NORMAL PUEPERIUM

➡️ Introduction:

During normal pueperium ,the female reproductive organs return to normal anatomical state.Also all physiological changes that occurred during pregnancy are reversed to their normal state.

Lactation is initiated, building up of the bound relationship between the baby and the parents .Mother recovers from the stresses of the pregnancy and delivery, and resumes the care and nurturing her infant.

Principles of caring baby and mother

during normal pueperium:

🔻There three principles:

1. Promoting the physical well being of the mother and baby.

2. Encouraging sound methods of infant feeding and promoting the development of good maternal – child relationships.

3. Supporting and strengthening the mothers confidence in herself ,and enabling her to fulfils her mothering role within her particular personal family and cultural situation.

Definitions:

PUEPERIUM:

Is the period of 6 -8 weeks begins as soon as the placenta and membranes are compltely expelled.

LOCHIA:

Is the term used to describe the discharges from the uterus during the pueperium and the term is plueral.

Physiology of pueperium:

There four physiological changes during pueperium:

➖ oxytocin (changes in the endocrine)

➖ Prolactin

➖ Involution of the uterus

➖ Lochia

Oxytocin:

Oxytocin is secreted by the posterior pituitary gland.(endocrine activity)

It acts upon the uterine muscles and the breast tissue.

During the 3rd stage the action of the oxytocin: aids in separation of the placenta.

maintains contraction of the uterine muscle.

reduces the placental site.

Prevents hemorrhage.

In mothers who choose to breast feed their babies ,sucking reflex stimulates further secretion of oxytocin,which aids contraction of the uterus (involution).

Thus expulsion of milk occurs continuously.

After expulsion of the placenta:

Following hormones falls rapidly and bring a number of changes:

human chorionic gonadotrophin hormone.

human placental lactogen.

oestrogen and progestrone.

Prolactin:

Fall of ostrogen allows prolactin secreted by anterior pituitary gland to act upon the alveoli of the breast to stimulate production of the milk.

In mother who feed ,the level of prolactin remains high and ovulation is prevented due to resumption of follicle stimulating in the ovary is suppressed.

Cont: prolactin:

For mothers who do not breast feed, the level of prolactin falls within 14 -21 days after delivery and this allows the follicle stimulating hormone to be secreted by the anterior pituitary gland to act upon the ovary, leading to establishment of normal pattern of oestrogen and progesterone production. Follicle growth, ovulation and menstruation.

Cont: prolactin:

The ligament of the uterus, pelvic floor, perineum, vulva, and bowel gains recovery of their normal tone .

Increasing of the kidney functioning in early pueperium because of reduction of blood volume and excretion of the waste products of autolysis.

Cont: prolactin:

In the breast prolactin acts upon alveoli and stimulates production of the milk as a result the fist 4 days the breast becomes heavy and engorged.

They are tender and must be handled gently and supported well.

Cont: prolactin:

In mothers who do not breast feed engorgement is gradually reduced by the fall in prolactin which occurs when secretion is no longer stimulated by suckling.

The involution of the uterus:

At the completion of labour the uterus weighs approximately 1kg.

-By the end of pueperium it has returned to its non pregnant weight of 50g.

-The marked reduction of size uterus takes place during the first 10 days.

Involution is not completely until the end of 6–8 weeks.

Cont : involution:

Immediately after delivery the contracted uterus is found at the level of umbilicus or below the umbilicus .

-1 week is palpable just above the symphysis pubis.

-By the 10 - 12 day it is no longer palpable.

At least every day involution takes place 2cm

Cont : involution:

-The cervix is soft and vascular immediately after delivery, and may be seen protruding into the vagina.

It losses its vascularity rapidly and regains its usual hard consistency within 2 or 3 days of delivery.

Within 10 days the cervical os size reduced to 1cm wide.

THE LOCHIA:

These are secretions from the uterus during pueperium period after delivery.Lochia have an alkaline reaction in which organisms can’t flourish rapidly than in normally acid vaginal secretions.

Cont: lochia:

-The odor of lochia is heavy but not offensive.The amount varies in different mothers.

-The colour depends on days or weeks as involution continuous.

Sequential changes of lochia:

Names are given according to the sequential changes: (TYPES OF LOCHIA)

1).RED LOCHIA: (RUBRA LOCHIA) : (1st week)

The name given to the first 3-4 days of pueperium. Its red in colour and consist of blood from placental site ,debris arising from decidua and chorion.

Cont: lochia:

2 ) SEROUSA LOCHIA: (SEROSA LOCHIA):

2nd week

From 5th -9th day, it’s pink in colour.

Lochia has less blood but more serum and contain leucocytes from the placental site.

Cont: lochia:

3).WHITE LOCHIA: (LOCHIA ALBA): (3rd week):

-Discharges are pale ,creamy ,brown in color Contains leukocytes ,cervical mucus and debrits from healing tissues.Some evidence of blood may continue to be seen for 2-3 weeks.

Cont: lochia:

The quantity ,colour, or odour are significant:

Scanty lochia may suggest infection.

Offensive lochia may suggest poor vulva hygiene and contamination of debris.

But if condition persists ,despite of hygienic management it may indicate genital tract infection.

Psychology of pueperium:

Parenting is a complex experience, affected by expectation of the family ,society.

It is accompanied by comflicts,reactions,and feelings.

Thus the mother must learn to care for her new baby during the time she is still recovering from physical stress of pregnancy and labour.

Older children must be taught how to share love and attention of their parents and the new babies.

Maternal and child relationship:

-The relationship begins during pregnancy as the mother becomes aware of the fetal movement and activity.