postpartum period. Complications of the postpartum period

Sometimes there may be various pathologies during the postpartum period. We will consider here the main ones, indicate the causes of their occurrence and preventive measures.

Delayed postpartum discharge(lochia) occurs when the uterus is bent backwards (with prolonged bed rest) and its slow contraction. The woman notes a sharp decrease in the release of lochia, a feeling of heaviness in the lower abdomen, chills, fever. In order to prevent delayed discharge, it is recommended to get up as soon as possible after childbirth, postpartum physiotherapy, timely emptying of the bladder and intestines.

postpartum ulcer occurs on the 3rd - 4th day after childbirth as a result of infection of the wound surface of the perineum, vagina and cervix. The inflammatory process is accompanied by the formation of necrotic plaque. Sometimes noted subfebrile temperature. The diagnosis is made during a gynecological examination of the perineum, vagina and cervix. An ulcer is a wound surface covered with a grayish plaque that is firmly seated on the base. Peripheral tissues swollen and hyperemic. In order to prevent postpartum ulcers, the toilet (washing) of the external genital organs of the puerperal is performed 2 times a day. If stitches were placed on the perineum, then they are treated with an antiseptic solution.

Postpartum endometritis usually develops as a result of the penetration of microbes into the remnants of the decidua of the uterus with the involvement of adjacent areas of the myometrium in the process. The cause of the inflammatory process is usually a staphylococcal, streptococcal or colibacillary infection. The disease begins on the 3rd - 4th day after birth. The temperature rises to 380C, the pulse quickens, but corresponds to the temperature, there is a single chill. The general condition is almost not disturbed. Local changes: subinvolution of the uterus, soreness "along the ribs of the uterus" - the location of large lymphatic vessels, lochia with an admixture of pus. The disease lasts 8-10 days.

Postpartum parametritis- a consequence of the spread of infection (staphylo-streptococcus, Escherichia etc.) by the lymphogenous route from a postpartum ulcer or an infected uterus. The penetration of infectious agents into the parametric tissue is facilitated by ruptures of the cervix and the upper third of the vagina. Inflammatory effusion quickly becomes dense, which gives a characteristic consistency to the affected tissues. The disease begins acutely on the 2nd week after delivery with deterioration general condition, chills, high fever, urination disorders.

Endometritis often accompanies parametritis. Peritoneal symptoms are mild or absent, since the inflammatory infiltrate is located extraperitoneally. Diagnosis is based on clinical picture and data gynecological examination. On the side of the uterus, a dense infiltrate (one- or two-sided) is palpated, reaching the walls of the pelvis.

Postpartum salpingo-oophoritis- inflammation of the uterine appendages. The causative agents of infection are microbes of the septic group; most often a complication of endometritis. The infection spreads lymphogenously or through the fallopian tubes. The inflammatory process first captures the fallopian tubes, then passes to the ovaries, forming a single conglomerate. The disease develops on the 8th - 10th day after childbirth, accompanied by a deterioration in the general condition, an increase in temperature to 38 - 39 ° C, chills, tachycardia, severe pain in the abdomen, nausea, bloating; signs of irritation of the peritoneum are noted. In a vaginal examination, endometritis and pastosity of the uterine appendages are determined on one or both sides. The uterine appendages are sharply painful on palpation. Differentiate with parametritis, thrombophlebitis of the pelvic veins, acute appendicitis.

Postpartum pelvic peritonitis(pelvioperitonitis). The causative agent of infection are microbes of the septic group, less often gonococcus. The infection spreads mainly by the lymphogenous route from the uterus. It is often a complication of salpingo-oophoritis. The defeat of the peritoneum leads to the formation of serous or purulent exudate. The process tends to be limited to the pelvic area. Occurs on the 1st - 2nd week after childbirth. The onset is acute: chills, high fever, sharp pains in the lower abdomen, flatulence.

After a few days, the patient's condition improves, in the lower abdomen begins to palpate the boundary furrow, delimiting inflammatory process in the pelvis. At vaginal examination at the beginning of the disease, only a sharp soreness of the posterior fornix of the vagina is found. In the following days, an effusion begins to be clearly palpated, protruding posterior fornix dome-shaped vagina.

Postpartum thrombophlebitis there are superficial veins lower extremities, uterine veins, pelvic veins or deep veins of the lower extremities. Thrombophlebitis of the superficial veins of the lower extremities usually occurs against the background of varicose veins veins. The inflamed veins are tense, painful on palpation, the skin over the affected area is hyperemic, the temperature is subfebrile, slight tachycardia.

Thrombophlebitis of the veins of the uterus is characterized by symptoms of subinvolution of the uterus, prolonged bleeding from the vagina, fever, increased heart rate. Vaginal examination may reveal tortuous cords (veins) on the surface of the uterus. Thrombophlebitis of the pelvic veins develops at the end of the 1st week after childbirth, accompanied by high temperature, increased heart rate, chills, deterioration in general condition. During vaginal examination, tortuous and painful veins are determined on the side walls of the small pelvis.

Thrombophlebitis of the deep veins of the lower extremities occurs on the 2nd week of the postpartum period. The onset of the disease is acute, accompanied by pain in the leg, the appearance of edema, chills, fever, the pulse is much faster (more than 120 beats per minute). At objective research pay attention to the smoothness of the inguinal fold of the affected limb; palpation in the area of ​​​​the Scarpov triangle with thrombophlebitis of the deep veins of the thigh is painful. Pain is also noted along the large vascular trunks of the thigh and lower leg. The duration of the disease is 6-8 weeks.

The postpartum period is dangerous with the occurrence of complications. During this period, a woman needs special care and attention so as not to miss a life-threatening health effect. Postpartum complications can occur both in the early and late period after childbirth.

The early postpartum period lasts two hours after the end of the third stage of labor, during all this time the woman is on the delivery table under supervision medical staff. The late postpartum period continues for another month and a half after childbirth. During this time, the woman visits the antenatal clinic, with her conduct preventive conversations to prevent complications.

Classification of postpartum complications

Complications arising from a dead fetus and complications after epidural anesthesia of childbirth were singled out as a separate group.

Complications after epidural anesthesia of childbirth in a woman

Epidural anesthesia - effective method labor pain relief in women. Epidural anesthesia is carried out strictly according to indications in the first stage of labor, not later. With the help of this type of anesthesia, contractions can be anesthetized, but further labor activity (attempts and contractions preceding them) are not anesthetized.

Most often, epidural anesthesia is used for anomalies labor activity, rarely in physiological childbirth. Contraindications to its implementation are:

• Individual intolerance to the components of the drug.
• Deformities of the bone canal of the spine.
• Thrombocytosis and increased blood clotting.
• Infection of the skin at the puncture site.
• Second stage of labor, cervical dilatation more than 6 cm.

Epidural anesthesia has its own consequences, among which are:

1. Allergic reactions up to anaphylactic shock. In this case, a malfunction occurs in the work of all body systems, which requires medical care. To avoid this, before the introduction of the drug, tests are carried out on the tolerance of the components of anesthesia.
2. Asphyxia, difficulty entering and exhaling. Occurs when the drug was administered above lumbar and with good absorption of the components of the mixture. There is a failure in the work of the intercostal muscles. A serious consequence, which is stopped by connecting a woman to the device artificial ventilation lungs.
3. Pain in the lumbar region.
4. Headache.
5. Decreased blood pressure due to the effect on the cardiovascular system of the components of epidural anesthesia.
6. Difficulties in urination and defecation.
7. Paralysis or paresis of the lower extremities.
8. The entry of anesthesia components into the general circulation, which leads to intoxication, metabolic disorders, headaches and nausea.
9. Lack of analgesic effect from anesthesia or anesthesia of only one half of the body.
10. One of the most formidable complications of epidural anesthesia is labor anomalies. If the components of the drug circulate too long in cerebrospinal fluid or absorbed into the blood, the doctor and the woman herself may miss the moment of full disclosure of the cervix. On the birth table, it is important for a woman to understand the period of attempts so that the baby passes through the birth canal in accordance with labor activity. During anesthesia, a state of discoordination occurs, the woman does not catch periods of attempts. There is a high risk of ruptures and injuries of the birth canal, there is a weakness of contractions and attempts.

Complications after a dead fetus

Intrauterine fetal death can occur both in early and on later dates pregnancy or during childbirth. The complications of stillbirth are the same as after normal physiological childbirth. Most frequent complications- infectious. Therefore, it is especially important to remove the dead fetus from the womb as soon as possible.

On early dates most often there is a miscarriage. If this does not happen, curettage of the uterus is carried out. If the fetus died in the later stages, miscarriage does not occur. To extract the fetus, artificial stimulation of labor is carried out, followed by the imposition obstetric forceps or carrying out a fruit-destroying operation. To prevent infection, a thorough examination of the uterine cavity and ultrasound control are carried out. A woman is observed by a gynecologist for six months, where the cause of miscarriage is also clarified.

Another possible complication late miscarriages and stillbirths - mastitis. Milk in the mammary glands is produced for several weeks after the death of the fetus, which leads to lactostasis. For prevention, it is recommended to take drugs that suppress lactation and express milk from the breast daily.

For liquidation psychological complications a woman, if necessary, is referred to a psychologist. Bleeding, ruptures, eversion and atony of the uterus after a dead fetus are practically not observed.

Bleeding

Bleeding often complicates the postpartum period. Normal physiological blood loss is no more than 300-400 ml of blood. Anything above is considered pathological bleeding, which requires the immediate intervention of medical personnel and stop bleeding. The diagnosis of massive blood loss is made in case of loss of more than 1 liter of blood fluid. Massive blood loss is the main cause of maternal mortality.

Bleeding can occur in both the early and late postpartum period. Prevention of this complication is carried out throughout all periods of childbirth, up to the very discharge of the patient from the maternity ward.

Important to remember! Bleeding can also occur after discharge, at home. If you notice bloody issues from the scarlet genital tract, call immediately ambulance or go to the emergency room.

The causes of bleeding are varied. Main preventive measures the doctor undertakes: the woman in labor is injected with hemostatic drugs and drugs that reduce the uterine muscles, increasing their tone.

Infectious complications in women

It is also a fairly common pathology that can occur in a latent, erased form or with a detailed clinical picture and serious health consequences. Let us dwell on the most common pathologies.

Postpartum endometritis and chorioamnionitis

These diseases begin with an increase in body temperature to subfebrile (up to 39 C) and febrile temperature numbers (above 39 C), chills, weakness, loss of appetite, pain in the lower abdomen. Discharge from the vagina changes color: becomes abundant, with bad smell. Involution and contraction of the uterus is disturbed. IN severe cases infection can go from local forms to a generalized infection - sepsis and septicopyemia.

Prevention begins with the introduction of antibiotics immediately after childbirth, careful decontamination of postpartum sutures and examination of the birth canal. Even with the slightest doubt about the presence of remnants of the placenta or membranes in the uterus, a manual examination of all the walls of the uterus is carried out, if necessary, curettage.

What can you do:

The main rule for preventing infection is the observance of the rules of personal hygiene. Listen to your doctor's advice.

1. Rinse daily with warm water, preferably after each trip to the toilet.
2. Change pads at least 4-5 times a day.
3. Sanitize chronic foci of infection, especially the genital tract.
4. Treat daily postpartum sutures disinfectant solution until they are completely healed.

postpartum mastitis

Mastitis is an inflammation of the mammary glands. Mastitis occurs in mild forms. However, if it is not recognized in time, then gangrene may occur, which will entail the removal of one breast.

In puerperas with heart disease, after the end of the birth act, the risk of complications does not decrease.

S. S. Indenbaum (1938), N. F. Rybkina (1960), E. F. Ukraintseva (1962), N. M. Didina (1966), Mendelson (1960), who observed deaths childbirth due to heart disease, note that death occurs in the postpartum period more often than during pregnancy or childbirth.

NM Didina from 1914 to 1963 collected in the literature 358 cases of maternal mortality due to heart defects. Of these, 238 patients (66.4%) died in the postpartum period.

In the puerperal period, complications can be expressed primarily in the occurrence or increase in circulatory disorders, respiration and uterine contractility.

In the first hours after childbirth, due to the shutdown of the placental circulation, the movement of blood from the vessels of the contracting uterus (more than 1 l, according to I. F. Zhordania) into the general circulation, as well as the so-called bleeding into the vessels abdominal cavity due to the decrease intra-abdominal pressure after emptying the uterus, the cardiovascular system is subject to high demands. In women with heart disease, this stress can cause or worsen heart failure.

In the postpartum period, circulatory disorders by the type of right ventricular failure is a common complication. Most often it occurs in patients with stage IV mitral stenosis and with multivalvular heart disease. These patients have a pronounced general weakness, cyanosis of the lips and acrocyanosis, bad dream, shortness of breath increases, heartbeat quickens. Neck veins swell. Congestive rales are heard in the lungs. The liver increases, its edge sometimes falls to the level of the navel. On palpation, its edge is dense and painful.

These symptoms during vaginal delivery often increase until the 3rd day of the postpartum period, then stabilize for 1-2 days and finally subside. With delivery by abdominal, an increase in decompensation is usually observed until the 6-7th day.

Less commonly, signs of heart failure in the postpartum period progress, despite active therapy, and then peripheral edema appears, first on the feet and legs, then ascites occurs in the sacro-lumbar region.

The endocrine role of the placenta is known. After its rejection, the level of corticosteroids decreases, especially in puerperas with incompetence of the adrenal cortex due to a long rheumatic process and circulatory decompensation. In such patients in the early postpartum period with physiological blood loss (no more than 300 ml), one can observe a sharp sudden deterioration in blood circulation by the type of collapse.

A frequent complication of the postpartum period is pulmonary edema due to left ventricular or total heart failure.

Significant hemodynamic fluctuations in the puerperal period contribute to the occurrence of thromboembolism in the system pulmonary artery with the subsequent development of pulmonary infarctions and perifocal pneumonia.

The immobile position of the patient after childbirth leads to the occurrence of ventilation disorders and atelectasis of the lungs, which in turn is one of the main predisposing factors for the development of pneumonia.

Impaired function congestive liver (cardiac cirrhosis) with a decrease in blood clotting on this basis can lead to abundant uterine bleeding both in the early postpartum and in the later period.

sustainable arterial hypotension(at systolic pressure below 90 mm Hg. Art.) in puerperas creates the basis for thrombophlebitis and thromboembolism after a shift bed rest to a more active one.

Pain factor, especially in multiparous, associated with painful contractions postpartum uterus, the presence of stitches on the perineum (especially after episiotomy), undoubtedly has an impact on a number of postpartum complications, and primarily on the part of the cardiovascular system (violations heart rate and etc.). This should include some cases of urinary retention, gas retention, pneumonia due to gentle breath holding and cough shock.

However, when assessing the severity of the patient's condition after childbirth, it should be borne in mind that pulse lability is a typical state of the physiologically occurring puerperal period. The displacement of the lower border of the liver beyond the edge of the costal arch does not always indicate the presence of stagnation in the body. N. M. Didina (1966) observed a pronounced displacement of the liver borders down with a significant protrusion from under the edge of the costal arch (by 1.5-2 cm) in somatically healthy puerperas, which, apparently, depends on general ptosis abdominal organs, which manifests itself in the first days after childbirth, and is associated with overstretching of the abdominal wall by displacement of organs after emptying the uterus.

It should also be borne in mind that the increase in decompensation phenomena (tachycardia, shortness of breath, congestion in the lungs, liver, etc.) in patients in the postpartum period may not be accompanied by a decrease in diuresis. It is known that the physiologically proceeding postpartum period is accompanied by a significant drop in the level of aldosterone excretion (Venning and Dyrenfurth, 1956), which plays an important role in sharp rise diuresis after childbirth (physiological polyuria). Therefore, in patients with cardiac decompensation and their characteristic aldosteronism during pregnancy, diuresis may remain normal during the first days after delivery.

Symptoms of heart failure in a number of patients from the 6-7th day begin to increase again, which is usually associated with an exacerbation of the rheumatic process.

Thus, during the puerperal period in patients with heart disease, two critical periods are observed. The first period falls on the first 2-3 days after birth, when there is an increase in circulatory decompensation. The second period corresponds to the 6-7th day, when, due to a decrease in the level of corticosteroids in the body, the ground is created for exacerbation of rheumatism (see section ""). These periods must be taken into account when determining the regimen and therapeutic measures.

Severe consequences rheumatism and hypoxia often adversely affect the involution of the postpartum uterus and the regenerative processes of the endometrium. Often (in 8.5% of cases, according to N. M. Didina), these puerperas have subinvolution of the uterus, prolonged spotting is observed in the absence of signs of postpartum infection.

MV Alexandrov (1949) studied the pathomorphological picture of the uterus and ovaries in patients with rheumatic heart disease and found that the main change in the genital organs in rheumatism is sclerosis in all parts of the reproductive apparatus. Apparently, subinvolution of the postpartum uterus is associated with this.

It has been established (AK Apatenko, 1952) that in patients with decompensated heart disease there are significant changes in the skeletal muscles. With chronic decompensation, atrophy is observed in it. muscle fibers, their fibrillar splitting, waxy transformation, myelosis, vacuolar and fatty degeneration. Under these conditions, regenerative abilities muscle tissue, undoubtedly worsen, and with this we associate an increased frequency (7.1% of cases, according to N.M. Didina) of partial divergence of sutures on the perineum and on the abdominal wall (after caesarean section), without signs of suppuration. At the same time, in 50 patients observed by us, in whom biological glue MK-3 was used during the restoration of the damaged perineum during childbirth, healing occurred by primary intention.

I. I. Yakovlev (1928), S. S. Indenbaum (1938), A. Yu. Lurie and N. Ya. puerperas with heart disease. According to Zoltan (1961), in 19.4%, and according to N. M. Didina (1966) - in 29.7% of cardiac patients, a complicated course of the puerperal period is observed. 13.8% of them had postpartum septic diseases and 15.9% had other complications (pneumonia, pyelitis).

Postpartum septic diseases were observed in 11.9% of patients with compensated heart disease and in 15.7% of patients with decompensated heart disease.

Naturally, the frequency of postpartum diseases is affected by complications in childbirth, which are often observed in patients with heart disease (untimely outpouring of water, anomalies of labor forces, pathological blood loss, etc.). Of no small importance in creating the soil for postpartum complications are also operations in childbirth, which is confirmed by the studies of V. Ya. ), A. Ya. Tarasevich (1964) and others.

However, the largest number of postpartum septic diseases is associated with the active phase of rheumatism. Among puerperas with acute rheumatism, the prevalence of postpartum septic diseases reaches 41.6% (N. M. Didina).

Of the diseases of septic etiology in puerperas with heart disease, mastitis, metroendometritis, postpartum ulcers are most often observed, less often Metrophlebitis and thrombophlebitis of the veins of the pelvis and legs.

There are no pronounced deviations from the typical period of development of symptoms of the listed diseases in puerperas with heart disease. Metroendometritis and postpartum ulcer are detected on the 3-5th day, thrombophlebitis - on the 12-14th day after birth.

Data on the features of the course of postpartum diseases with heart defects are heterogeneous. So, A. A. Polyakova and N. A. Abdieva (1957) believe that postpartum diseases in cardiac patients, the flow is more sluggish and prolonged than in somatically healthy women. At the same time, according to our clinic, in the clinical picture and the timing of the course of these diseases, there is no dependence on the presence of heart disease.

Thus, in addition to the two critical periods noted above during puerperia in cardiac patients, there is heightened danger development of postpartum septic diseases due to active rheumatism. Prevention of these complications is of exceptional importance long before childbirth, from the very beginning of pregnancy, and should include persistent treatment of rheumatism.

Insufficient secretion of milk (hypogalactia) is often found in puerperas suffering from heart disease. According to N. M. Didina (1966), hypogalactia is observed in 12.5%, and according to the observations of L. N. Granat et al. (1967), in 17.5% of such women. Predispose to its occurrence neurohormonal disorders, late attachment of the child to the breast, insufficient development of his sucking reflex. Breast function is also affected by some medicinal substances used in the puerperal period with therapeutic purpose. So, pituitrin, oxytocin, glutamic acid increase the secretion of milk, and camphor preparations, diuretics, suppress it.

The discharge of the placenta after the birth of a child marks the beginning of the postpartum period. It lasts 6-8 weeks. At this time, there is an involution of the organs and systems of the female body that took part in pregnancy and childbirth. uterus, cervix, the cardiovascular system return to their pre-pregnancy state. The mammary glands begin to function in connection with lactation. Especially strong changes occur in the genitals.

Understanding how the recovery process goes will help a woman feel confident in the first days and weeks. This article is about the changes that are taking place in female body after childbirth.

The duration of the early postpartum period is 2-4 hours after the placenta has passed. At this time, the young mother is under the supervision of an obstetrician and gynecologist. The midwife monitors pressure, uterine contractions, and monitors secretions. Postpartum complications most often occur in the first 4 hours, so strict monitoring of the condition of the puerperal is necessary. The doctor examines the uterus with the help of gynecological mirrors, and checks the condition of the vagina. If necessary, sews up damage, cuts or tears. Information about how the birth went, and indicators of the woman's condition are documented in the history of childbirth.

In the first hours after childbirth, the puerperal usually experiences severe fatigue due to exhausting contractions. But you can't sleep at this time. Otherwise, hypotension of the uterus may develop, which means a weakening of its contractions.

What happens to organs

Active contraction of the uterus is facilitated by the first attachment of the baby to the breast and a surge of hormones. The uterus contracts quickly and strongly in the first hours after childbirth. Immediately after the baby has left the womb, the size of the uterus shrinks to a size equal to 20 weeks of pregnancy. On the first day after birth, the uterus continues to contract rapidly. After delivery of the placenta inner surface uterus looks like open wound and bleeds. Bleeding is especially pronounced in the place where the placenta was attached.

Changes in the uterus after childbirth

The cervix immediately after the birth of the child misses the hand. closes first internal os. Three days after birth, 1 finger passes through it. And after 10 days it closes completely.

If the first 2 hours passed without complications, the puerperal is transferred to the postpartum department. It would be nice to sleep in the ward and gain strength, but it is unlikely that you will be able to fall asleep. In the blood after childbirth, there was a release of adrenaline, which acts on nervous system exciting. The transfer of mother and child to the ward means that the birth was successful. From this moment the recovery period begins.

late postpartum period

The postpartum period is managed by an obstetrician-gynecologist. It controls the state of the uterus. If it contracts weakly, then oxytocin injections are prescribed. A woman feels contractions of the uterus cramping pains lower abdomen. In multiparous women, they are often very intense and painful. Episiotomy sutures on the perineum are treated daily. Doctors often recommend lying on your stomach. This promotes contraction of the uterus and also helps it to take right place in the pelvic area.

postpartum discharge

Cleansing and healing of the uterus is manifested in the separation of the inner layer. Blood secretions, which are called lochia, are rejected endometrial cells, blood, mucus. In the first 2-3 days, the discharge is scarlet, bloody. On the 3-4th day they become blood-serous, with a rotten smell of blood. A week later, red-brown with an admixture of mucus. In the following days, the lochia weakens and stops by the 40th day after birth. Late postpartum period ends with the end of selections. We described in more detail about postpartum discharge in the article.

Postpartum discharge continues 6-8 weeks postpartum

Lactation

After the birth of a child, milk is produced in the mammary glands under the action of hormones. The process of lactation depends on two hormones: prolactin and oxytocin. Prolactin is responsible for the formation of milk, and oxytocin is responsible for its release from the breast. Breastfeeding triggers lactation hormones.

In the first two days, colostrum is secreted from the breast. This is the precursor of mature milk, which comes in 3-4 days. Colostrum is the first food of the baby, which populates the intestines with beneficial microflora. The high content of protein and immunoglobulins form the defenses of the body of the newborn.

The first attachment of a newborn to the breast occurs on the delivery table immediately after the birth of the child if the birth was uneventful. During stimulation of the nipple, the uterus contracts intensively, the placenta separates and the lochia discharges.

The process of milk production with the participation of prolactin and oxytocin

Mom and newborn are discharged 3-5 days after birth if they feel well. Before discharge, the puerperal undergoes an ultrasound scan to make sure that the involution of the uterus is normal and there are no blood clots.

Hygiene

Proper hygiene of the postpartum period will help to avoid complications.

List of rules for personal hygiene after childbirth:

• Wash your face after every visit to the restroom. The direction of movement is from front to back.
• Change your panty liners every 2 hours.
• Do not use a washcloth. After a shower, blot your perineum with a cotton diaper.
• Use baby soap to wash. It has a neutral ph, does not irritate the skin, cleanses well.
• It is better to use special postpartum panties-mesh. They are made of hypoallergenic, breathable material and do not tighten the skin.
• It is useful to arrange air baths for the perineum and nipples: walk in the ward with bare breasts, remove panties during rest. It is useful for healing stitches and cracked nipples.
• Towels for face, hands, intimate hygiene and the bodies must be separate.
• Wash your breasts with baby soap only during your morning and evening showers. Do not wash your breasts with soap before each feeding. Soap washes away the protective layer from the nipple area and areola, it dries and provokes the formation of cracks.
• It is useful to sleep and rest on the stomach so that the uterus takes its place and its contractions are effective.

To avoid cracked nipples, properly latch your baby to the breast during feeding.

Prohibited :

• You can not use tampons during the lochia period. The secretions must come out.
• You can not lift weights more than the weight of the child due to the weakness of the muscular corset.
• Do not use soap with a high alkali content (household).
• Douching is prohibited throughout the postpartum period. This washes out the microflora of the vagina.

Problems of the postpartum period

Childbirth is a stress for the mother’s body, high costs of mental and physical strength. In the first days after the birth of a child, puerperas face some difficulties:

1. Episiotomy stitches. Gaps and incisions on the perineum are sewn up, as a rule, with self-absorbable threads. Nurses in the postnatal ward clean the stitches daily and monitor their healing. For antibacterial hygiene, after washing, rinse the perineum with a solution of chlorhexidine or furacilin. A young mother with stitches in her perineum is not allowed to sit for the first 10 days after giving birth.
2. Sometimes the mother does not feel the urge to urinate. During passage through the birth canal, the child's head pinched nerve endings, resulting in a loss of sensation in this area. Therefore, if a woman does not feel the urge to urinate, she should urinate every 2-3 hours without waiting for the urge. If you have difficulty passing urine, tell your doctor. You may need to insert a catheter.
3. – frequent occurrence after childbirth. In late pregnancy, the baby's head squeezes blood vessels. The outflow of blood is disturbed and it stagnates in the veins of the small pelvis. The hemorrhoidal lump due to strong tension during labor can fall out. With the problem of hemorrhoids, it is important to avoid constipation, adjust the diet. Sometimes laxatives are required. ABOUT postpartum hemorrhoids we wrote a link here.

Pathologies and complications of the postpartum period

Sometimes the postpartum period is overshadowed by complications. Pathologies are often caused by microbes with which the body is already populated. In the usual state, they are not able to provoke the disease, the immune system suppresses them. But against the background of the weakened forces of the body pathogenic microflora grows, and the body can not cope with big amount bacteria. Some complications of the postpartum period that are dangerous to the life and health of a woman:

is a blood infection. The focus of infection is formed at the site of attachment of the placenta in the uterus, if pieces of the placenta remain there. Another cause of sepsis is endometritis. This disease is dangerous because it can cause toxic shock. Sepsis develops 8-10 days after birth. If a young mother observes such signs as: a temperature of 39 ° C and above, putrid smell lochia, the discharge is red-purple and is similar in consistency to a thick tomato paste, general intoxication of the body, abdominal pain - you need to urgently consult a doctor. Sepsis is a dangerous condition that threatens life.

- inflammation of the mucous membrane of the uterus. The cause of endometritis may be a blockage of the cervical canal with a blood clot, the remains of the placenta in the uterine cavity. AND inflammatory diseases pelvic organs in history. A young mother should carefully monitor the discharge, well-being after childbirth, and if there are abdominal pains, the smell of lochia has become unpleasant putrid, you should immediately consult a doctor.

endometritis

- inflammation of the breast tissue. Mastitis occurs due to infection through cracked nipples. Sometimes the disease is a consequence of neglected lactostasis. Mastitis is manifested by general intoxication of the body, reddening of the chest in the area of ​​stagnation, temperature 38-39°C. There may be discharge of milk with an admixture of pus from the affected breast.

- Inflammatory damage to the kidneys. Infection by ascending paths passes from the uterus to the bladder. Temperature high up to 40°C, fever, pain in the lower back. With signs of pyelonephritis, you should immediately consult a doctor.

The main indicator that recovery period goes well - it's lochia. The appearance of a sharply unpleasant smell of rot, a sharp cessation blood secretions or, conversely, unexpectedly abundant suckers should alert the young mother. The appearance of one of these signs is a reason to see a doctor.

Restorative gymnastics after childbirth

It is better to postpone the first sports activities until the end of postpartum discharge. By this time, the organs will return to their places, the body systems will begin to function stably. But you should not completely deny yourself physical education even immediately after childbirth. home exercise therapy task in the postpartum period - to restore muscle tone pelvic floor. For this purpose, a set of Kegel exercises is suitable. They strengthen the muscles of the perineum and vagina, the uterus contracts more efficiently.

To learn how to control the muscles of the pelvic floor, you need to find them. Try to stop the stream of urine during urination, and you will understand which muscles need to be worked out.

A set of Kegel exercises consists of several types of techniques:

• Compression and relaxation. Squeeze your pelvic floor muscles, hold for 5 seconds, relax.
• Reduction. Tighten and relax your pelvic floor muscles without delay at a fast pace.
• Straining. Slight straining, as during childbirth or the act of defecation.
• You need to start with 10 contractions-squeezing-straining 5 times a day. Gradually increase up to 30 times a day.

Video: a detailed description of the technique for performing Kegel exercises

After the end of postpartum discharge, you can gradually introduce new types physical activity: yoga, Pilates and others. But train the body without preparation internal muscles It's like building a house without a foundation.

The postpartum recovery period requires a woman to be attentive to her health and a reasonable distribution of physical and moral strength. IN best case This time should be devoted to the child and his recovery. And household questions to entrust to the husband and relatives.

postpartum period- the final stage of the gestational process, which occurs immediately after the birth of the fetus and lasts about 6-8 weeks.

The postpartum period is divided into: early postpartum period- the next 2 hours after delivery; late postpartum period- starts from the moment the mother is transferred to the postpartum department and lasts 6-8 weeks.

During the period, the shifts in the endocrine, nervous, cardiovascular and other systems that have arisen in connection with pregnancy disappear. The exception is the mammary glands, whose function reaches its peak in the postpartum period. The most pronounced involutionary processes (reverse development) occur in the genitals. The rate of involutional processes is especially pronounced, for the first time 8-12 days.

Involution of the sex organs

Uterus. In the postpartum period, there are postpartum contractions that contribute to a significant decrease in the size of the uterus. By the end of the 1st day after birth, if the bladder is empty, the bottom of the uterus reaches the level of the navel (15-16 cm above the womb). In the future, the height of the fundus of the uterus decreases daily by 2 cm (approximately 1 transverse finger).

The inner wall of the uterus after separation of the placenta and membranes is an extensive wound surface. The epithelization of the inner surface of the uterus is completed by the end of 7-10 days, with the exception of the placental site, where this process ends by the end of 6-8 weeks.

The slow process of the reverse development of the uterus is one of the early clinical signs of the pathology of the course of the postpartum period. One of these signs is the subinvaluation of the uterus, which in the future can cause severe purulent-septic inflammatory diseases. The infection present in the uterus reduces its contractile activity, thereby causing the spread of the infectious process.

In the early days of lochia (wound secretion of the uterus) have bright red color, from the 3rd day their color changes and becomes brownish-red with a brown tint, from the 7-8th day due to the abundance of leukocytes they become yellowish-white, and finally from the 10th day - white. The amount of ancestral secret by this time is scarce. In general, the amount of lochia in 7 days is about 300 ml.

Cervix. The involution of the cervix is ​​made from the inside to more superficial areas. This occurs much less intensively than the involution of the body of the uterus.

The internal os of the cervix is ​​closed by the 10th day, the external os is closed only by the end of the 2nd or 3rd week after birth. However, even after that, its original form is not restored. It takes the form of a transverse slit, which indicates a previous birth.

Vagina. It shrinks, shortens, hyperemia disappears, and by the end of the 3rd week it becomes normal. However, during subsequent births, its lumen becomes wider, and the walls become smoother, the vagina becomes more closed, the entrance to the vagina remains more ajar.

Crotch. If the perineum was not damaged during childbirth, and when it was torn, it was properly sewn up, it is restored after 10-12 days.

In the presence of a perineal injury in a puerperal, it is necessary to carry out active rehabilitation measures. This need arises due to the fact that, firstly, the injury sites are the entrance gate for infection and can contribute to the occurrence of severe septic complications and, secondly, when secondary healing wounds, the anatomy of the muscles and fascia of the perineum is disturbed, and this leads to anomalies in the development of the genital organs and even to the disability of women.

The fallopian tubes. In the postpartum period, hyperemia of the fallopian tubes gradually disappear. The tubes, together with the uterus, descend into the pelvic cavity and by the 10th day take their usual horizontal position.

Ovaries. In the postpartum period, regression ends in the ovaries corpus luteum and the maturation of the follicles begins.

In non-nursing mothers, menstruation usually resumes within 6-8 weeks postpartum, with ovulation occurring 2-4 weeks postpartum.

In nursing mothers, ovulation can occur after 10 weeks of the postpartum period. In this regard, breastfeeding mothers should be aware that the period of contraception due to lactation lasts only 8-9 weeks, after which the resumption of the ovulatory menstrual cycle and the onset of pregnancy are possible.

Abdominal wall. The condition of the abdominal wall is gradually restored by the end of the 6th week. Sometimes there is some divergence of the rectus abdominis muscles, which progresses with subsequent births. Crimson scars of pregnancy on the surface of the skin gradually turn pale and remain in the form of whitish wrinkled stripes.

Mammary gland. The function of the mammary glands after childbirth reaches its highest development. In the first days (up to 3 days) of the postpartum period, colostrum is released from the nipples. Colostrum is a thick yellowish liquid. Colostrum contains, in addition to a large number protein and minerals, factors that neutralize some viruses and inhibit the growth of Escherichia coli, as well as macrophages, lymphocytes, lactofferin, lysozyme. On the 3-4th day, the mammary glands begin to produce transitional milk, and by the end of the first month - mature milk. The main components of milk (proteins, lactose, water, fat, minerals, vitamins, amino acids, immunoglobulins) act on the entire body of the newborn, especially on his gastrointestinal tract. It has been proven that breastfed babies are less likely to get sick than formula-fed babies. Women's milk contains T- and B-lymphocytes, which carry out a protective function.

Metabolism. In the first weeks of the postpartum period, the metabolism is increased, and then becomes normal. Basal metabolism becomes normal at 3-4 weeks after birth.

Respiratory system. Due to the lowering of the diaphragm, the capacity of the lungs increases. The respiratory rate is reduced to 14-16 per minute.

The cardiovascular system. The heart occupies its normal position due to the lowering of the diaphragm. Often there is a functional systolic murmur, which gradually disappears. Under the influence of external stimuli, there is a large lability of the pulse, there is a tendency to bradycardia (60-68 beats / min). Blood pressure in the first days may be somewhat reduced, and then reaches normal numbers.

Morphological composition of blood. The composition of the blood has some features: in the first days after childbirth, the number of erythrocytes decreases slightly, the number of leukocytes remains elevated. These changes soon disappear, and the picture becomes normal.

Urinary system. Diuresis is normal or slightly increased in the first days of the postpartum period. Bladder function is often impaired. The mother does not feel the urge or has difficulty urinating.

Digestive organs. As a rule, the digestive system functions normally. Sometimes there is atony of the intestine, manifested by constipation.

Management of the postpartum period

2 hours after delivery, the puerperal on a gurney with a newborn is transferred to the postpartum department. Before the transfer of the puerperal to the postpartum department, it is necessary to: assess the condition of the puerperal (find out complaints, evaluate the color skin, visible mucous membranes, measure arterial pressure, pulse and measure body temperature); through the anterior abdominal wall to determine the condition of the uterus, its consistency, configuration, sensitivity to palpation; determine the amount, nature of secretions from the genital tract. Place a vessel under the pelvis of the puerperal and offer to empty the bladder. In the absence of urination, release urine with a catheter; to carry out the toilet of the external genital organs with a disinfectant solution according to the generally accepted scheme; in the history of childbirth, note the general condition of the puerperal, body temperature, pulse, blood pressure, condition of the uterus, the amount and nature of vaginal discharge.

Every day, a nurse monitors the puerperal woman: she measures body temperature 2 times a day (in the morning and in the evening); during the bypass finds out complaints, evaluates the condition, color of the skin and visible mucous membranes, the nature of the pulse, its frequency; measures blood pressure. Pays special attention to the mammary glands; determines their shape, condition of the nipples, the presence of cracks on them, the presence or absence of engorgement. Produces palpation of the abdomen, which should be soft, painless; determines the height of the standing of the bottom of the uterus, its configuration, consistency, the presence of pain. Daily examines the external genitalia and perineum. Draws attention to the presence of edema, hyperemia.

For the prevention of infectious complications in the postpartum period, timely correction of the slightest deviations from physiological development is no less important than monitoring the clinical course. involutionary process and strict observance of sanitary and epidemiological requirements, as well as personal hygiene rules. great attention should be addressed to the treatment of the external genital organs. At least 4 times a day, the puerperal should be washed away warm water with soap. Change diapers after washing. If there are seams on the perineum, they are processed in the dressing room.

The nature and number of lochia is assessed. They don't have to be copious; their character should correspond to the days of the postpartum period and have a normal smell.

Problems of the mother. For the first three days, the puerperal is worried about periodic pains in the lower abdomen (postpartum contractions), lactastasis (breast engorgement), urinary retention and bloody discharge from the genitals.

The pain syndrome is expressed in multiparous women and in women at the time of breastfeeding.

Laktostasis - engorgement of the mammary glands. Only pronounced pathological lactastasis is subject to treatment: decantation of the mammary glands, a decrease in the volume of fluid taken by the puerperal and medications prescribed by the doctor.

Urinary retention is usually observed in puerperas who have had complications in childbirth. The puerperal woman has no urge to urinate, which is explained by the fact that during childbirth the sphincter of the bladder long time presses the head against the bones of the pelvis. Urine accumulates in bladder sometimes up to a large amount (3 or more liters). The second option is also possible, when the puerperal has increased urination, but the amount of urine excreted is insignificant. The rest of the urine also accumulates in the bladder.

Bloody discharge from the genital tract is a physiological process, but blood and mucous membrane residues are a breeding ground for the microorganism. It is necessary to strictly observe the rules of infectious safety in the maternity hospital.

If during pregnancy the nipples of the mammary glands were not prepared for childbirth or the baby was incorrectly attached to the breast, then nipple cracks may form.

Potential issues:

Bleeding

Postpartum septic diseases

Hypogalactia

The first application of the child to the breast should be carried out in the first 30 minutes. after birth, if there are no contraindications. Some obstetricians practically put the baby to the breast before cutting the umbilical cord.

Feeding of the baby is carried out on demand, and the more often the mother will put the baby to the breast, the longer the feeding will be.

Sleep the child next to the mother in the same room.

At breastfeeding giving the child water, glucose is not recommended.

If there is no lactostasis, then pumping the mammary glands after feeding is not recommended. This is due to the fact that the mammary gland produces as much milk as is necessary for the nutrition of the child.