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Normal Puerperium

Puerperium is the period following childbirth during which the pelvic organs and other body tissues revert back to their pre pregnant state, both anatomically and physiologically, as far as possible.
 

Involution of Uterus

  1. Immediately postdelivery, the uterus measures 20 x 12 x 7.5 cm3 - and weighs 1000 g.
  2. At the end of 6 weeks, the uterus returns back to its pre pregnant size and weighs 60 g.
  3. During puerperium, the number of muscle fibers is not decreased but there is substantial reduction in myometrial cell size.
  4. Withdrawal of estrogen and progesterone leads to increase in collagenase and proteolytic enzymatic activity, leading to autolysis.
  5. Regeneration of the epithelium is completed by the 10th day, and the entire endometrium is restored during the third week except at the placental site where it takes about 6 weeks.
  6. Following delivery, the fundal height remains constant for the first 24 h and then steadily decreased daily by 1.25 cm, so that by the end of the second week the uterus becomes a pelvic organ.
  7. After pains: In primiparas, the puerperal uterus tends to remain tonically contracted, whereas in multiparas, the uterus often contracts vigorously at intervals, giving rise to after pains. They are more pronounced as parity increases. They worsen when the infant suckles, likely because of oxytocin release. Usually, they decrease in intensity and become mild by the third day.
  8. Lochia is the vaginal discharge for the first fortnight during puerperium:

Name

Color

Timing

(days)

Contents

1. Lochia rubra

Red

1-4

Blood, decidua, fetal membranes, vernix,

 

 

 

lanugo, and meconium

2. Lochia serosa

Yellowish, pink, and brownish

5-9

Leucocytes, cervical mucus, and organisms

3. Lochial alba

Pale white

10-15

Decidua, cells, leucocytes, mucin, cholesterin

 

 

 

crystals, and fat cells


The average amount of discharge for the first week is 250 mL and the normal duration is up to 3 weeks.

 

Percent composition of colostrum and breast milk:

 

 

Protein

Fat

Carbohydrate-s,

Water

Colostrum

 8.6

2.3

3.2

86

Breast milk

 1.2.

3.2

7.5

87

 

Lactation suppressors and galactagogues

 

Lactation suppressors

Galactagogues

1. Bromocriptine cabergoline

1. Nipple stimulation

2. Testosterone

2. Breast pump

3. Ethinyl estradiol

3. Metoclopramide

4. Pyridoxine

 





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