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Complication of puerperium

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Complication of puerperium

  1. 1. COMPLICATIONS OF PUERPERIUM DR. NAHEED BANO Assistant Professor (Unit 1) Holy Family Hospital
  2. 2. NEWBORN INFANTS NEED • Easy access to mother • Appropriate feeding • Adequate environment • Parental care • Cleanliness • Observation of body signs by someone who cares and can take action if necessary • Access to health care for suspected of manifested complications • Nurturing, cuddling, stimulation
  3. 3. In the Postpartum Period Women Need: • Information/counseling on – Care of the baby and breastfeeding – What happens with and in their bodies including signs of possible problems – Self care/hygiene and healing – Contraception – Nutrition
  4. 4. RESPIRATORY Mechanical •Immediate reduction in intra-abdominal pressure •Chest wall compliance returns to normal with the relief of diaphragmatic pressure •All diameters and angles return to normal 1 – 3 weeks postpartum Biochemical •Feelings of dyspnea disappear shortly after delivery Lung Volumes •Tidal volume and residual volume return to normal •Expiratory reserve volume may remain low for several months
  5. 5. RESPIRATORY Ventilation •Rate returns to normal in First few hours Diffusing Capacity •May remain decreased up to 12 months Acid Base Changes •Maternal antepartum alkalosis and intrapartum respiratory acidosis resolve in first few hours
  6. 6. CARDIOVASCULAR Anatomic •Heart returns to normal placement •Diaphragm returns to normal placement •Decrease in venous and arterial pulsation Cardiac Output =HR x •Increase significantly for 1-2 hours Stroke Volume postpartum(60-80% pre labor) then stabilizes •Returns to normal although may stay elevated for up to 1 year Heart Rate •Decreases immediately PP •Returns to normal 6-8 weeks
  7. 7. CARDIOVASCULAR Stroke Volume •Increases immediately PP •Returns to normal 6-8 weeks Blood pressure •Transient rise in first 4 days •Returns to normal 6-8 weeks Regional blood flow •Returns to normal 6-8 weeks •Split in first heart sound resolves by 2-4 weeks •SEM – 80% resolve by 4 weeks Heart Sounds EKG and Echo-cardiogram •Returns to normal 6-8 weeks
  8. 8. HEMATOLOGICAL Total blood volume •Decreases immediately PP due to blood loss at delivery Plasma volume •Decreases immediately PP due to blood loss and delivery •Increases 3 days PP due to shift of extra cellular fluid into vessels RBCs •RBC production returns to normal levels •RBC count returns to normal by 8 weeks PP
  9. 9. HEMATOLOGICAL Hgb & Hct •Immediate decrease in Hb immediately PP due to blood loss at delivery •Hb levels stabilize by 2-3 days •Hct returns to non-pregnant levels 4-6 weeks WBCs •Decrease to 6- 10,000 after high of 25-30,000 during intrapartum and immediate postpartum •Returns to normal 4-7 days Platelets •Increases at 3-4 days •Gradually returns to non-pregnant levels
  10. 10. HEMATOLOGICAL ESR •Gradually returns to non-pregnant levels after antepartum increase Serum Fe •Increases as Hgb is catabolized •Gradually returns to non-pregnant levels Coagulation factors •Increase in fibrolytic activity in first hours •Slow decrease to non-pregnant levels by 1-4 weeks •Slow decrease in coagulation factors by 1-4 weeks
  11. 11. COMPLICATION OF PUERPERIUM PERINEAL COMPLICATION  Discomfort,Infection,Gaped episiotomy BOWEL FUNCTION  Constipation  Occult anal sphincter trauma  Fecal incontinence due to 3rd or 4th degree tears
  12. 12. BLADDER FUNCTION  Voiding difficulty  Urinary retention  Incontinence • Infection • Stress • Over-flow
  13. 13. LACTATION PROBLEMS • Inadequate milk production • Sore and cracked nipples • Mastitis * Delayed initiation, infrequent or timed feeding * Supplementary feed • Breast abscess
  14. 14. POSTPARTUM HYPERTENSION  Blood Pressure rises in first 48 hours  Get the right balance between over treating and not treating  Postpartum eclampsia  Labetalol/Nifedipine given if BP is persistently above 160/100  Review at 2 weeks
  15. 15. SECONDARY PPH  Bleeding from genital tract between 24 hours and 6 weeks of delivery.  Common between 7-14 days  Mainly due to retained products of conception
  16. 16. THROMBOEMBOLISM  ↑ risk by 5 times  More common after operative delivery  DVT /Pulmonary embolism  Prophylactic anticoagulation in high risk cases • Previous VTE • Thrombophilia,Infection,Pre-eclampsia • Age >35years,parity > 4,BMI > 30 • Operative delivery,PPH
  17. 17. PUERPERAL PYREXIA  Common sites of infection are Chest,Throat Breast Urinary tract Genital tract (puerperal sepsis) Wound infection Legs
  18. 18. PSYCHIATRIC DISORDERS Incidence is 15%-20% Recurrence risk is 50% Risk factors are poor social support, H/O depression, stressful life events Leading cause of maternal death in developed countries  Non- serious emotional disturbance (baby blues).3rd -10th day. Changes in oestriol levels  Puerperal psychosis  Severe postnatal depression
  19. 19. PUERPERAL PSYCHOSIS  Abrupt onset, rarely before 3rd day, mostly on day 5.  Manic/Depressive types  Restlessness,agitation,confusion,fear, insomnia  Refer to psychiatrist  Chlorpromazine 50mg TDS,Haloperidol 5mg BD,Trifluoperazine 5mg BD  ECT in depressive form  Relapse and recurrence are common