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Dr Anju Shrestha

PUERPERIAL PYREXIA
PUERPERIAL SEPSIS
SUBINVOLUTION
URINARY COMPLICATION
BREAST COMPLICATION
PUERPERAL VENOUS THROMBOSIS
PULMONARY EMBOLISM
PSYCHIATRIC DISORDER
OBSTERIC PALSIES
DEFINITION: when the invoution is impaired
or retarted
CAUSES: predisposing factor-
Grand multiparity
Over distension of uterus:twin, hydramnion
Maternal ill health
Cesatrean section
Prolapse uterus
Fibroid
Agrravating factor:
Retained product of conception
Uterine sepsis
SYMPTOMS:
1. Asymptomatic
2. Abnormal lochial discharge: excessive or
prolonged
3. Irregular and excessive bleeding
4. Irregular cramp
5. Fever: if retained product of conception
Signs:
I. Uterine height is proportionally grater
II. Feels boggy and soft
MANAGEMENT: antibiotics and specific to cause
URINARY TRACT INFECTION
RETENTION OF URINE
INCONTINENCE OF URINE
Common cause of puerperial pyrexia
Cause:
Recurrence of previous cystitis or pyelitis
Overt asymptomatic bacteriuria
During puererium:
Frequent catheterization during labor
Stasis of urine: due to lack of bladder tone or less
desire to pass urine
COMMON SYMPTOMS AND CAUSE:
Bruising and edema of the bladder neck
Reflex from the perineal injury
Unaccustomed position
TREATMENT:
Encourage to pass urine
Indwellig catheter: 48 hours
Urinary antiseptic
NOT COMMON SYMPTOM
type:
1. Overflow incontinence: due to retention
2. Stress incontinence: late puerperium
3. True incontinence: with in first week; genito
urinary fistula
Breasr engorgement
Cracked nipples
Retracted nipples
Acute mastitis
Breast abscess
CAUSE: due to exagerated normal venous and
lymphatic engorgement.i n turns prevents
escape of milk.
Primipara involved due to inelastic breast.
Usually 3rd and 4th day; after start of milk
secretion
Symptoms:
1. Pain and tensed and heaviness in breast
2. Painful breast feeding
3. Malaise
4. Slight fever
1. Avoid prelacteal feeds
2. Exclusive breast feeding on demand
3. Feeding in correct position
TREATMENT:
1. Support breast
2. Mannual expression of excess milk after
feeding
3. Analgesics
4. Breast pump
5. Ice pack
Loss of epithelium with the formation of raw area
Fissure at base or top of nipple
Cause:
Unclean hygiene:crust over nipple
Retracted nipple
Traumas from baby mouth due to incorrect attachment
to the breast
TREATMENT:
Correct attachment: immediate releive
Fresh human milk and saliva: got healing properties
Severe: breast pump/ nipple shield
Organism: staphylococcus aureus, S. epidermidis ,
staphylococcus
RISK FACTOR; poor nurishing and cracked nipple
MODE OF INFECTION: two diff types:
1. Cellulitis; breast parenchymal tissue
2. Mammary adenitis; infection to lactiferous duct
NON INFECTIVE MASTITIS: due to milk stasis
CLINICAL FEATURE:
1. headache and generalized malaise
2. Fever with chills
3. Fever and tender swelling over breast
4. Overlying skin: red, hot,tensed and tender
IF NOT MANAGED AT THIS TIME: COMPLICATED TO
BREAST ABSCESS
Breast support
Continue breast feeding( nursing is initiated
first on uninfected side to establish let down)
Infected side is emptied mannually with each
feed
Cloxacillin antibiotics: 500mg 6hrly
Analgesics: ibuprofen
Flushed breast not responding to antibiotics
Edematous overlying skin
Marked tenderness with fluctuation
Swinging temparature
Abscess drained under general anaesthesia
Breast feeding continue in the uninvolved
side
Infected breast is mechanically pumped every
two hours