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Normal and Abnormal Puerperium cervicitis

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									Normal and Abnormal

          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
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
 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)
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
         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
 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

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