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Puerperium - Coggle Diagram

- - - - Affects 10% of mothers
      - Within 6mo of delivery
      - Symptoms similar to depression
  - - - Symptoms transient
      - No suicidal thoughts
      - Little guilt feeling
      - No loss of self esteem
    - - Symptoms persist over a week
      - Loss of self esteem
      - Guilt feeling, fear of harm
      - Psychomotor retardation and suicidal thought in severe cases
- - - - Treatment: IV augmentin 1.2g Q8H
        
        Oral augmentin for milder cases
        
        Complete the course of antibiotics with oral augmentin 1g BD
        
        If there is persistent or worsening clinical condition in 48 hours
        
        Switch to IV meropenem (1000mg every 8 hours)
        
        And IV amikacin (750mg STAT dose x 1)
- - - - Involution of uterus
        
        Uterus returns back to normal size
        
        Day 1: umbilical level, reduces in size at around 1 finger breadth per day
        
        Day 10-14: not palpable abdominally
        
        6 weeks: non-pregnant size
        
        Involution is usually faster in mothers who breastfeed
      - Lochia
    - - May be torn during delivery or cut (episiotomy) to facilitate delivery
      - Even when the perineum appears intact, some muscle fibers may be damaged
      - Long term complications
        
        Urinary incontinence
        
        Fecal incontinence
    - - Tends to have constipation due to perineal pain
      - Haemorrhoids are common due to increased intraabdominal pressure during pregnancy
      - Pelvic floor weakening can lead to fecal incontinence
    - - The blood that filled the uterus is returned to the body's circulation
  - - - Treatment: antibiotics after swabs for culture
- - - - CBC
        
        Look at whether there is anaemia
      - White cell count
        
        Infection
      - USG
        
        Suspicion of retained products
      - Urinary hCG
        
        Check for GTD
        
        New pregnancy
        
        Proceed to take blood
- - - - Primary
        
        Loss of blood > 500ml within 24 hours of delivery
        
        From the genital tract
      - Secondary
        
        Poorly defined
        
        Any significant bleeding from the genital tract 24 hours after delivery till 6 weeks
        
        Common causes
        
        Retained product of gestation
        
        Infection (endometritis)
        
        Return of menses
        
        In such cases, bleeding should stop within a few days
  - - - Visual disturbances
      - Nausea, vomiting
- - - - 10% of women have ovulatory cycles while breastfeeding
- - - - Toilet / commode instead of bedpain
      - Running warm tap water over perineum
      - Adequate pain relief for perineal pain
      - Suprapubic pressure
    - - Catheter required when retained volume over 500mL
      - Keep for 48h
- - - - Endometritis
      - Retained product of gestation