DEFINITION period of adjustment after pregnancy when anatomic and physiologic changes are reversed immediate - first 24 hours after de...
DEFINITION
- period of adjustment after pregnancy when anatomic and physiologic changes are reversed
- immediate - first 24 hours after delivery
- early - first week
- traditionally, puerperium lasts 6 weeks
The 8 B’s:
Blues (post-partum), Breathing (DVT/PE), Breast, Belly, Bowels, Bladder, Bleeding, Baby
BREAST
- 2 events stimulate lactation
- sudden drop in placental hormones (especially estrogen)
- suckling stimulates release of prolactin and oxytocin
- colostrum secreted for ~ 2 days (contains protein, fat, minerals, IgA and IgG)
- replaced by milk after ~ 3-6 days (contains protein, lactose, water, fat)
- breast feeding encouraged
- through process of catabolism, uterus weight rapidly diminishes
- cervix loses its elasticity and regains firmness
- start oxytocin drip or give oxytocin 10 U IM after 3rd stage (i.e. after delivery of placenta; some give IM dose after delivery of head)
- generally should involute ~ 1 cm (1 finger breadth) below umbilicus per day in first 4-5 days
- involution then slows down; reaches non-pregnant state in 4-6 weeks postpartum
- normal vaginal discharge postpartum
- monitored for signs of infection or bleeding
- normally decreases and changes colour from red (lochia rubra; due to presence of erythrocytes) to yellow (lochia serosa) to white (lochia alba; residual leukorrhea)over 3-6 weeks
- foul smelling lochia suggests endometritis
