上海交通大学医学院：《妇产科学》（双语） 14 Normal and abnormal Puerperium

Normal and abnormal Puerperium Liu wei Department of ob Gy Ren Ji hospital

Normal and Abnormal Puerperium Liu Wei Department of Ob & Gy Ren Ji hospital

Normal Puerperium Definition 1. The time from the delivery of the placenta through the first few weeks after the delivery. 2. 6 weeks in duration 3. By 6 weeks after delivery, most of the changes of pregnancy, labor, and delivery have resolved and the body has reverted to the nonpregnant state

Normal Puerperium • Definition 1. The time from the delivery of the placenta through the first few weeks after the delivery. 2. 6 weeks in duration. 3. By 6 weeks after delivery, most of the changes of pregnancy, labor, and delivery have resolved and the body has reverted to the nonpregnant state

Normal Puerperium The relevant anatomy and physiology in the puerperium 1. Reproductive organs 1) Uterus v1000g→50-100g v The endometrial lining rapidly regenerates (16 days) The placental site undergoes a series of changes in the postpartum period

Normal Puerperium • The relevant anatomy and physiology in the puerperium 1. Reproductive organs 1) Uterus ✓ 1000g → 50-100g ✓ The endometrial lining rapidly regenerates (16 days) ✓ The placental site undergoes a series of changes in the postpartum period

Normal Puerperium 2) Cervix it never returns to the nulliparous state. v the external os is closed to the extent that a finger could not be easily introduced 3) Vagina v shrinks to a nonpregnant state resolution of the increased vascularity and edema occurs by 3 week the vaginal epithelium appears atrophic on smear. This is restored by weeks 6-10

Normal Puerperium 2) Cervix ✓ it never returns to the nulliparous state. ✓ the external os is closed to the extent that a finger could not be easily introduced. 3) Vagina ✓ shrinks to a nonpregnant state ✓ resolution of the increased vascularity and edema occurs by 3 weeks ✓ the vaginal epithelium appears atrophic on smear. This is restored by weeks 6-10

Normal Puerperium 4) Perineum swelling and engorgement are completely gone within 1-2 weeks the muscle tone may or may not return to normal, depending on the extent of injury 5) Ovaries ovulate as early as 27 days after delivery(not breastfeed ) 12 weeks(most); 7-9 weeks (mean). the suppression of ovulation due to the elevation in prolactin

Normal Puerperium 4) Perineum ✓ swelling and engorgement are completely gone within 1-2 weeks ✓ the muscle tone may or may not return to normal, depending on the extent of injury. 5) Ovaries ✓ ovulate as early as 27 days after delivery (not breastfeed ); 12 weeks (most); 7-9 weeks (mean). ✓ the suppression of ovulation due to the elevation in prolactin

Normal Puerperium 6)Breasts Lactation can occur by 16 weeks' gestation v Lactogenesis is initially triggered by the delivery of the placenta(ElLand prolactin). v the prolactin levels decrease and return to normal within 2-3 weeks(not breastfeeding The colostrum初乳( the first2-4days) The milk continues to change throughout the period of breastfeeding to meet the changing demands of the baby

Normal Puerperium 6) Breasts ✓ Lactation can occur by 16 weeks' gestation. ✓ Lactogenesis is initially triggered by the delivery of the placenta (E↓P↓and prolactin). ✓ the prolactin levels decrease and return to normal within 2-3 weeks (not breastfeeding) ✓ The colostrum初乳(the first 2-4 days) ✓ The milk continues to change throughout the period of breastfeeding to meet the changing demands of the baby

Normal Puerperium 2. Systemic change 1)Cardiovascular system Blood volume returns to nonpregnant levels by the tenth days of puerperium Cardiac output t(immediately after delivery) slowly declines- reach late pregnancy levels 2 days postpartum- normal 2-6 weeks. 2) Hematologic changes v Hemoglobin concentration t on the first postpartum days v Several clotting factors(fibrinogen) fon the first days

Normal Puerperium 2. Systemic change 1) Cardiovascular system ✓ Blood volume returns to nonpregnant levels by the tenth days of puerperium ✓ Cardiac output ↑(immediately after delivery) → slowly declines→ reach late pregnancy levels 2 days postpartum→ normal 2-6 weeks. 2) Hematologic changes ✓ Hemoglobin concentration↑on the first postpartum days ✓ Several clotting factors (fibrinogen) ↑on the first days

Normal Puerperium Manifestation 1. Fever(24 hours) 2. Pain(uterine contraction) 3. Sweat 4. Lochia恶露 a large amount of red blood initially flows from the uterus as the contraction phase rapidly occurs. (5 weeks) lochia rubra; lochia serosa(brownish red, with a more watery consistency); lochia alba (yellow)

Normal Puerperium • Manifestation 1. Fever (24 hours) 2. Pain (uterine contraction) 3. Sweat 4. Lochia 恶露 ✓ a large amount of red blood initially flows from the uterus as the contraction phase rapidly occurs. (5 weeks) ✓ lochia rubra; lochia serosa (brownish red, with a more watery consistency); lochia alba (yellow)

Normal Puerperium Management 1. 2 hours after delivery v Bleeding Uterine contraction v HR and Bp and r and T 2. 1 weeks after delivery Bleeding

Normal Puerperium • Management 1. 2 hours after delivery ✓ Bleeding ✓ Uterine contraction ✓ HR and Bp and R and T 2. 1 weeks after delivery ✓ Bleeding

Normal Puerperium 3. Emiction and defecate 4. Lochia 5. Episiotomy and Laceration 6. Breast

Normal Puerperium 3. Emiction and defecate 4. Lochia 5. Episiotomy and Laceration 6. Breast