFRINCIPLES OF

POSTPARTUM CAREOSTPARTUM CARE

Establish successful lactationEstablish successful lactation

Estrogen & progesterone

Stimulate anterior pituitary gland to produce prolactin

Acts on acinar cells to produce foremilk

Stored in collecting tubules

8/14/2019 puerperium v2

14/16

8/14/2019 puerperium v2

15/16

8/14/2019 puerperium v2

16/16

Advantages of breastfeedingAdvantages of breastfeedingFor the mother For the mother

EconomicalEconomicalRapid involutionRapid involutionLess incidence of breast CaLess incidence of breast Ca

For the babyFor the babyBondingBondingContains antibodiesContains antibodies

Less incidence of GI dsesLess incidence of GI dsesAlways availableAlways availableRight temperatureRight temperature