Writer : Dr. Sayma Tabassum.

The Latin word “Puerperium” means — Childbirth.
Here, ‘Puer’ = Boy & ‘pario’= To bear/bringing forth ;

The Women in Childbirth/labour is called Puerpera

Puerperium বলতে আমরা কি বুঝি? (Definition)

➡️ It is the period following childbirth
during which the body tissues,specially the pelvic organs revert back approximately to the pre pregnant state both physiologically & anatomically.

Duration of puerperium :

➡️ Total duration 6 weeks(42 days)
এই duration কে আবার 3 ভাগে ভাগ করা যায় —
1️⃣ Immediate — within 24 hours (1 day)
2️⃣ Early — upto 7 days (1 week)
3️⃣ Remote — upto 6 weeks

Criteria of normal puerperium–

🔹Temperature, Pulse, BP– normal
🔹No sign of infection
🔹Involution rate of uterus is good
🔹Lochia is normal in amount & color
🔹No breast abnormalities & other complaints

Involution কি? (Definition)

➡️ Involution is the process whereby the genital organs revert back approximately to the pre pregnant state.
📍এখানে genital organ বলতে মূলত Uterus কে বুঝানো হয়েছে।

Pregnancy তে Uterus এ Hypertrophy & Hyperplasia দুটোই হয়। Delivery-র পর এই Hypertrophied & hyperplastic অবস্থা থেকে Uterus progessively & gradually pregnancy এর আগের অবস্থায় ফিরে আসাই Involution.

🔶 Involution is caused by :

✔️Autolysis of muscle fibre by enzymatic action.
✔️Relative anoxia induced by contraction & retraction of the uterus.

Rate of normal involution — from 2nd day of puerperium 1.25cm (half inch) per day till the end of 2nd week of puerperium.

Examination করে কিভাবে বুঝবো কখন Delivery হয়েছিলো❓

Deliveryr 24 ঘন্টা পর থেকে প্রতিদিন 1.25 cm করে ছোট হয় (involution of uterus). এই হিসেবের সাথে Uterus এর Fundal height measure করে মিলিয়ে নিলে delivery date পাওয়া যাবে।

Lochia কি? (Definition)
➡️ It is the vaginal dischage for the 1st fortnight (14 days/ 2 weeks) during puerperium from the uterine body, cervix & vagina.

Types of lochia??
➡️ 3 types ( Remember traffic light colors 🚦 & just change the green into white )

1️⃣ Lochia Rubra —
✔️Duration — 1-4 days
✔️Color — Red/reddish (Rubra means red)
✔️Composition — Blood, Shreds of foetal membranes & deciduas, Vernix caseosa, Lanugo hair & Meconium.
📌 Lanugo hair — 1st hair that grows all oover the body of newborn. This indicates maturity of the foetus.
📌 Vernix caseosa —the waxy or cheese-like white substance found coating the skin of newborn babies.

2️⃣ Lochia serosa
✔️Duration — 5-9days
✔️Color — Yellowish/pale brownish (📌 serum= yellowish)
✔️Composition — Less RBC, More leucocytes, Wound exudates, Mucus

3️⃣Lochia alba
✔️Duration– 10-15 days
✔️Color — pale white (Alba means white)
✔️Composition — Blood, decidua, Vernix, Lanugo hair etc.

Clinical importance of lochia–

✔️ More/persistent lochia rubra– indicates retained bits of placenta/membrane or clots
✔️ Offensive lochia– indicates infection (Puerperal sepsis)
📍Mild puerperal sepsis — offensive & copius lochia
📍Severe puerperal sepsis — odorless & scanty lochia
✔️ Suppression of lochia — indicates some obstruction of internal os (by foreign material/growth etc)

❓ কিভাবে Lochia nature এর history নিব?
➡️ Patient কে 🔹 Number of used pad (amount of lochia) &🔹 Color of lochia র কথা জিজ্ঞেস করব।
➡️ If the patient fails to give history, we can check the used pad to detect the type of lochia.
➡️ In examination, P/V examination can be done to detect the type of lochia.

PNC (Post natal care)

PNC Visit schedule --
✔️1st visit — within 24 hours
✔️2nd visit — after 2/3 days(between 48-72 hours)
✔️3rd visit — after 6/7 days (7-14 days)
✔️4th visit — at 42nd day ( at the end of puerperium)

💠 Postnatal advice given during dischage—
🔶 For mother—

1. Rest for—- 6 weeks
2. Avoid doing heavy work for—- 6 months
3. Avoid coitus for —6 weeks
4. Do not conceive for — 2 years
5. Diet– high calorie, adequate protein, fat, vitamin & minerals (extra 700 calories)
6. Maintenance of personal hygiene
7. Care of breast —
   🔹In case of normal delivery, start breastfeeding immediately
   🔹In case of LUCS, start breastfeeding after 1 hour
   🔹Wash breast after each feed with mild soap & water
   🔹Gentle massage of areola & pull the nipple out ( Okatani massage)
   🔹Prevent nipple inversion & crack (by maintaining good attachment)
8. Care of bowel –take high fibre diet & plenty of liquids.Ensure regular bowel habit
9. Care of bladder — void frequently (6-8 times) & take plenty of fluids
10. Perineal care ( if episiotomy) — clean the wound area with soap & normal water after each defecation & keep it dry.
    (🚫🚫 Don’t use schitz bath)
    11.Post-partum exercise (Kegel exercise)
11. Post natal check up
12. Complete TT schedule if not immunized before
13. Family planning

🔶 For baby—

1. EBF for 6 months & complementary feeding after 6 months. Breastfeeding should be continued upto 2 years of age.
2. Bathing of the baby after 3 days
3. Care of the umbilicus — just keep it dry, nothing should be applied
4. Immunization of the baby from 6th weeks onwards

💠 Contraceptive advice to mother after delivery-

✔️ Barrier method
✔️ IUCD
✔️ Progesterone only pill
✔️ Injectable contraceptive (depo-provera)
✔️ Norplant
📍Exclusive breastfeeding provides 98% contraception

Edited By : Nahid Hassan.