Normal and Abnormal
Puerperium
Liu Wei
Department of Ob & Gy
Ren Ji hospital
Normal Puerperium
? Definition
1,The time from the delivery of the placenta
through the first few weeks after the delivery,
2,6 weeks in duration,
3,By 6 weeks after delivery,most of the changes
of pregnancy,labor,and delivery have
resolved and the body has reverted to the
nonpregnant state,
Normal Puerperium
? The relevant anatomy and physiology in the
puerperium
1,Reproductive organs
1) Uterus
? 1000g → 50-100g
? The endometrial lining rapidly regenerates
(16 days)
? The placental site undergoes a series of
changes in the postpartum period
Normal Puerperium
2) Cervix
? it never returns to the nulliparous state,
? the external os is closed to the extent that a
finger could not be easily introduced,
3) Vagina
? shrinks to a nonpregnant state
? resolution of the increased vascularity and
edema occurs by 3 weeks
? the vaginal epithelium appears atrophic on
smear,This is restored by weeks 6-10,
Normal Puerperium
4) Perineum
? swelling and engorgement are completely
gone within 1-2 weeks
? the muscle tone may or may not return to
normal,depending on the extent of injury,
5) Ovaries
? ovulate as early as 27 days after delivery (not
breastfeed ); 12 weeks (most); 7-9 weeks
(mean),
? the suppression of ovulation due to the
elevation in prolactin
Normal Puerperium
6) Breasts
? Lactation can occur by 16 weeks' gestation,
? Lactogenesis is initially triggered by the
delivery of the placenta (E↓P↓and prolactin),
? the prolactin levels decrease and return to
normal within 2-3 weeks (not breastfeeding)
? The colostrum初乳 (the first 2-4 days)
? The milk continues to change throughout the
period of breastfeeding to meet the changing
demands of the baby,
Normal Puerperium
2,Systemic change
1) Cardiovascular system
? Blood volume returns to nonpregnant levels
by the tenth days of puerperium
? Cardiac output ↑ (immediately after delivery)
→ slowly declines→ reach late pregnancy
levels 2 days postpartum→ normal 2-6 weeks,
2) Hematologic changes
? Hemoglobin concentration↑ on the first
postpartum days
? Several clotting factors (fibrinogen) ↑on the
first days
Normal Puerperium
? Manifestation
1,Fever (24 hours)
2,Pain (uterine contraction)
3,Sweat
4,Lochia 恶露
? a large amount of red blood initially flows
from the uterus as the contraction phase
rapidly occurs,(5 weeks)
? lochia rubra; lochia serosa (brownish red,
with a more watery consistency); lochia alba
(yellow)
Normal Puerperium
? Management
1,2 hours after delivery
? Bleeding
? Uterine contraction
? HR and Bp and R and T
2,1 weeks after delivery
? Bleeding
Normal Puerperium
3,Emiction and defecate
4,Lochia
5,Episiotomy and Laceration
6,Breast
Puerperal Infection
? Puerperal Infection
any bacterial infection of the genital tract after
delivery,Incidence,6%,The most important
cause of maternal death,
? Puerperal Morbidity
temperature 38.0℃ or highter,the temperature
to occur on any 2 of the first 10days
postpartum,exclusive of the first 24 hours,and
to be taken by mouth by a standard technique
at least four times daily,
Puerperal Infection
? Risk factors
1,PROM
2,Anemia
3,Hemorrhage
4,EP and CS
5,Placenta retain
Puerperal Infection
? Common pathogens
1,Aerobes
? Group A,B,and D streptococci溶血性链球菌
? Gram-negative bacteria,Escherichia coli大肠
杆菌,Klebsiella克雷伯氏菌
? Staphylococcus aureus葡萄球菌
Puerperal Infection
2,Anaerobes
? Petococcus species消化球菌
? Petostreptococcus species消化链球菌
? Bacteroides fragilis group脆弱类杆菌
? Clostridium species梭状芽孢杆菌
3,Other
? Chlamydia trachomatis沙眼衣原体
? Mycoplasma species支原体
Puerperal Infection
? Manifestation
? Acute vulvitis vaginitis and cervicitis
? Uterine infection
? Adnexal infections
? Septic pelvic thrombophlebitis 血栓性静脉炎
? Sapremia 败血症
Puerperal Infection
? Diagnosis
? History
? Physical examination and PV
? Lab finding
? Differential diagnosis
Puerperal Infection
? Treatment
1,Nutrition,anemia prevention
2,Antimicrobial treatment
broad-spectrum,high dose,long time
3,Drainage
4,Treatment of thrombophlebitis
Late Postpartum Hemorrhage
? Definition
Uterine bleeding by 24 hours after delivery,
? Etiology
?Placenta or membrane or decidua retain
?Abnormal redintegration
?Infection
?Problems of incision
END
Puerperium
Liu Wei
Department of Ob & Gy
Ren Ji hospital
Normal Puerperium
? Definition
1,The time from the delivery of the placenta
through the first few weeks after the delivery,
2,6 weeks in duration,
3,By 6 weeks after delivery,most of the changes
of pregnancy,labor,and delivery have
resolved and the body has reverted to the
nonpregnant state,
Normal Puerperium
? The relevant anatomy and physiology in the
puerperium
1,Reproductive organs
1) Uterus
? 1000g → 50-100g
? The endometrial lining rapidly regenerates
(16 days)
? The placental site undergoes a series of
changes in the postpartum period
Normal Puerperium
2) Cervix
? it never returns to the nulliparous state,
? the external os is closed to the extent that a
finger could not be easily introduced,
3) Vagina
? shrinks to a nonpregnant state
? resolution of the increased vascularity and
edema occurs by 3 weeks
? the vaginal epithelium appears atrophic on
smear,This is restored by weeks 6-10,
Normal Puerperium
4) Perineum
? swelling and engorgement are completely
gone within 1-2 weeks
? the muscle tone may or may not return to
normal,depending on the extent of injury,
5) Ovaries
? ovulate as early as 27 days after delivery (not
breastfeed ); 12 weeks (most); 7-9 weeks
(mean),
? the suppression of ovulation due to the
elevation in prolactin
Normal Puerperium
6) Breasts
? Lactation can occur by 16 weeks' gestation,
? Lactogenesis is initially triggered by the
delivery of the placenta (E↓P↓and prolactin),
? the prolactin levels decrease and return to
normal within 2-3 weeks (not breastfeeding)
? The colostrum初乳 (the first 2-4 days)
? The milk continues to change throughout the
period of breastfeeding to meet the changing
demands of the baby,
Normal Puerperium
2,Systemic change
1) Cardiovascular system
? Blood volume returns to nonpregnant levels
by the tenth days of puerperium
? Cardiac output ↑ (immediately after delivery)
→ slowly declines→ reach late pregnancy
levels 2 days postpartum→ normal 2-6 weeks,
2) Hematologic changes
? Hemoglobin concentration↑ on the first
postpartum days
? Several clotting factors (fibrinogen) ↑on the
first days
Normal Puerperium
? Manifestation
1,Fever (24 hours)
2,Pain (uterine contraction)
3,Sweat
4,Lochia 恶露
? a large amount of red blood initially flows
from the uterus as the contraction phase
rapidly occurs,(5 weeks)
? lochia rubra; lochia serosa (brownish red,
with a more watery consistency); lochia alba
(yellow)
Normal Puerperium
? Management
1,2 hours after delivery
? Bleeding
? Uterine contraction
? HR and Bp and R and T
2,1 weeks after delivery
? Bleeding
Normal Puerperium
3,Emiction and defecate
4,Lochia
5,Episiotomy and Laceration
6,Breast
Puerperal Infection
? Puerperal Infection
any bacterial infection of the genital tract after
delivery,Incidence,6%,The most important
cause of maternal death,
? Puerperal Morbidity
temperature 38.0℃ or highter,the temperature
to occur on any 2 of the first 10days
postpartum,exclusive of the first 24 hours,and
to be taken by mouth by a standard technique
at least four times daily,
Puerperal Infection
? Risk factors
1,PROM
2,Anemia
3,Hemorrhage
4,EP and CS
5,Placenta retain
Puerperal Infection
? Common pathogens
1,Aerobes
? Group A,B,and D streptococci溶血性链球菌
? Gram-negative bacteria,Escherichia coli大肠
杆菌,Klebsiella克雷伯氏菌
? Staphylococcus aureus葡萄球菌
Puerperal Infection
2,Anaerobes
? Petococcus species消化球菌
? Petostreptococcus species消化链球菌
? Bacteroides fragilis group脆弱类杆菌
? Clostridium species梭状芽孢杆菌
3,Other
? Chlamydia trachomatis沙眼衣原体
? Mycoplasma species支原体
Puerperal Infection
? Manifestation
? Acute vulvitis vaginitis and cervicitis
? Uterine infection
? Adnexal infections
? Septic pelvic thrombophlebitis 血栓性静脉炎
? Sapremia 败血症
Puerperal Infection
? Diagnosis
? History
? Physical examination and PV
? Lab finding
? Differential diagnosis
Puerperal Infection
? Treatment
1,Nutrition,anemia prevention
2,Antimicrobial treatment
broad-spectrum,high dose,long time
3,Drainage
4,Treatment of thrombophlebitis
Late Postpartum Hemorrhage
? Definition
Uterine bleeding by 24 hours after delivery,
? Etiology
?Placenta or membrane or decidua retain
?Abnormal redintegration
?Infection
?Problems of incision
END
