Puerperium

1
Puerperium

• Dr. Yasir Katib
• MBBS, FRCSC
• Perinatologest

2
Objectives

• Anatomical and physiological changes in pregnancy
  that led to normal lactation
• Understand the physiology and advantages of
  normal lactation
• Available methods of lactation suppression
• Prevent, recognize and manage breast-feeding
  complications
• Diffrentiate the causes of puerperal pyrexia
• Recognize the postpartum mental illnesses

3
Puerperium

• Puerperium
• It is the time from the delivery of the
  placenta through the first 6 weeks after the
  delivery
• Why??
• Anatomical and physiological changes of
  pregnancy return to pre-pregnancy state

4
Puerperium

• Examples
• Uterus
• Weight
• Cervix
• Lochia (rubra, serosa then alba)
• Vagina
• Pelvic floor
• Vaginal vs. C/S
• Episiotomy
• Menstruation
• Breast feeding
• Ovulation

5
Postpartum Care

• Discharge time
• Rh immunoglobulin
• Vaginal (episiotomy, pain and hemorrhoids)
• C/S (ambulation, eating and voiding)
• Sexual intercourse
• Education and discharge instruction
• Contraception

6
Breast Feeding

• Physiology
• Lactation can occur by 16 weeks' gestation
• Lactogenesis is initially triggered by the
  delivery of the placenta, which results in
  falling levels of estrogen and progesterone, with
  the continued presence of prolactin
• Suckling stimulates the release of prolactin and
  oxytocin secondly
• If the mother is not breastfeeding, the prolactin
  levels decrease and return to normal within 2-3
  weeks

7
Breast Feeding

• Physiology
• Colostrum is the liquid that is initially
  released by the breasts during the first 2-4 days
  after delivery
• High in protein, lactose and water
• This liquid is very protective for the newborn

8
Breast Feeding

• Infants
• Maternal
• Delays fertility
• Decrease cancers (breast, uterine, ovarian)
• Emotional health
• Promote wt loss
• Decrease osteoporosis
• Society

9
Breast Feeding Complications

• Breast engorgement
• Swelling of the breast and can occur early or
  late in the postpartum period
• During 1st week (Day2 /- 1day)
• Resolves spontaneously in the majority of cases,
  but may be exaggerated if the infant does not
  latch on
• Management

10
Breast Feeding Complications

• Cracked (sore) Nipples
• Pain (sensitivity vs. fissure trauma)
• Management
• Good latch-on and proper suckling
• Ankyloglossia
• Topical care (Lanolin cream)

11
Breast Feeding Complications

• Mastitis
• An infection of the breast
• Causative agent (staphylococcus aureus,
  streptococcus, and Escherichia coli)
• 1 to 3 lactating women
• Management
• Supportive measures
• Antibiotic treatment (cloxacillin)
• Recurrent mastitis

12
Breast Feeding Complications

• Breast Abscess
• Incidence of 0.1 percent
• Risk factors (maternal age over 30 years of age,
  primiparity, gestational age 41wk and mastitis
• Management

13
Breast feeding Suppression

• Timing
• Indications
• Medications (e.g. iodieds)
• Infections (e.g. HIV)
• Methods
• Mechanical
• Medical (e.g. bormocryptin)

14
Puerperal Pyrexia

• It is a temperature of 38C, maintained for or
  recurring within 24 hours, within 2-3 weeks of
  childbirth or abortion
• Causes
• Womb Local infection
• Wound Vaginal Vs. C/S
• Water UTI
• Walk DVT
• Wind RTI
• Wondering drugs Meds
• Others Breast, IV

15
Womb
16
Puerperal Pyrexia

• History Examination
• Investigations
• complete septic work up
• Treatment
• broad spectrum antibiotics
• wait for cultures

17
Mental illnesses

• Post-partum 'Blues'
• This occurs in around 50 of women within 4 to 5
  days of delivery
• It is usually a self limiting condition
• Rarely progress

18
Mental illnesses

• Postnatal Depression
• It is a relatively common disorder
• Onset between 1-6 months after delivery
• May last 6 moths or longer
• Clinical features
• sleep disturbance
• depressed mood
• social withdrawal
• lack of worthiness about being a mother
• Suicidal thoughts

19
Mental illnesses

• Management
• Social support
• Psychiatric or psychological care
• Medications

20
Mental illnesses

• Puerperal Psychosis
• Psychotic illness occurs in 0.2 of mothers and
  the onset is earlier than postnatal depression.
• This is a serious condition and requires expert
  psychiatric evaluation and treatment