1. Definition:

The puerperium is the time taken for a woman to have returned physiologically to her non-pregnant state (6 weeks).

The process by which the uterus returns to its pre-gravid state is known as involution (due to withdrawal of support of the placental hormones) and is caused by the phenomenon of autolysis (enzymatic digestion of  excess cytoplasm and thrombosis and hyaline degeneration of vessels).

The endometrium is regenerated by the 10^th day, except at the placental site where it takes 6wks.

Lochia: uterine discharge of birth consist of blood and necrotic decidua. It persists for about 2wks and gradually becomes colorless and scanty.

Motherhood is accompanied by dramatic effects on the psychology of women, so support must be offered. Better physical and emotional preparation for childbirth had led to a decrease in puerperal morbidity. All mothers should be encouraged to breast feed their babies.

2. Abnormal puerperium:

Includes:

Puerperal pyrexia caused by:

• Genital tract infection.
• UTI.
• Breast infection.
• Thromobophlebitis.
• RTI.

DVT caused by:

• Change in the composition of blood because of hypercoagulable state.
• Stasis.
• Lesions of the vascular intima.
• Diagnosis:
  • History.
  • Examination.
  • USS (Doppler USS).
• Treatment:
  • Tight crepe bandage.
  • Raising the end of the bed.
  • Heparin + warfarin.
• Complication: (Pulmonary embolism).

Mental illness:

• Of every 1000 pregnant women about 17 will be attending the psychiatric clinics. the mental illness in the puerperium is divided into 3 types:
  • Post partum blues: occurs in around 50% of woman within 4 to 5 days of delivery. The mother will suffer from fatigue, anxiety, anger and frustration and all this is due to maladjustment to the situation.
  • Post natal depression: occurs around 4wks after delivery and may last for 6months. The clinical features are of sleep disturbance, depressed mood, social withdrawal and lack of worthiness about being a mother with suicidal thoughts.
  • Puerperal psychosis: occurs in about 0.2% of mothers and the onset is earlier than post-natal depression.
• Treatment of all types of mental illness consists of social support, use of self help groups, referral to psychiatric units.

PPH:

• Post-natal physiotherapy.
• Return of menstruation: in lactating woman menstruation is suppressed for  about 3months after which may return even if breast feeding is continued. If menstruation is occurring so probably is ovulation & F.P. be needed.
• Breast feeding.