Postpartum lecturers often

2021-03-21 12:00 AM

After delivery, the lower and cervical segment dilates and collapses, the outer edge of the cervix corresponding to the outer hole of the cervix is ​​often torn to the sides.

Anatomical and physiological phenomena

Define

When pregnant, the genitals and breasts develop gradually, after giving birth, they will return to their normal condition when they were not pregnant. The return to normal time of the genital organs (except for the breast that is still developing lactation) is anatomically and physiologically known as the postpartum period. This period lasts about 42 days from immediately after birth, in people who do not breastfeed, menstruation can reappear.

Changes in the uterus

Changes in the body of the uterus

After the vegetable book, the uterus shrinks into a safe block, the uterus weight is about 1,000g at that time, after 1 week, the uterus weighs about 500g, the second week is about 300g, the days after 100g, at the end of postpartum weight to normal weight as before pregnancy (50-60g).

There are 3 clinical phenomena:

Spasticity: After the vegetable book, the uterus contractes to perform physiological embolism. Clinically the uterus is a solid mass called a safe mass that lasts a few hours after delivery.

Contractions: In the first few days after birth, the uterus has contractions to expel fluid. Sometimes women have pain, after each pain, they notice a little blood clots and discharge through the vagina.

Uterine contraction: After giving birth, the uterus is about 13 cm above the hip joint, the day after that, the base of the uterus gradually lowers, each day shrinks about 1 cm, so after 2 weeks, the bottom of the uterus is not palpable guard joints. The uterus returns to its unborn size, weight and position within 4 weeks of delivery.

Change in uterine muscular layer

After birth, the uterine muscular layer is 4-5 cm thick. The anterior wall and posterior wall are tightly closed together, the blood vessels are blocked, so the postpartum uterine tomography shows anemia, unlike uterine muscle purple in pregnancy due to increased blood vessel proliferation.

The uterine muscle layer becomes thinner because the muscle fibers become smaller, shorten, some of the muscle fibers degenerate and go away. The blood vessels also contract due to the contraction of the muscular layer.

Changes in the lower uterus and cervix

The postpartum lower uterus segment shrinks like a folding lamp, gradually shortens.

After childbirth, the lower and cervical segment dilates and collapses, the outer edge of the cervix corresponding to the outer hole of the cervix is ​​often torn to the sides. The cervix shrinks and shortens. The hole in the cervix closes on 5 to 8 days postpartum, the cervical canal is re-established as in the absence of pregnancy. The extra cervical hole closes more slowly on day 12, 13 postpartum. The cervical canal is no longer cylindrical, usually conical, the base is lower because the outer hole of the cervix has been deformed, from a round shape to a flat shape and often open.

Changes in the peritoneum and abdominal wall

As the uterine muscle contracts and contracts, it gradually shrinks after birth, the peritoneum covering the uterus also contracts to form wrinkles. These wrinkles are lost quickly because the peritoneum shrinks and atrophy.

Abdominal wall: stretch marks still exist. The abdominal wall muscles also gradually contract. The weight and especially the big straight muscle weight gradually shrinks but the abdominal wall is still bolder than before, when not pregnant, especially in people who have had multiple births, poly amniotic fluid, multiple pregnancy ...

Changes in the uterine lining

Vegetables peel off in the spongy layer, when the vegetables carry out the thick layer, the lost membrane is still intact and will develop and restore the uterine lining.

The uterine muscle layer is thinner in the placenta area than elsewhere. When controlling the uterus, this area is concave, rough. Immediately after spawning, the location of the lettuce is about the size of the palm of the hand, but it shrinks quickly. By the end of the 2nd week, it was only 3 - 4 cm in diameter. Complete restoration of the uterine lining can take up to 6 weeks.

In the area of ​​the clingy membrane, there is no congestion like in the area of ​​the clinging vegetables, so it feels smooth.

After delivery, the uterine lining will go through two stages to return to the function of the normal uterine lining.

Degradation stage: Occurs in the first 14 days after giving birth, the first 2-3 days after giving birth, the shed membrane will differentiate into 2 layers. The surface layer (glandular ducts, cytoplasm ...) is necrotic and drains out with the fluid. The basal layer of the base of the gland remains intact and is the source of the new mucosa.

Development stage: The cylindrical cells in the base of the glands develop and divide under the influence of estrogen and Progesterone. After 6 weeks of delivery, the uterine lining fully recovers and will perform the first menstrual cycle if not breastfeeding.

Changes in appendages, vagina, vulva

Ovaries, ovaries, round ligaments, ligaments gradually return to normal in length, direction and position.

The vulva and vagina that are stretched during childbirth also shrinks and will return to normal in 15 days.

The hymen, after childbirth, is torn, leaving only the remains of the hymen.

Changes in the urinary system

After delivery, not only the bladder wall is swollen and congested, but also congestion under the bladder lining. There is also a bladder volume increase and a relative loss of sensitivity to the pressure of the amount of urine in the bladder. Therefore, after giving birth, it is necessary to monitor the phenomenon of urinary retention and diabetes. The muscular paralysis effect of anesthetics, especially spinal anesthesia, temporary nerve dysfunction of the bladder are additional contributing factors. An injured bladder plus dilated kidney and ureter create favorable conditions for the development of postpartum urinary tract infection. Renal pelvis and ureter that are dilated will return to normal after 2-8 weeks of delivery.

Breast changes

The postpartum breast develops quickly, the breasts are large and firm. The nipples are enlarged, elongated, and the veins under the breast skin are clearly prominent. The milk glands are enlarged, clearly shaped, sometimes spread to the armpits. After about 2-3 days, the breast produces milk, which is called a droop. The mechanism of lactation is postpartum, estrogen levels drop suddenly, Prolactin is released and acts on the milk glands causing lactation.

Lactation is maintained by nipple sucking, which stimulates the anterior pituitary to secrete Prolactin continuously. On the other hand, due to the effect of sucking breast, the posterior pituitary gland secretes oxytocin, which depletes the milk in the lactating gland.

Clinical phenomena

Uterine contraction

After giving birth, the uterus is 13 cm high above the pubic joint, the uterus shrinks 1 cm per day on average, the first day it can shrink 2 - 3 cm faster and after 12 to 13 days after birth, the bottom of the uterus is not found on the joint.

Since there is still blood clots and fluid in the uterus, sometimes the uterus has strong contractions to eject the blood clot and the fluid to the uterus causes pain in the uterus. the uterine muscle is good, the uterus is always contracting. Uterine pain is common in people, the degree of pain depends more or less depending on the feeling of each person, but the more times you give birth, the more pain because the quality of uterine muscle weakens, the uterus needs to contract harder. previous times to push the blood clot and fluid out. Sometimes, these uterine aches require pain medicine because the intensity is so strong. In some women, these pains can last for many days. Special uterine pain can also be experienced with breastfeeding due to the high release of oxytocin. Usually the pain gradually decreases in intensity and the woman feels comfortable by day 3 after giving birth.

Postpartum it is necessary to monitor uterine contraction by measuring the height of the uterus, from the pubic joint to the base of the uterus. The uterine contraction depends on:

In humans, the uterus contracts faster than that in humans.

In a caesarean, contraction is usually faster than that of a caesarean.

Breast-feeding people contract faster than people who are not breast-feeding.

An infected uterus contracts more slowly than an uninfected uterus.

Urinary retention, constipation after delivery of the uterus is pushed up high and contracted slowly.

Clinically, if the uterus is slowly contracting, the uterus is still enlarged and painful, the patient with fever and foul production should think of postpartum infection.

Translation

An fluid from the uterus and genital tract that flows out in the early days of the postpartum period.

Ingredient

Fluid is produced by blood clots and dilute blood flowing from the uterine lining, especially from the placenta, epithelial fragments, cells, epithelial cells in the cervix and vagina degenerate Slough off.

Nature

During the first 3 days, the fluid is diluted entirely with blood and a small blood clot should be dark red. From day 4 to day 8, the fluid is thinner, only a mucus mixed with little blood, so the color is ignoring the fish's blood. From the 9th day onwards, translation is only one translation. Normally, there is never pus in the fluid, but when passing through the vagina, vulva, the fluid loses its sterility and can be infected with pathogenic bacteria.

Odor

The fluid has a strong fishy smell, alkaline pH, if infected, it will have a bad smell.

Mass

Varies depending on people. In the first 10 days, on average, the output can be up to 1500g, especially on the first and second day, the volume can be up to 1000g. After 2 weeks, the epidemic will be less and less epidemic.

In humans, the production of fluid disappears quickly because the uterus contracts faster.

In caesareans, production is usually less than normal delivery.

Clinically, 3 weeks postpartum in some pregnant women may bleed a little, which is the premature menstrual phenomenon due to early recovery of uterine lining.

The descent of milk

During pregnancy, colostrum may be present. After giving birth 2-3 days for a straw, 3-4 days for a compared, under the effect of Prolactin, the breasts will become enlarged and secreted, called the phenomenon of lactation. When getting out of milk, the woman feels uncomfortable, has a low fever ( £   380C), her breasts are tight, firm, and her pulse is a bit fast. These phenomena go away after milk is secreted.

Colostrum is secreted in the first 3 days after birth, is lemon yellow in color, contains high amounts of mineral salts and proteins (globulins and antibodies), and is low in sugar and fat. Colostrum is suitable for babies in the early days. Later, secreted milk will be thicker, sweeter, and that is normal breast milk.

Other phenomena

The shivering cold

Immediately after giving birth, pregnant women can have chills, which are physiological tremors, pulse, temperature, and blood pressure are normal.

Great secret of urination

After delivery, pregnant women can urinate urinary retention due to decreased bowel movements, prolonged labor, and the fetal position presses on the bladder.

Other phenomena of the whole body

The pulse usually slows 10 beats / min and persists 5-6 days after delivery.

Normal temperature does not change.

Blood pressure returns to normal 5-6 hours after birth.

Breathing slowed and deepened as the diaphragm was no longer pushed up.

Blood: In the first days after delivery, Hemoglobin, Hematocrit, and red blood cells are slightly decreased compared to before labor due to the loss of blood during labor. After 1 week, the blood volume returns to almost the same level as before pregnancy. Cardiac output remains elevated for at least 48 hours after delivery. Two weeks after delivery, these changes returned to normal values.

The number of leukocytes, especially granulocytes, increases. Fibrinogen and blood sedimentation rate remain high for at least 1 week after delivery.

Body weight: After giving birth, pregnant women can lose 3 to 5 kg due to the excretion of sweat, urine, fluid production.

If you do not breastfeed, your first menstrual period may be returned after 6 weeks after giving birth and that is also the end of the postpartum period, the first menstrual period is usually much longer and longer than normal periods.

Postpartum care is often

Take care immediately after giving birth

In the first 2 hours immediately after giving birth, it is necessary to monitor the general state of the pregnant woman to detect early blood loss or obstetric dizziness. Monitor the pulse, measure blood pressure, rub the bottom of the uterus to determine the safe volume of the uterus after delivery. Evaluate the amount of blood flowing through the vagina every 15 minutes, at least during the 1 hour postpartum period.

Need early detection and early management of uterine sputum and postpartum bleeding. The uterus shrinks into a safe block. If you find that you lose a safe mass, the uterus is soft, the bottom of the uterus is gradually rising above your navel, there will be bleeding in the uterus.

Need to evaluate postpartum bleeding. Postpartum bleeding can be due to vegetable defects, uterine sputum or genital tract injury. Blood can flow out through the vagina or collect in the uterus without leaking out.

Mental care

Childbirth is a major anatomical and physiological upheaval, and also an emotional upheaval, a woman's life. Therefore, it is necessary to pay attention to motivate pregnant women, explain to women to be assured, do not worry after giving birth, especially in the births that do not match the wishes of the pregnant woman.

Ensure good sanitary conditions for pregnant women

The room is cool in summer, warm enough in winter, clean and quiet. There must be a separate treatment room for pregnant women with infectious and infectious diseases to avoid cross-contamination to other women and to have their own staff.

Limit visiting relatives to give pregnant women a break and to avoid bringing illness to pregnant women and babies.

Follow up pregnant women

Monitor pulse, temperature, blood pressure closely in the first 6 hours.

Follow up daily for the following days to detect early signs of postpartum infection.

Monitor uterine contraction: measure the height of the uterus on the joint and palpate the uterus to evaluate:

The uterus contracts, good or bad.

The density of the uterus is firm or soft.

Move the uterus or palpate the uterus with or without pain.

If the uterus contracts slowly, the density is soft, the pressure of the uterus is infected, and should be treated early.

Epidemic Tracking: By looking at the pregnant woman's daily inventory to evaluate:

Quantity produced more or less.

Has the epidemic been closed (no epidemic is found)

Color of translation.

The smell is not bad, if there is a bad smell, there is an infection.

Monitoring bowel and urination: After giving birth, pregnant women are susceptible to urinary retention and constipation due to decreased bowel movements and bladder muscle paralysis. If the woman is not able to urinate 12 hours after giving birth despite medical treatment such as bladder massaging, hot compresses, acupuncture ..., she must clear the bladder and then pump into the bladder 5-10 ml of solution. Glycerin borate 5% to stimulate bladder contraction. If urinary failure still exists, the bladder must be washed in the next day, and then injected with glycerin borate until the woman can urinate on her own.

If pregnant women are constipated, they need to give laxatives, after 3 days they cannot go out, they must enema or pump Microlax into the rectum. Note, for pregnant women after giving birth, do not use strong bleach.

Take care of

To make topical medicine: wash the vulva area, perineal layer and anus for pregnant women at least 2 times with cooking water or a mild antiseptic solution (Betadin, Providine), then replace sterile lozenges. Do not douche because the cervix is ​​not closed in the first few days after giving birth, water can pass through the cervix into the uterine cavity causing an upstream infection.

For cases with episiotomy cutting and stitching, after making medicine, it is required to dry and clean loincloths.

Note: To do external medicine, wash from the vulva to the anus, not vice versa.

Breast care: Keep the nipples clean to avoid infection. Advise pregnant women to breastfeed as soon as possible after giving birth to their baby to stay with the mother to stimulate milk secretion and make the uterus contract better.

When there is a blockage phenomenon, it is necessary to day, express or pump to prevent blockage of milk resulting in a breast abscess. If a nipple crack occurs, the baby must stop feeding on that side, wash the nipple, blot dry and apply 5% Glycerin borate.

Hygiene, exercise and nutrition regimes

You can bathe on the 3rd day after giving birth by pouring water. Do not take a bath in a draft, or soak in a tub of water because the cervix is ​​open.

Intercourse should be avoided in the postpartum period because it is susceptible to infection.

Eat well, abstain from stimulants such as alcohol, tea, coffee, cigarettes ...

Get enough sleep to quickly recover your health and get enough milk to feed your baby.

Dressing mode: loose, clean, airy clothes, do not wear clothes that are too tight.

Movement mode: motionless for the first 24 hours, 6-8 hours after giving birth, motionless in bed, but being able to turn around, stretch limbs. Light exercise can be done to avoid constipation; helping to eat well and making the abdominal wall muscles recover quickly. A week after giving birth can be light work. Avoid heavy labor, carrying heavy loads in the postpartum period to avoid causing genital prolapse.