Question

Discuss six possible complications that can arise in the pueperium?

Answer 1

PUERPERIUM

Pueperium is the period following childbirth during which the body tissues, especially the pelvic organs revert back approximately to the prepregnant state both anatomically and physiologically.

COMPLICATIONS

Pueriperal pyrexia

A rise of temperature reaching 100.4degree F or more (measured orally0 on two seperated occasions at 24 hour apart (excluding first 24hours) within first 10 days following delivery.

Causes

puerpera sepsis,Urinary tract infection, mastitis, Breast abcess,wound infections,pulmonary infections

Subinvolution

when involution is impaired or retarded ,it is called subinvolution.

causes

predisposing-Grand multiparity,Overdistension of uterus as in twins and hydramnios,maternal ill health, cesarean section,prolapse of uterus.

Aggravating factors-Rtained products of conception, Uterine sepsis

Signs and symptoms

Abnormal lochial discharge,excessive uterine bleeding,irregular cramps like pain,uterine height is greater than normal for the particular day of puerperium

Management

Exploration of uterus for retained products,antibiotic therapy

Urinary complications

*tract infection

it is the most common cause of puerperal pyrexia in 1-5% of deliveries.

organisms responsible are:E.coli,kiebsiella,Proteus.

retension of urine

common in early puerperium.

causes-bruising or edema of bladder neck ,reflex from the perineal injury unaccustomed position.

*incontinence of urine

it can be overflow incontinence,sress incontinence,true incontinence.

*supression of urine

if the 24 hour urine excertion is less than 400 ml or less ,supression of urine is diagnosed.

Breast complications

Breast engorgement

causes-exaggerated normal venous and lymphatic engorggement of the breast whicj precedes lactation.

symptoms-cosiderable pain and feeling of tenderness,heavinessin the both bresats,

Treatment

support breast with abinder or brassiere,frequent scukling manual expression of any remaining milk, analgesics for pain,baby should be put to the breast regularly at frequent intervals.

other breast complication are cracked or retracted nipple, acute mastitis,Breast pain.

Pulmonary Embolism

it is a leadind cause of maternal death.

signs and symptoms

tachycardia ,non specificST change,POmore than 85mmHg,positive DVT

Management(active)

resuscitation,IVfluids,Digitalis to treat tachycardia,if recurrent attacks occur-embolectomy,placement of inferior caval filter or ligation og inferior venacava,surgical treatment is done followinf angiography.

REFERENCE -DC Dutta's textbook of obsterics ,Jaypee publications, 8 th edition ,page no-168,500.512.