Ob And Gyn

Terminology 2ºsemestre

Puerperium:

1º Exercise: Define puerperium

Puerperium is defined as

2º Exercise: Fill in the gaps

|BLEEDING | |HEMORRHAGES | |RESTORED | |
|BROWNISH | |HEMOSTASIS | |UTERINE FUNDUS| |
|CONTRACTIONS | |LOCHIA | |VAGINAL DISCHARGE | |
|ENDOMETRIAL LINING | |NOMPREGNANT | |WEIGHS & WEIGHT | |
|PLACENTAL SITE | |REDUCTION| |YELLOW | |


UTERUS:

The pregnant term uterus (not including baby, placenta, fluids, etc) WEIGHS approximately 1000g. In the 6 weeks following delivery, the uterus recedes to a WEIGHT of 50-100g.

Immediately postpartum, the UTERINE FUNDUS is palpable at or near the level of the maternal umbilicus. Thereafter, most ofthe REDUCTION in size and weight occurs in the first 2 weeks, at which time the uterus has shrunk (encoger/reduced) enough to return to the true pelvis. Over the next several weeks, the uterus slowly returns to its NONPREGNANT state, although the overall uterine size remains larger than prior to gestation.

The ENDOMETRIAL LINING rapidly regenerates, so that by the 7th day endometrial glands arealready evident. By the 16th day, the endometrium is RESTORED throughout the uterus, except at the placental site.

The PLACENTAL SITE undergoes a series of changes in the postpartum period. Inmediately after delivery, the CONTRACTIONS of the arterial smooth muscle and compression of the vessels by contraction of the myometrium (“physiologic ligatures”) result in HEMOSTASIS. The size of theplacental bed decreases by half, and the changes in the placental bed result in the quantity and quality of the LOCHIA that is experienced.

Inmediately after delivery, a large amount of red blood flows from the uterus until the contraction phase occurs. Thereafter, the volume of VAGINAL DISCHARGE (LOCHIA) rapidly decreases. The duration of this discharge, known as lochia rubra, is variable. The reddischarge progressively changes to BROWNISH red, with a more watery consistency (LOCHIA SEROSA). Over a period of weeks, the discharge continues to decrease in amount and colour and eventually changes to YELLOW (LOCHIA ALBA). The period of time the lochia can last varies, although it averages approximately 5 weeks.

The amount of flow and color of the lochia can vary considerably. 15% of womenhave continue to have lochia 6 weeks or more postpartum. Often, women experience an increase in the amount of BLEEDING at 7-14 days secondary to the sloughing of the eschar on the placental site. This is the classic time for delayed postpartum HAEMORRHAGES to occur.

3º Exercise:

BREAST

The changes to the BREAST that prepare the body for breastfeeding occur throughout pregnancy. If deliveryensues, lactation can be established as early as 16 weeks’ gestation. Lactogenesis is initially triggered by the delivery of the placenta, which results in falling levels of estrogens and progesterone, with the continued presence of prolactin. If the mother is not breastfeeding, the prolactin levels decrease and return to normal within 2-3 weeks.

The colostrums, which the baby receives in thefirst few days postpartum, is already present in the BREAST, and suckling by the newborn triggers its release. The process, which begins as an endocrine process, switches to an autocrine process; the removal of milk from the BREAST stimulates more milk production. Overthe first 7 days, the milk matures and contains all necessary nutrients in the neonatal period. The milk continues to change...