Shaafi Medical College

Obstetrics & Gynecology

Dr Mustafe Muhumed Aw-Ali
Dip. Ed, MBBS, MPH(Candidate)
THE NORMAL PUERPERIUM
 The Normal Puerperium
 Definition: Puerperium is period from the
expulsion of the placenta to the time the
reproductive organs returns to pregravid state
lasts 6 weeks.
 Cont…
 Puerperium is characterized by the following
features
The reproductive organs return to the non-
pregnant state
Other physiological changes occurred during
pregnancy are reversed (Involution)
Lactation is initiated
Recovery of the mother from the stress of
pregnancy and delivery and assumes
responsibility for the care &nurture of her infant.
 Physiology of Puerperium
Involution of the uterus
 Definition: the uterus returns to its normal
size, tone & position of non-pregnant state

Mechanism:
Ischemia: After the birth of the baby &
placenta, the uterine muscle & blood vessels
contracts so the blood circulation decreases. (A
localized anemia)
 CONT…
Autolysis: muscle fibers are digested by
hydrolytic enzyme, waste product then pass
into the blood stream and are eliminated by the
kidneys.
Lining of the uterus is cast off and is replaced
first by granular tissue and then by
endometrium.
Management of the Puerperium
 Advice the mother to care for herself and
for her baby covering a wide range of
subjects like hygiene nutrition,
immunization, family planning, etc
 CONT…
 Admission to post natal ward
The mother and baby are usually transferred to
the post natal word within an hour or 2 after
delivery.
The midwife/nurse should welcome the mother
and help her to settle in the ward.
She will observe her general condition, palpate
the uterus to note whether it is contracted or not
and observe the lochia.
 CONT…
 Sleep and rest
The mother should have sufficient sleep and rest.
Keep a quiet comfortable atmosphere without
disturbance.
Inability to sleep must be regarded with concern and
Doctor should be consulted.
Hypnotics may be needed and it is given without
hesitation.
Undue anxiety, sleeplessness and loss of appetite should
be regarded as serious.
Rest is usually encouraged during the day preferably in
prone position as this aids drainage from the uterus and
vagina.
 CONT…
 Ambulation
 Mothers benefit a feeling of wellbeing
from this early activity and this reduces the
incidence of thromboembolic disorders.
 CONT…
 Diet
 a good balanced diet should be taken as
advised in pregnancy, the woman’s appetite
usually returns very quickly after labor is
ended & has had some sleep. Protein foods
are important particularly if she is breast
feeding. Excess fruit should be avoided as
substances from this will pass to the baby in
the milk & may cause diarrhea. The daily
fluid intake should be from 2.5-3 liters of
which at least 600ml should be milk.
 CONT…
 Postnatal exercises
Advantages
Gives the women a sense of well beingness
Maintains good circulation, lessens possibility of venous
thrombosis.
Restores muscle tone of the abdominal wall & pelvic floor.
Promotes for normal drainage of lochia
Prevents hypostatic pneumonia
Helps in emptying the bladder, bowels and uterus
Permits her to enjoy a daily bath
Enables her to take early care of her baby.
Restores her body figure