Minor Discomforts of Puerperium

Although the puerperium is a typical state, some women may have little or major difficulties at this time. The first two to three weeks of puerperium are when the problems are most prevalent. Examples of frequently occurring mild diseases include:

• After pain
• Sub -involution of the uterus
• Retention of urine
• Postpartum blues

After Pain

It is characterized by infrequent, spasmodic lower abdominal pain that lasts for two to four days following delivery. The uterus contracts spasmodically and hypertonically in an effort to expel a blood clot or a little amount of postpartum. Multigravidae are more likely to experience ischemia discomfort than primigravidae do.

Causes

• Uterine contraction
  • The uterus expands throughout pregnancy, requiring contractions to reduce its size after delivery. These contractions are painful.
• Lactation
  • Injuries occur when nursing. The synthesis of the hormone oxytocin, which causes the smooth muscles of the reproductive organ to contract, is increased during lactation by the posterior pituitary gland. As the mother's parity rises, the severity of the aftereffects worsens. This is due to the uterus's reduced muscular tone in multiparae moms, which prevents it from simply growing back to its original size. Pain could cause this to occur.
• Lochia drainage
  • Lochia is the vaginal discharge of decidua, membranes, blood from a placental site, uterine debris, and epithelial cells. After feeling discomfort, the uterus should contract to release the lochia.
• Infection
  • Microorganisms may grow in the lochia's alkaline media if the result of conception is not fully evacuated and the lochia is not completely drained. The pain that follows is also a result of this infection. There will be discomfort if the placental pieces prevent effective involution from occurring in the uterus.

Management

• Encourage the mother to eat a warm, nutrient-rich food that is water-rich.
• Allow ample time for rest and physical activity to deal with the side effects, such as walking to the bathroom, standing carefully, working the muscles in your pelvic floor, etc.
• We advise gently belting the abdominal regions to strengthen the uterus and recommend continuous nursing and uterine massage to quickly relieve pain.
• We should inform the mother that involution can only be facilitated by mild to moderate pain.
• By changing the pad without touching the anus or vulva or rubbing it, you can encourage the mother to maintain vulval cleanliness. After every surgical procedure, we should employ an aseptic technique to prevent infection.
• If the pain is intense, a moderate analgesic is administered.
• It is possible to provide paracetamol and antispasmodics.
• To aid in the passage of clots, ergometrine may be administered intramuscularly (0.5 mg) or orally (1 mg).

Sub -involution of the uterus

When involution is slowed down or delayed, sub-involution happens. The organ most frequently impacted by sub-involution is the uterus. Uterine involution is utilized clinically to evaluate subinvolution since it is the easiest organ to quantify per abdomen.

Causes

The following are risk factors

• grand multiparity
• over uterine distention as in twins and hydramnios 
• maternal illness 
• cesarean section
• prolapse of the uterus
• retroversion once the uterus becomes a pelvic organ
• uterine fibroids

Aggravating elements include

• retained product of conception 
• uterine sepsis

Sign and symptoms

Signs

• For the day of Puerperium, the fundal height is higher than usual.
• The uterus is softer and more marshy.
• Palpating the uterine fundus might be challenging.

Symptoms

• The illness could not show any symptoms.
• Atypical lochia discharge is excessive or ongoing.
• Bleeding from the uterus that is irregular or occasionally excessive.
• The discomfort is irregular and cramp-like in cases of retained products or fever increases in sepsis.

Management

• After the placenta is delivered, any residual substances and blood clots need to be extracted.
• Uterine leakage during the postnatal period can be reduced with early ambulation and perineal care.
• Avoid having a heavy rectus and a distended bladder.
• Offer a healthy diet that includes plenty of fluids.
• Antibiotics should be given if puerperal sepsis is visible.
• Retained products explore the uterus.
• It might be necessary to use ergometrine to hasten the involution process by reducing blood flow to the uterus.

Retention of urine

Women may struggle with urine retention during puerperium for the first 24 hours following delivery.

Causes

• The urethra is strained and the bladder's muscle tone is lost as a result of the bladder being forced into the belly during delivery. Micturition is painful and results in urine retention due to bladder bruising.
• The fetal head may place tremendous pressure on the urethra and base of the bladder during prolonged labor, resulting in swelling and bruising that may cause the internal sphincter to contract and cause urine retention.
• For delivery, forceps or vacuum extraction are employed.
• In the event that a vaginal pack is inserted and cannot be removed.
• Following anesthesia with an epidural.
• After the perineum and vagina have been repaired from rips and lacerations.

Complications

UTIs and pain are caused by urinary retention. It might advance to the point of retention with overflow if it is not relieved. When this occurs, urine spills from the stretched-out bladder. The internal sphincter muscles are put under additional strain by this kind of distention, which makes persistent urine incontinence more likely.

Nursing management

• Encourage the females to urinate frequently.
• Get people to walk.
• Give enough liquid.
• Let mum go to the bathroom.
• Allow bathing or turn on the water's sound by opening the faucet.
• Apply hot and cold temperatures in succession on the bladder.
• Start doing pelvic floor exercises to stop leaking urine.
• Catheterization should be considered if these treatments are unsuccessful.
• Maintain your output and intake.

Postpartum blues (3rd or 4th-day blues)

Emotional reactions can be attributed to various factors, including anxiety throughout pregnancy, fear of giving birth, physical effort during labor, and increased parental duty following delivery. Many women give off the impression of being depressed, irritable, and easily upset. She could bemoan her lack of sleep and constantly express worries about not being able to care for the baby. She worries frequently about whether the baby is getting enough nutrients. These concerns frequently pass, reaching their height on the fifth day and disappearing within two weeks.

Causes

• Weariness from childbirth stress
• Sleep and rest deprivation social pressure or a familial problem
• Excessive number of visitors

Sign and symptoms

• Mood fluctuations ranging from minor to severe, from gladness to melancholy irritation
• Reduced attention due to anxiety
• Insomnia, sensitivity to tears, and weeping outbursts

Management

• Give yourself time to rest.
• Family ties and emotional support.
• Don't invite too many people around.
• Helps in feeding and caring for babies.

Contact her doctor as soon as possible since she will need psychiatric treatment if their behavior becomes strange and delirium sets in.

Advice to husband and relatives

• Correctly manage the postnatal situation.
• Help her with domestic duties and feeding the baby.
• Advice to maintain a healthy diet, get enough sleep, and love and care for others.
• The infant shouldn't be left with the mother alone if the situation is critical and getting worse.