SESSION TOPIC: PARTICIPANTS: VENUE: TIME AND TIME ALLOTMENT: LEARNING OBJECTIVES:

Anatomical and Physiological Changes during Puerpurium Pregnant Patients of the Out Patient Department OPD, De La Salle University Medical Center 8 minutes After the session, the women of the Obstetric ward should be able to: 1. Define puerperium, 2. Describe maternal anatomical and physiological changes in puerperium, 3. Correct misconceptions related to the anatomical and physiologic changes in puerperium CONTENT Definition of Puerperium Puerperium is the period of adjustment from the delivery of the placenta to six weeks post-partum. The anatomical and physiological changes seen during puerperium are mostly similar to pre-pregnancy state of the mother. TEACHING METHOD Audio-Visual Presentation RESOURCES EVALUATION TIME ALLOTMENT 15 seconds

LEARNING OBJECTIVES 1. Define puerperium

2. Describe maternal anatomical and physiological changes in puerpurium

Breast Engorgement Women who do not breast feed may experience engorgement, milk leakage, and breast pain, which peaks at 3 to 5 days after delivery (Spitz and associates, 1998). As many as half require analgesia for breast-pain relief. Up to 10 percent of women report severe pain up to 14 days. Breasts should be supported with a well-fitting brassiere. Pharmacological or hormonal agents are not recommended to suppress lactation. Instead, ice packs and oral analgesics for 12 to 24 hours can be used to relieve discomfort. A breast binder is used at Parkland

Hospital for these women, and a sports bra is used at the University of Alabama Hospital. Milk Fever Puerperal fever from breast engorgement is common. Before breast feeding was commonplace, Almeida and Kitay (1986) reported that 13 percent of postpartum women had fever that ranged from 37.8 to 39C from engorgement. Fever seldom persisted for longer than 4 to 16 hours. The incidence and severity of engorgement, and fever associated with it, are much lower if women breast feed. Uterine Involution The uterus is stretched to hold the infant and now needs to shrink back into a tight ball of muscle. The nurse or doctor may gently massage the area over your uterus to feel for this tightness. Right after birth, you will be able to feel the top of the uterus just below your bellybutton. The uterus shrinks a little every day. By the end of the first week, it will grow smaller. The nurse or doctor may want to teach the mother on how to locate the uterus and feel for firmness to make sure it shrinks about one finger-width a day. Some women will notice afterbirth pains that feel like menstrual cramps. These cramps are the result of the muscle of the uterus contracting back to its prepregnant size. These pains are usually felt more strongly by women when they start to breastfeed or by those who have given birth to other children.

By the end of the second week, you should no longer be able to feel the top of your uterus through your belly. The afterbirth pains should be over. The uterus should return close to its pre-pregnant size by the sixth week. After Pains In primiparas, the uterus tends to remain tonically contracted following delivery. However, in multiparas, it often contracts vigorously at intervals and gives rise to afterpains, which are similar to but milder than the pain of labor contractions. Lochia color changes Early in the puerperium, sloughing of decidual tissue results in a vaginal discharge of variable quantity. The discharge is termed lochia and consists of erythrocytes, shredded decidua, epithelial cells, and bacteria. For the first few days after delivery, there is blood sufficient to color it redlochia rubra. After 3 or 4 days, lochia becomes progressively pale in color lochia serosa. After about the 10th day, because of an admixture of leukocytes and reduced fluid content, lochia assumes a white or yellowish white color lochia alba. Lochia persists for up to 4 to 8 weeks after delivery (Visness and co-workers, 1997). Post partum hemorrhages Such bleeding most often is the result of abnormal involution of the placental site. It occasionally is caused by retention of a placental fragment. Weight loss In addition to the loss of 5 to 6 kg due to uterine

evacuation and normal blood loss, there is usually a further decrease of 2 to 3 kg through diuresis. Chesley and co-workers (1959) demonstrated a decrease in sodium space of about 2 L during the first week postpartum. According to Schauberger and co-investigators (1992), women approach their selfreported prepregnancy weight 6 months after delivery but still retain an average surplus of 1.4 kg (3 lb). 3. Correct misconceptions related to the anatomical and physiologic changes in puerperium Lactating women need to eat twice as much Additional caloric intake depends on the current nutritional status of the mother. But as a rule of thumb, there should be an additional 500 calories to sustain lactation. Stretch marks can be managed during pregnancy to avoid permanency The number of stretch marks depends on how the elastic skin is. Family history plays an important role in the determination of having it. The best thing to do is ask her mother if she got stretch marks during pregnancy, if she did the pregnant woman is more likely to have it. Weight gain also plays an important role as a contributing factor for having stretch marks. The more weight gain during pregnancy the more likely to have stretch marks so proper and managed weight gain should be maintained during pregnancy. Staying fit, healthy and well hydrated during pregnancy also prevent it. Kangaroo pouch is because the uterus was stretched out The abdominal wall remains soft and flaccid. If the distention of the abdomen during pregnancy resulted

in marked separation of the rectus muscles, diastasis recti may result causing the midline abdominal wall to be formed only by peritoneum, attenuated fascia, subcutaneous fat and skin. This shall heal on its own or can be helped with exercise. Sex can resume during puerperium Health providers recommend four to six weeks before having sex. This allows the cervix to close, postpartum bleeding to stop, and any tears or repaired lacerations to heal. On the average, non-lactating mothers ovulate by the seventh week post-partum. Thus, couples should be informed to prevent unplanned pregnancy. REFERENCES Cunningham, F. Gary, Kenneth Leveno, Steven Bloom, John Hauth, Dwight J. Rouse and Catherine Spong. 23rd Edition. Williams Obstetrics. The Mc-Graw Hill Companies, Inc. 2010. Jackson-Cannady, Ayren. The Truth about your Body after Baby. October 5, 2011. http://shine.yahoo.com/blogs/author/fitness-magazine-ycn1137103. Viewed: January 31, 2012. Sumpaico, Walfrido, Imelda Ocampo-Andres, Sylvia de las Alas-Carnero, Lourdes Blanco-Capito, Arangel Diamante and Zaida Noblejas-Gamilla. 3rd Edition. Textbook of Obstetrics. Association of Writers of the Philippine Textbooks of Obstetrics and Gynecology, Inc., Philippines. 2008. Sutter Health. 2008. http://www.babies.sutterhealth.org/afterthebirth/newmom/pp_physical.html. Viewed: January 31, 2012.