MSALABA obsgyn

Jul 29th, 2016
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This document covers normal and abnormal puerperum

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THE NORMAL AND ABNORMAL PUERPERIUMPuerperiumPeriod of adjustment after pregnancy and delivery when Anatomic and physiological changes of pregnancy reversed Body returns to the normal non-pregnant state.Factors that may affect these changes Time frame varies with the organ systems Alterations because of complications of labour or delivery Alterations because of administration of exogenous drugs and hormones Pre-existing medical and surgical conditions of pregnancy New behaviour patterns e.g. breastfeeding1Periods of puerperium (arbitrary division) Immediate puerperium- first 24hrs after parturition when acute post anaesthetic or post deliverycomplications may occur. Early puerperium- Extends until the first week postpartum Remote puerperium- Includes that period of time required for the involution of genitalorgans, traditionally upto sixth week postpartum.Anatomic and Physiological Changesa) Uterine Involution: Oestrogens Progesterone Chronic uterine muscle stretchingAll act synergistically to stimulate synthesis of actinomysin and collagenWithdrawal of steroidsafter deliveryIncreased activity of uterine collagenaseRelease of proteolytic enzymesMacrophages also migrate into endometrium and myometriumThe two factors lead to rapid catabolism of uterine tissue as shown by: Release of approximately 20g of nitrogen Increase in urinary excretion of creatinine and ureaMain reason of uterin

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