Topics today
? Normal puerperium
? Diseases of puerperium
? Ectopic pregnancy
? Abortion
Zhao Aimin MD.PhD,
Normal puerperium
(Postpartum care)
Puerperium
? 6 weeks periods after birth
? the reproductive tract return to its
normal,non-pregnancy state
the initial postpartum visit is scheduled at
42th days
Physiology of the puerperium
?Involution of the uterus
? return to the pelvis by about 2 weeks
? be at normal size by 6 weeks
? the weight changes of uterus
? 1000g immediately after birth
? 500g 1 weeks after birth
? 300g 2 weeks after birth
? 50g 6 weeks after birth
?
? Cervix,
? It has reformed within several hours of
? delivery
? it usually admits only one finger by 1 weeks
? the external os is fish-mouth-shaped
? it return to its normal state at 4 weeks after
birth
? Ovarian function
the time of ovulation is 3 months in non-
breast -feeding women
? Cardiovascular system,
return to normal after 2-3 weeks
Clinical manifestaion of
puerperium
T is less than 38?
Involution of uterus
After-pains
onsets 1-2 days and maintant
2-3days
?lochia
discharge comes from the placental site
and maintants for 4-6 weeks
?Lochia rubra
? be red in color for the first 3-4 days
?Lochia serosa
? maintants for 2 weeks
?Lochia alba
? maintants for 2-3 weeks
Management of the
puerperium
? Maternal -infant bonding
rooming in
? Uterine complications
? postpartum hemorrhage,infection,
the amount of lochia
? Bowel movement
? Urination
? Care of the perineum
Management of breast
Breast-feeding
the benefits of breast-feeding
increase the conversation
decrease the cost
improve infant nutrition and protect
against infection and allergic reaction
uterus contraction
Diseases of puerperium
Puerperal infection
Late puerperal hemorrhage
Postpartum depression
puerperal heat stroke
Puerperal infection
Puerperal infection
?Genital infected by pathogenic
? microorganism during labor and
puerperal
? period
?The incidence is about 1%-7.2%
?It is one of the four kinds of causes which
? result in maternal mortality
Puerperal morbidity
T of maternal more than 38? occurs twice
within 24h-10 days after birth
?It may be caused by pueperal infection,
? urogenital infection et al,
Induction factors of puerperal
infection
General asthenia,Dystrophy
Anemia,Sexual intercourse
PROM,Infection of amnotic cavity
Obstetric operation
Hemorrhage pre and postpartum
The kinds of pathogen
Bata-hemolytic streptococcus
Anaerobic streptococcus
Anaerobic bacillus
Staphylococcus
Bacillus coli
Pathology and clinical
manifestation
Acute vulvitis,vaginitis,cervicitis
Acute endometritis,myometritis
Acute inflammation of pelvic connective
tissure,Salpingitis,Peritonitis
Thrombophlebitis
Pyemia and hematosepsis
Diagnosis and treatment
supporting treatment
Delete the induction factors
Broad-spectrun antibiotic
Expectant treatment
Late puerperal hemorrhage
Excessive bleeding in puerperal period
after 24h delivery
It can occur sudden and profuse
It can occur slowly but prolonged and
persistent
Etiology and clinical
manifestation
?Retained placenta and membrane
? Lochia rubra prolonged
? Blood loss repeated or bleeding excessive suddendly
? Dys-involution of tuerus
? Relax of cervix
? Placenta tissure can be palpable
? Retained decidua
? Infection of the placenta attachment
? area
? Dys-involution of uterus
? Fissuration of utrine insision
? postcesarean
? Trophoblastic tumor postpartum
? Submucus myoma
Diagnosis and treatment
supporting treatment
Delete the etiologic factors
Broad-spectrun antibiotic
Expectant treatment
Ectopic pregnancy
Definition
Implantation outside of the uterine cavity is
termed ectopic pregnancy
It is a condition that significantly jeopardizes the
mother because catastrophic bleeding may occur
when the implanting pregnancy erodes blood vessels
or ruptures of the tubal wall
Implant locations
?Tubal 95% (80% ampullary portion)
?Ovarian <1%
?Abdominal 1-2%
?Cervical 0.15%
?Cornual 2%
Etiology
Salpingitis have 6-fold increase the risk of ectopic
pregnancy
Operation of tubal
IUD(intrauterine device)
Dysfunction of tubal
Orther,endometriosis
Outcomes of ectopic pregnancy
Tubal abortion
8-12 Weeks ampullary portion
Rupture of tubal pregnancy
5 weeks isthmic portion
Tubal abortion with subsequent implantation
on an intraperitoneal structure for example liver
pregnancy
Clinical manifestation of ectopic pregnancy
Amenorrhea 70-80% 6-8 weeks
Abdominal and pelvic pain
the most common symptom,which is present in nealy all
patients,Pain is a result of distented of tubal and irritation of
peritoneum by blood
Irregular vaginal bleeding
results from the sloughing of the decidua
Shock result from amount of blood loss
Abdominal mass
Physical findings in tubal pregnancy
General findings,
? Anemic or pale face
? pulse increased
? BP decreased
? T< 38 degree
Abdominal examination
?distention and tenderness with or without rebound
?Decreased bowel sound
?Shifting dullness positive
?mass
Pelvic examination
?Slightly open cervix with bleeding
?Cervical motion tenderness
?Adnexal tenderness
?Adnexal mass
?The uterus size may be normal or enlarged
Diagnostic procedures
Typical cases can be determined easy
Early ectopic pregnancy or unrupture type difficulty
It is nessesary to need assistant examination
?HCG test 80-100% positive
Urinary HCG level
Blood HCG level
If HCG negative,ectopic pregnancy does not be rule out
?Type B Utrasound
?Culdocentesis
Aid in the identification of peritoneum bleeding
Positive (noncloting blood)
ectopic pregnancy may be confirmed
Negative ectopic pregnancy does not be depletion
?Laproscopy
It is a direct visualization and accurte method to
diagnosis ectopic pregnancy
Even laproscopy,however,carries 2-5%
misdiagnosis rate,because an extremely early
tubal pregnancy gestation may not be identified
?Pothology of endometriun
Curettage of the uterine cavity can also help
rule out ectopic pregnancy
Identification of chorionic villi in curetting may
identify an intrauterine pregnancy
Differential diagnosis
?Abortion
?Acute salpingitis
?Acute appendicitis
?Rupture of corpus luteum
?Torsion of ovarian cyst
Treatment of ectopic pregnancy
?Surgical treatment
?Salpingectomy
?Conservative operation
Salpinggostomy
Segmantal resection and tubal reanatomosis
?Nonsurgical therapy
?Chinese traditional medicine
?Chemical therapy
Drug:MTX
Indication
? The diameter of the mass <3cm
? Unrupture
? Not significantly bleeding
? HCG level <2000U/L
Abortion
Definition
Abortion is the termination of a pregnancy
before 28 weeks from the first day of the
last menstrual period and the fetus weight
<1000g
Classification
?Early abortion <12W
?Late abortion 12-28W
?Spontaneous abortion
?Artificial abortion
Etiology
?Genetic factors
?Maternal factors
Infection
systemic factors heart disease sever anemia endocrine
Reproductive tract abnormality
?Immunologic factors
?Enviromental factors Toxin Radiation smoking
alohol
Pathology
1.Haemorrhage
occurs in the
decidua basalis
leading to local
necrosis and
inflammation,
2,The ovum,partly or wholly detached,acts as a foreign
body and irritates uterine contractions,The cervix begins to
dilate,
3,Expulsion complete,The
decidua is shed during the next
few days in the lochial flow,
Clinical manifestation
? Haemorrhage is usually the first sign
and may be significantly if placental
separation is incomplete,
? Pain is usually intermittent,‘like a
small labrur’,It ceases when the
abortion is complete,
Threatened abortion
Low abdominal Pain
company vaginal bleeding
Cervix is closed
unrupture of membrane
Embryo survive
Inevitable abortion
Bleeding increased
Pain development
Ruputure of membrane
Cevix dilation
Embryo tissue
incarcerated in the cervix
Complete abortion
Uterine contractions are
felt,the cervix dilates and
blood loss continues,
The fetus and placenta are
expelled complete,the
uterus contracts and
bleeding stops,No further
treatment is needed,
Incomplete abortion
In spite of uterine
contractions and cervical
dilatation,only the fetus and
some membranes are expelled,
The placenta remains partly
attached and bleeding
continues,This abortion must
be completed by surgical
methods,
Missed abortion
Is the retention of a failed intrauterine
pregnancy for a extended period,usually defined
as more than two menstrual cycles
Recurrent abortion
It is a term used when a patient has had two or
more consecutive spontaneous abortions
Septic abortion
Treatment of abortion
? Incomplete abortion
Remove the embryo and placenta as soon as possible
? Negative pressure suction
? Embryulcia
Missed abortion
Notice blood clot function prevent DIC
Septic abortion
Broad-spectrum antibiotics
Removal of placental
tissue with ovum forceps,
? Normal puerperium
? Diseases of puerperium
? Ectopic pregnancy
? Abortion
Zhao Aimin MD.PhD,
Normal puerperium
(Postpartum care)
Puerperium
? 6 weeks periods after birth
? the reproductive tract return to its
normal,non-pregnancy state
the initial postpartum visit is scheduled at
42th days
Physiology of the puerperium
?Involution of the uterus
? return to the pelvis by about 2 weeks
? be at normal size by 6 weeks
? the weight changes of uterus
? 1000g immediately after birth
? 500g 1 weeks after birth
? 300g 2 weeks after birth
? 50g 6 weeks after birth
?
? Cervix,
? It has reformed within several hours of
? delivery
? it usually admits only one finger by 1 weeks
? the external os is fish-mouth-shaped
? it return to its normal state at 4 weeks after
birth
? Ovarian function
the time of ovulation is 3 months in non-
breast -feeding women
? Cardiovascular system,
return to normal after 2-3 weeks
Clinical manifestaion of
puerperium
T is less than 38?
Involution of uterus
After-pains
onsets 1-2 days and maintant
2-3days
?lochia
discharge comes from the placental site
and maintants for 4-6 weeks
?Lochia rubra
? be red in color for the first 3-4 days
?Lochia serosa
? maintants for 2 weeks
?Lochia alba
? maintants for 2-3 weeks
Management of the
puerperium
? Maternal -infant bonding
rooming in
? Uterine complications
? postpartum hemorrhage,infection,
the amount of lochia
? Bowel movement
? Urination
? Care of the perineum
Management of breast
Breast-feeding
the benefits of breast-feeding
increase the conversation
decrease the cost
improve infant nutrition and protect
against infection and allergic reaction
uterus contraction
Diseases of puerperium
Puerperal infection
Late puerperal hemorrhage
Postpartum depression
puerperal heat stroke
Puerperal infection
Puerperal infection
?Genital infected by pathogenic
? microorganism during labor and
puerperal
? period
?The incidence is about 1%-7.2%
?It is one of the four kinds of causes which
? result in maternal mortality
Puerperal morbidity
T of maternal more than 38? occurs twice
within 24h-10 days after birth
?It may be caused by pueperal infection,
? urogenital infection et al,
Induction factors of puerperal
infection
General asthenia,Dystrophy
Anemia,Sexual intercourse
PROM,Infection of amnotic cavity
Obstetric operation
Hemorrhage pre and postpartum
The kinds of pathogen
Bata-hemolytic streptococcus
Anaerobic streptococcus
Anaerobic bacillus
Staphylococcus
Bacillus coli
Pathology and clinical
manifestation
Acute vulvitis,vaginitis,cervicitis
Acute endometritis,myometritis
Acute inflammation of pelvic connective
tissure,Salpingitis,Peritonitis
Thrombophlebitis
Pyemia and hematosepsis
Diagnosis and treatment
supporting treatment
Delete the induction factors
Broad-spectrun antibiotic
Expectant treatment
Late puerperal hemorrhage
Excessive bleeding in puerperal period
after 24h delivery
It can occur sudden and profuse
It can occur slowly but prolonged and
persistent
Etiology and clinical
manifestation
?Retained placenta and membrane
? Lochia rubra prolonged
? Blood loss repeated or bleeding excessive suddendly
? Dys-involution of tuerus
? Relax of cervix
? Placenta tissure can be palpable
? Retained decidua
? Infection of the placenta attachment
? area
? Dys-involution of uterus
? Fissuration of utrine insision
? postcesarean
? Trophoblastic tumor postpartum
? Submucus myoma
Diagnosis and treatment
supporting treatment
Delete the etiologic factors
Broad-spectrun antibiotic
Expectant treatment
Ectopic pregnancy
Definition
Implantation outside of the uterine cavity is
termed ectopic pregnancy
It is a condition that significantly jeopardizes the
mother because catastrophic bleeding may occur
when the implanting pregnancy erodes blood vessels
or ruptures of the tubal wall
Implant locations
?Tubal 95% (80% ampullary portion)
?Ovarian <1%
?Abdominal 1-2%
?Cervical 0.15%
?Cornual 2%
Etiology
Salpingitis have 6-fold increase the risk of ectopic
pregnancy
Operation of tubal
IUD(intrauterine device)
Dysfunction of tubal
Orther,endometriosis
Outcomes of ectopic pregnancy
Tubal abortion
8-12 Weeks ampullary portion
Rupture of tubal pregnancy
5 weeks isthmic portion
Tubal abortion with subsequent implantation
on an intraperitoneal structure for example liver
pregnancy
Clinical manifestation of ectopic pregnancy
Amenorrhea 70-80% 6-8 weeks
Abdominal and pelvic pain
the most common symptom,which is present in nealy all
patients,Pain is a result of distented of tubal and irritation of
peritoneum by blood
Irregular vaginal bleeding
results from the sloughing of the decidua
Shock result from amount of blood loss
Abdominal mass
Physical findings in tubal pregnancy
General findings,
? Anemic or pale face
? pulse increased
? BP decreased
? T< 38 degree
Abdominal examination
?distention and tenderness with or without rebound
?Decreased bowel sound
?Shifting dullness positive
?mass
Pelvic examination
?Slightly open cervix with bleeding
?Cervical motion tenderness
?Adnexal tenderness
?Adnexal mass
?The uterus size may be normal or enlarged
Diagnostic procedures
Typical cases can be determined easy
Early ectopic pregnancy or unrupture type difficulty
It is nessesary to need assistant examination
?HCG test 80-100% positive
Urinary HCG level
Blood HCG level
If HCG negative,ectopic pregnancy does not be rule out
?Type B Utrasound
?Culdocentesis
Aid in the identification of peritoneum bleeding
Positive (noncloting blood)
ectopic pregnancy may be confirmed
Negative ectopic pregnancy does not be depletion
?Laproscopy
It is a direct visualization and accurte method to
diagnosis ectopic pregnancy
Even laproscopy,however,carries 2-5%
misdiagnosis rate,because an extremely early
tubal pregnancy gestation may not be identified
?Pothology of endometriun
Curettage of the uterine cavity can also help
rule out ectopic pregnancy
Identification of chorionic villi in curetting may
identify an intrauterine pregnancy
Differential diagnosis
?Abortion
?Acute salpingitis
?Acute appendicitis
?Rupture of corpus luteum
?Torsion of ovarian cyst
Treatment of ectopic pregnancy
?Surgical treatment
?Salpingectomy
?Conservative operation
Salpinggostomy
Segmantal resection and tubal reanatomosis
?Nonsurgical therapy
?Chinese traditional medicine
?Chemical therapy
Drug:MTX
Indication
? The diameter of the mass <3cm
? Unrupture
? Not significantly bleeding
? HCG level <2000U/L
Abortion
Definition
Abortion is the termination of a pregnancy
before 28 weeks from the first day of the
last menstrual period and the fetus weight
<1000g
Classification
?Early abortion <12W
?Late abortion 12-28W
?Spontaneous abortion
?Artificial abortion
Etiology
?Genetic factors
?Maternal factors
Infection
systemic factors heart disease sever anemia endocrine
Reproductive tract abnormality
?Immunologic factors
?Enviromental factors Toxin Radiation smoking
alohol
Pathology
1.Haemorrhage
occurs in the
decidua basalis
leading to local
necrosis and
inflammation,
2,The ovum,partly or wholly detached,acts as a foreign
body and irritates uterine contractions,The cervix begins to
dilate,
3,Expulsion complete,The
decidua is shed during the next
few days in the lochial flow,
Clinical manifestation
? Haemorrhage is usually the first sign
and may be significantly if placental
separation is incomplete,
? Pain is usually intermittent,‘like a
small labrur’,It ceases when the
abortion is complete,
Threatened abortion
Low abdominal Pain
company vaginal bleeding
Cervix is closed
unrupture of membrane
Embryo survive
Inevitable abortion
Bleeding increased
Pain development
Ruputure of membrane
Cevix dilation
Embryo tissue
incarcerated in the cervix
Complete abortion
Uterine contractions are
felt,the cervix dilates and
blood loss continues,
The fetus and placenta are
expelled complete,the
uterus contracts and
bleeding stops,No further
treatment is needed,
Incomplete abortion
In spite of uterine
contractions and cervical
dilatation,only the fetus and
some membranes are expelled,
The placenta remains partly
attached and bleeding
continues,This abortion must
be completed by surgical
methods,
Missed abortion
Is the retention of a failed intrauterine
pregnancy for a extended period,usually defined
as more than two menstrual cycles
Recurrent abortion
It is a term used when a patient has had two or
more consecutive spontaneous abortions
Septic abortion
Treatment of abortion
? Incomplete abortion
Remove the embryo and placenta as soon as possible
? Negative pressure suction
? Embryulcia
Missed abortion
Notice blood clot function prevent DIC
Septic abortion
Broad-spectrum antibiotics
Removal of placental
tissue with ovum forceps,
