puerperium 安红敏（ii）

8/14/2019 puerperium II

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Continue our class..


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Diseases of puerperium

Puerperal infection Late puerperal hemorrhage Postpartum depression


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Puerperal morbidity is an oral temperature of 38 or more

on any of the first 10 postpartum days ,excluding the first 24 hours.

Puerperal Infection is any postpartum infection of the genitaltract complicating labor or delivery.

Puerperal Infection is different from Puerperal morbidity.

Puerperal morbidity and Puerperal Infection


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Puerperal infectionPuerperal infection

Genital infected by pathogenicmicroorganism during labor and puerperal

period

The incidence is about1%-7.2%It is one of the four kinds of causes whichresult in maternal mortality


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Puerperal morbidity

T of maternal more than 38c occurs twice

within 24h-10 days after birth

It may be caused by puerperal infection,

urogenital infection et al.


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Induction factors of puerperal infection

General asthenia, Dystrophy

Anemia ,Sexual intercourse

PROMpremature rupture of membranes, Infection of

amniotic cavity

Obstetric operation

Hemorrhage pre and postpartum


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The kinds of pathogen Bata-hemolytic streptococcus( ) Anaerobic streptococcus

Anaerobic bacillus

Staphylococcus

Bacillus coli


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Pathology and clinical

manifestationAcute vulvitis, vaginitis,cervicitis

Acute endometritis, myometritis

Acute inflammation of pelvic connective

tissure, Salpingitis, Peritonitis

Thrombophlebitis

Pyemia and hematosepsis


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Diagnosis and treatment

supporting treatment

Delete the induction factors

Infected wound should be opened to secure

adequate drainage, pelvic abscess should be openedabdominally

Broad-spectrum antibiotic

Therapy of thrombophlebitis include bed rest and the use of anticoagulants and antibioticsExpectant treatment


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ProphylaxisAnemia and blood loss must be corrected and replaced by blood

transfusions.

Vaginal examination should be conducted with clean or sterile

gloves.

The delivery must be as atraumatic as possible.

cervix and vagina must be inspected after delivery and the

episiotomy and all lacerations must be repaired.

Placental fragments must not be left within the uterus.

delivery, perineal pads should be sterile and changed

frequently.


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Late puerperal hemorrhage Excessive bleeding in puerperal period

after 24h delivery

It can occur sudden and profuse It can occur slowly but prolonged and

persistent


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Etiology and clinical

manifestation

Retained placenta and membrane

Lochia rubra prolonged

Blood loss repeated or bleeding excessive suddendly

Subinvolution of urerus

Relax of cervix

Placenta tissue can be palpable


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Retained decidua Infection of the placenta attachment area

Subinvolution of uterus

Fissuration of uterine incision postcesarean

Trophoblastic tumor postpartum


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Diagnosis and treatmentsupporting treatmentAnemia and blood loss must

be corrected and replaced by blood transfusions.

Delete the etiologic factors Placentalfragments must not be left within the uterus.

Broad-spectrum antibiotic

Expectant treatment


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Postpartum depression

Considering the excitement, anticipation,

and tension associated with imminent

delivery; the marked hormonal alterations

following delivery.

It is not surprising that some women

experience depression after delivery.


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Depressive disorders

the term depression refers to a mood ,

symptom, or group of syndromes.

sadness

frustration

discouragement


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Depressive disorders types

postpartum blues----does not require

treatment.

Major depression----hospitalization may

be necessary.


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Treatment

mental consultation

Provide environment support

Psychotherapy

Antidepressant medication


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Other complications

Postpartum problems

Postpartum hemorrhage

Postpartum hemolytic uremia

.

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Thanks!

puerperium 安红敏（ii）

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