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Chapter-46 Abnormalities of Puerperium

BOOK TITLE: Essentials of Obstetrics

Author
1. Gupta Krishnendu
2. Chakravarti Sudip
3. Datta Sajal
ISBN
9788180613623
DOI
10.5005/jp/books/10288_46
Edition
1/e
Publishing Year
2004
Pages
8
Author Affiliations
1. Vivekananda Institute of Medical Sciences, Ramakrishna Mission Seva Pratishthan, Kolkata, Vivekananda Institute of Medical Sciences, Kolkata, India, Vivekananda Institute of Medical Sciences (VIMS), Kolkata, Kolkata, Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India, Vivekananda Institute of Medical Sciences, Kolkata, West Bengal; Indian College of Obstetricians and Gynecologists, Mumbai, Maharashtra, India, Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India; Kasturba Medical College, Manipal, Karnataka, India, Vivekananda Institute of Medical Sciences, Ramakrishna Mission Seva Pratishthan, Kolkata, West Bengal, India, Vivekananda Institute of Medical Sciences (VIMS), Kolkata, West Bengal, India, Vivekananda Institute of Medical Sciences, Ramakrishna Mission Seva Pratishthan Kolkata
2. Vivekananda Institute of Medical Sciences, Ramakrishna Mission Seva Pratishthan Kolkata, Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India, Ramkrishna Mission Sevapratisthan, Kolkata; Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India, Vivekananda Institute of Medical Sciences, 99 Sarat Bose Road, Kolkata, Bengal, India, Vivekananda Institute of Medical Sciences, Kolkata, India, Vivekananda Institute of Medical Sciences and Ramkrishna Mission Seva Pratisthan, Kolkata
3. Vivekananda Institute of Medical Sciences, Ramakrishna Mission Seva Pratisthan Kolkata, Vivekananda Institute of Medical Sciences, Ramakrishna Mission Seva Pratishthan, Kolkata, Vivekananda Institute of Medical Sciences, Kolkata, India, Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India, Columbia Asia Hospital, Salt Lake; Vivekananda Institute of Medical Sciences; Ramkrishna Mission Seva Prathishthan Hospital, Kolkata, West Bengal, India
Chapter keywords
puerperium, maternity care, pregnancy, infection of the breast, infectious mastitis, lactating women, skin, cracked nipple, breast, thromboembolism, clot embolus, soleal, pelvic veins, pulmonary circulation, urinary tract infection (UTI) postpartum, physiologic state, catheterization, birth trauma, conduction anesthesia, continuous contamination of the perineum, obstructive lung disease, smokers, general anesthesia, pneumonia postpartum, laceration, episiotomy, infection, breakdown of the wound, contamination, genital area, pelvic abscess, cul-de-sac abscess, acute pelvic inflammation, lower uterine, cervical, paravaginal injuries postpartum, uterine inversion, prolapse of the fundus, cervix, traction on the cord, placental separation

Abstract

The puerperium is indeed a time of great importance for both the mother and her baby, and yet it is an aspect of maternity care that has received relatively far less attention than pregnancy and delivery. Infection of the breast (synonymous with: infectious mastitis) occurs almost exclusively in lactating women. This infection usually enters through a break in the skin (cracked nipple). It is usually confined to one quadrant of the breast. The postpartum period is the most common time in pregnancy for a thromboembolism, as the puerperium fills all the criteria for Virchow’s triad. The most common resting place of a clot embolus from the soleal or pelvic veins is in the pulmonary circulation. About 2 to 4 percent of women develop urinary tract infection (UTI) postpartum. This altered physiologic state, in conjunction with catheterization, birth trauma, conduction anesthesia, frequent pelvic examinations, and nearly continuous contamination of the perineum, is sufficient to explain the high incidence of lower UTIs postpartum. Women with obstructive lung disease, smokers, and those undergoing general anesthesia are at increased risk of developing pneumonia postpartum. In general, the more extensive the laceration or episiotomy, the greater the chances for infection and breakdown of the wound. More tissue is devitalized in a large episiotomy, thereby providing greater opportunity for contamination. Women with infections elsewhere in the genital area are probably at a greater risk for infection of the episiotomy. Pelvic abscess (synonymous with: cul-de-sac abscess) may occur as a sequelae to acute pelvic inflammation and/or lower uterine, cervical or paravaginal injuries postpartum. Uterine inversion is the prolapse of the fundus to or through the cervix, so that the uterus is in effect turned inside out. Almost all cases of inversion occur after delivery and may be worsened by excess traction on the cord before placental separation.

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