BY:

EUNICE RAJKUMAR

 Time following delivery during which

the pregnancy induced maternal
anatomical and physiological changes
return to the non pregnant stage

Involution the Reproductive

Tract

UTERINE INVOLUTION

AFTERPAINS
Primiparas: uterus remains tonically
contracted
Multiparas: contracts vigorously at interval
afterpain
Infant suckles oxytocin release Ut.
contraction
afterpain
Occasionally severe enough to recieve
analgesics; becomes milder by 3rd
postpartum day

LOCHIA

Endometrial
Regeneration
the remaining decidua becomes
differentiated into 2 layers within 2 or 3
days after delivery
superficial layer
: become necrotic, sloughed in the
lochia
basal layer
: remains intact, source of new
endometrium

Urinary Tract Change

Peritoneum and
Abdominal Wall
Broad & round ligaments
: much more lax than nonpregnant
: require considerable time to recover from
stretching & loosening
Abdominal wall
: return to normal requires several weeks
(aided by exercise)
: usually resumes its prepregnancy state
except for silvery striae

Breast Anatomy

Lactation

Endocrinology of
Lactation

Oxytocin
release from
Neurohypoph
ysis

MILK
EJECTION

Contraction of
myoepithelial
cells in alveoli
and small milk
ducts

Nursing
Even though the milk supply at first
appears insufficient, it become
adequate
if suckling is continued
Nursing accelerates uterine involution
: repeated stimulation of nipples
release oxytocin contracts uterine
muscle

Care of the breasts and nipples

Dried milk is likely accumulate &
irritate the nipples
cleaning of areola with water &
mild soap is helpful before and after
nursing

CONTRACEPTION

Hospital Care
Attention immediately after labor
for the first hour after delivery
- BP & PR : should be taken every 15
minutes
monitor amount of vaginal bleeding
Fundus should be palpated to ensure that
it is well contracted

Hospital Care
Early ambulation
Advantages
less frequent bladder
complications & constipation
reduced frequency of
puerperal venous thrombosis &
pulmonary embolism

Hospital Care
Care of the Vulva
Should be instructed to cleanse vulva
from anterior to posterior (vulvaanus)
Ice bag applied to perineum
Warm sitz bath
: beginning about 24 hours after
delivery
Tub bathing after uncomplicated delivery
is allowed

Hospital Care
Bowel function
early ambulation and early feeding
constipation
Subsequent discomfort
during the first few days after vaginal
delivery
uncomfortable by afterpains,
episiotomy & lacerations, breast
engorgement
codeine, aspirin, acetaminophen

Hospital Care

Hospital Care
Abdominal wall relaxation
Exercise to restore abdominal wall tone
: any time after vaginal delivery,
as soon as abdominal soreness
diminishes after cesarean delivery
Diet
No dietary restrictions for women who
have been delivered vaginally
2 hours after normal vaginal delivery,
(if, no Cx)

Hospital Care
Immunizations
Anti D-immune globulin 300 g
: nonimmunized women
- within 72 hours of the birth of a Dpositive infant
Rubella vaccination
Diphtheria-tetanus toxoid booster
Measles immunization
Time of discharge
if, no complication (at vaginal delivery)
hospitalization period 48 hours

Return of menstruation and

ovulation
If not nursing
: usually return within 6-8 weeks
Lactating woman
: first period may occur 2nd~18th
months after delivery
Ovulation
- as early as 36-42 days(5-6 wks)
after delivery

LOCHIA

Subinvolution

Subinvolution

Late Postpartum
Hemorrhage

Obstetrical paralysis
Pressure on branches of lumbosacral
plexus during labor
: complaints of intense neuralgia or
cramplike pains
extending down one or both legs
as soon as the fetal head
begins to descend the pelvis

Obstetrical paralysis
Common fibular nerve: damaged
when legs in stirrups position
Lateral femoral cutaneous
neuropathies most common
Followed by femoral neuropathies

Breast Fever

Puerperal Infection

Bacteria Commonly Responsible for Female

Genital Tract Infection

Pathogenesis

Treatment
Regimen
Clindamycin+Gentamycin

Comments
Gold standard, 9097% efficacy,
once-daily gentamicin dosing
acceptable
plus
Ampicillin added to regimen with
sepsis syndrome or suspected
enterococcal infection

Clindamycin+Aztreonam

Gentamicin substitute for renal

insufficiency

Extended Spectrum penicillins

Piperacillin, piperacillin
tazobactam, ampicillin/sulbactam,
ticarcillin/clavulanate

Cephalosporins

Cefotetan, cefoxitin,
cefotaxime

Vancomycin

Added to other regimens for

suspected S aureus
infections

Metronidazole+Ampicillin+Gen Metronidazole has excellent

tamycin
anaerobic coverage

Carbapenems

Imipenem/cilastatin,
meropenem, ertapenem
reserved for special
indications