Trimester periods: know all but specific to 4th (puerperium); see previous study guides for trimester period refresher.
Puerperium & Abnormalities
The time from delivery of the placenta through the 6th week post-delivery. At this point, thebody reverts to non-pregnant state. Includes:
- i) Involution of uterus; size of uterus is usually larger than pre-pregnant state;
- (1) Contractions to reduce uterus
- (2) Afterpains – more pronounced contractions
ii) Lochia – see below
iii) Cervix – closes, becomes firm, regains shape
iv) Vagina & perineum – returns to prepregnant size but not shape. Rugae is often permanently flattened.
v) Pelvic muscles – weakened by childbirth & may take up to 6 months to repair. Kegel exercises arerecommended to strengthen pelvic floor & aid in healing.
vi) Abdomen – still appears pregnant for first couple of weeks post-delivery. Takes 6+ weeks to return tonon-pregnant state.
- ABNORMALITIES:i) Hemorrhage – see below mentioned section
ii) Infection – see below mentioned section
iii) Septic pelvic thrombophlebitis – venous inflammation & thrombus formation with fever & unresponsive to antibiotics treatment. Infiltration of anaerobic bacteria that spreads systemically to other regions ofbody. Symptoms: fever > 38*; resting tachycardia; tachypnea & stridor (if pulmonary involvement;tender, palpable, rope-like mass in ovarian region. Treated w/ anticoagulants & antibiotics.
iv) Endocrine disorders – postpartum thyroid dysfunction; postpartum thyroiditis, resulting in hypothyroidism. Symptoms are same as hypothyroidism.
v) Psychiatric disorders – see Baby Blues section