Pregnancy and delivery brings a myriad of physiological and psychological changes in the women during the post natal period. During this time the baby tries to adjust itself to the new environment ex-utero & is dependent on its sole nurturer - the mother, who has to adjust herself not only to the infants needs but also to her own physiological and psychological variations. This period of her after delivery is termed as puerperium.
The word Puerperium is derived from the Latin word ‘puer’ means ‘a child’ and the word ‘pario’ means ‘to bring forth’
Definition –
It is a time following delivery during which the body tissues, specially the pelvic organs revert back approximately to the pre pregnant state both anatomically and physiologically.
Duration –
It begins as soon as the placenta is expelled and lasts for approximately 6 weeks. This period is divided into
- Immediate – with in 24 hrs
- Early – 7 days
- Remote – up to 6 weeks.
Physiological aspects –
The main physiological event that occurs during the puerperium is the involution and the lactation.
Involution doesn’t only mean the involution of the uterus; in a broader sense it also includes the reverting back of the other pelvic organs like the vagina, cervix, etc, to the pre pregnant state.
Just after delivery the uterus is hard, retracted and weighing about 1000 grams. It is about 6 inches long, 4 ½ inch broad and 3 ½ inch thick. After 1 week it reduces to 500 grams and after 2 weeks to 300 grams, and at the end of 6 weeks to 50 grams, and 3x2x1 inch size. It never returns to the pre pregnant state. The rate of involution varies in different individual. In some cases it is pushed to one side or the other.
Lochia –
It is the vaginal discharge after delivery. It has a peculiar offensive fishy odour and alkaline in reaction.
Table : Lochia
Lochia
|
Days
|
Colour
|
Composition
|
Rubra
|
1-4
|
Red
|
Blood, shreds of fetal membrane & decidua, vernix caseosa, lanugo and meconium.
|
Serosa
|
5-9
|
Yellowish, pink or pale brownish
|
Less RBC, more leucocytes, wound exudates, mucus from cervix and microorganism.
|
Alba
|
10-15
|
Pale white
|
Plenty of decidual cells, leucocytes, mucus, cholestrin crystals, fatty & granular epithelial cells & micro-organisms.
|
The average amount of discharge for the 1st 5-6 days is 200ml.
Cardiovascular system –
There is 3-4 kg weight loss due to increase fluid & electrolyte loss in diuretics. Hematocrit values increases by 5% & cardiac output increases by 50%.
Urinary system - There is increased diuresis for 2-3 days. Mild trauma to bladder occurs in all cases of vaginal delivery. There is edema & hyperemia of the bladder mucosa. Chances of UTI are increased during this period.
Gastrointestinal system – constipation is commonly seen due to intestinal atony. Hemorrhoids may be a complication of the delivery process itself. Fluid loss induces increased thirst. Adequate diet is needed.
Lactation – colostrum is secreted from the breast following delivery for the 1st two days. It contains proteins, vitamin A, sodium, chloride, low levels of carbohydrate, fat, potassium, etc. the important feature is presence of IgA.
In puerperium, even mild health problem proves to be troublesome due to her weak body & reduced strength which is the result of the strenuous delivery process. So, the new mother should be taken special care during this period.
SOURCES:
- Stedman’s Medical dictionary, New Delhi, S. Chand & Company Ltd; 23rd edition
- D. C. Dutta, Text book of Obstetrics, Calcutta, New Central Book Agency (P) Ltd; 4th edition, 1998
- Dr. R. K. Sachdeva, A guide to Obstetrics & Gynecology, New Delhi, Jay Pee Brothers Medical publishers, 5th edition, 1996
- Mudaliar & Menon, Clinical Obstetrics, Madras, Orient Longman, 9th edition, 1990
- D. C. Dutta, Text book of Obstetrics, Calcutta, New Central Book Agency; 6th edition, 1998
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