SCHOOL:ADAMU ADAMU COLLEGE OF NURSING SCIENCE,AZARE BAUCHI STATE
CLASS:BASIC NURSING SET II
TOPIC:PRESENTATION ON NORMAL PUERPERIUM
COURSE:REPRODUCTIVE HEALTH
BY GROUP II
MEMBERS
1.MARYAM MUHAMMAD AUWAL
2.NASIR OZOHU MUFEEDAT
3.AISHA BASHEER ABUBAKAR
4.SUFIYAN FATIMA USMAN
5.SALISU AHMAD
6.ADEBAYO OLUWAFERANMI TAIWO
7.ANTHONY URUKO KENNETH
8.ADEWALE FAVOUR GRACE
9.KHADIJA YUSUF BABA.
DATE: 23/07/2024
NORMAL PUERPERIUM
Puerperium is defined as the time from the delivery of the placenta through the first few weeks
after the delivery. This period is usually considered to be 6 weeks in duration.
The puerperium, or postpartum period, generally lasts 6 weeks and is the period of adjustment
after delivery when the anatomic and physiologic changes of pregnancy are reversed, and the body
returns to the normal, nonpregnant state.
PHYSIOLOGICAL CHANGES DURING PUERPERIUM
A. UTERINE INVOLUTION:
this is a natural process that involves a pregnant uterus returning to its pre-pregnancy state. The
process begins after the delivery of the baby and the placenta and takes about six weeks to
complete. there might be experience of postpartum cramps called afterpains during uterine
involution.
THIS IS FOLLOWED BY:AUTOLYSIS: of the excess muscle fibres.The blood vessels are
obliterated by thrombosis and become degenerated while its remnants are transformed into elastic
tissues.The decidua, except the basal layer, is separated.Weight: After delivery the uterine weight
is 1000 gm . By the end of 6 weeks it is 50 gm.SIZE: After delivery the length of the uterus is 20
cm and felt at the level of umbilicus. After one week it is midway between umbilicus and
symphysis pubis. After 2 weeks it is at the level of symphysis. By the end of the 6th week it is 7.5
cm long.UTERINE LIGAMENTS: are involuted and subinvolution predisposes to prolapse and
retroversion.
ISCHEMIA (blockage of blood flow): is the intended result of embolization, depriving the fibroids
of blood, oxygen, and nutrients. The uterus and/or ovaries are also potentially affected, although
they have the capacity to recover and the fibroids do not.
LOCHIA:It is the genital tract discharge in the first 15 days of peurperium.It is alkaline and
composed of blood, decidual fragments, cervical mucus, vaginal transudate and bacteria.LOCHIA
RUBRA(RED) : consists mainly of blood and decidua. It lasts for 5 days.LOCHIA
SEROSA(PALE/PINKISH): due to relative decrease in RBCs and predominance of leukocytes. It
lasts for 5 days.LOCHIA ALBA(WHUTE) :onsists mainly of leukocytes and mucus. It lasts for 5
days.Persistence of red lochia means subinvolution.Offensive lochia means infection.In severe
infection with septicaemia, lochia is scanty and not offensive.
B. INITIATION AND ESTABLISHMENT OF LACTATION:
This begins around the 16th week of pregnancy Estrogen and progesterone rise and cause the milk
ducts to grow in number and size. This causes the breasts to become fuller. the mammary glands
begin to prepare for milk production.
Early initiation of breastfeeding, within one hour of birth, protects the newborn from acquiring
infection and reduces newborn mortality. It facilitates emotional bonding of the mother and the
baby and has a positive impact on duration of exclusive breastfeeding. When a mother initiates
breastfeeding within one hour after birth, production of breast milk is stimulated. The yellow or
golden first milk produced in the first days, also called colostrum, is an important source of
nutrition and immune protection for the newborn.
CONSITIONS FOR SUCCESSFUL BREAST FEEDING
1.Stay together after the birth.
2.Get your position and attachment right.
3.Be patient.
4.Feed on demand or according to need.
5.Keep baby in the room with you.
6.Avoid teats, dummies, and com
MANAGEMENT OF PUERPERIUM
It involves three parts which include :
1.the immediate management
2.subsequent management and
3.the medical management.
THE IMMEDIATE MANAGEMENT:
this involves observation of vital signs,give light meals, serve oxytocic drugs, bath the baby and
the mother and make them comfortable and good rest.
SUBSEQUENT MANAGEMENT;
1.psychological care
2.dealing with lochia
3.educate the patient
4.removal of sutures
5.diet
6.care of the bladder
7.care of the breast
8.prevention of infectio.
THE MEDICAL MANAGEMENT:
the medical management of the puerperium may be divided into three stages:
1.The management of the first hour after delivery of the placenta (sometimes called the fourth
stage of labour).
2.The management of the rest of the puerperium.
3.The six week postnatal visit.
The two main objectives of managing the first hour of the puerperium are:
1.To ensure that the patient is, and remains, in a good condition.
2.The prevention of a postpartum haemorrhage (PPH).
To achieve these, you should:
1.Perform certain routine observations.
2.Care for the needs of the patient.
3.Get the patient’s co-operation in ensuring that her uterus remains well contracted and that she
reports any vaginal bleeding.
*The correct management of the first 2 hours of the puerperium is most important as the risk of
postpartum haemorrhage is greatest at this time.
Immediately after the delivery of the placenta you should:
1.Assess whether the uterus is well contracted.
2.Assess whether vaginal bleeding appears more than normal.
3.Record the patient’s pulse rate, blood pressure and temperature.
*During the first hour after the delivery of the placenta, provided that the above observations are
normal, you should:
1.Continuously assess whether the uterus is well contracted and that no excessive vaginal bleeding
is present.
2.Repeat the measurement of the pulse rate and blood pressure every 15 minutes for the 1st hour
and every 30 minutes for the 2nd hour.
3.If the patient’s condition changes, observations must be done more frequently until the patient’s
condition returns to normal.
*Observations during the first hour of the puerperium are extremely important.
After the placenta has been delivered the patient needs to be:
1.Washed.
2.Given something to drink and maybe to eat.
3.Allowed to bond with her infant.
4.Allowed to rest for as long as she needs to.
The patient should be shown how to observe:
1.The height of the uterine fundus in relation to the umbilicus.
2.The feel of a well-contracted uterus.
3.The amount of vaginal bleeding.
4.She should be shown how to ‘rub up’ the uterus.
5.She should be told that if the uterine fundus rises or the uterus relaxes or if vaginal bleeding
increases, she must:
i.Immediately call the Nurse,
ii.In the meantime rub up the uterus.
*These two important steps may help prevent a postpartum haemorrhage.
CARE OF THE MOTHER:
1.acces the general condition
2.ask about mood changes and problems with breathing and cough
3.access the pulse rate, temperature and blood pressure
4.access vaginal bleeding amount
5.check Episiotomy site for healing.
6.measure haemoglobin count if patient looks pale
CARE OF THE BABY:
1.access whether the baby looks well.
2.access for signs jaundice
3. examine the umbilical stump for signs of infections
4.ask whether the baby has pass urine or stool
5.examine the eyes for conjunctivitis,oedema and discharge
6.access the infant feeding
HEALTH TEACHING DURING PUERPERIUM
1.discussing birth control
2.wait until after first check up visit before intercourse
3.avoid douching in the first few weeks of child birth
4.eat healthy meal and drink alot of water
5.continue taking pre natal vitamins everyday
RESPONSIBILITIES OF THE NURSES IN PRE NATAL, LABOUR AND AFTER CHILD
BIRTH.
1.examining and monitoring pregnant woman
2.accessing care requirements and writing care plans
3.undertaking ante natal care in the hospitals and homes
4.carrying out screeening test eg urinalydis, RVS, RBS, FBC
5.observation of vital signs and taking samples
6.Assissting in carrying women for labour
7.Give information,encouragement and emotional support
8.monitor progress of labour
9.suggest strategies to help in labour
10.monitor tye baby's heart beat and other signs of well being and offer pain relief
11.conducting delieveries
12.offer extra medical help when necessary
13.immediately after the delivery,the midwife checks and estimate blood lost, check for perineal
tear,or Episiotomy and repair as soon as possible
14.observe general condition of the mother and baby
15.helping and setting baby for breast feeding
16.administering pain relievers and other drugs
17.examination of the new born from head to toe
18.carrying out sone routine health tests and newborn screening.
19.provide home visits after child birth.
20.encourage exclusive breast feeding.
