Postpartum complications are rare. The most common are

The clinical manifestations of childbed (6 weeks after birth) generally reflect the recovery of the physiological changes that occur during pregnancy, resist (see table: Normal changes after birth). These changes are mild and transient and should not be confused with pathological changes. Postpartum complications are rare. The most common are postpartum hemorrhage endometritis puerperal UTIs (cystitis and pyelonephritis) mastitis postpartum depression Clinical parameters within the first 24 hours, the pulse rate of the woman begins to fall, their temperature can be increased slightly. The vaginal discharge is about 3-4 days strong bloody (lochia rubra), during the following 10 to 12 days it changes in pale brown (Lochia fusca) and finally to yellowish white (lochia alba). About 1-2 weeks postpartum, the scabs from the placenta adhesion surface strips off and there is bleeding on; hemostasis is achieved mostly spontaneous. The total loss of blood is approximately 250 ml; it can be recorded by comfortable to wear intravaginal (often impersonated) tampons or external binding. Tampons should not be used if they could impede the healing of perineal or vaginal injuries. Prolonged bleeding (postpartum hemorrhage) can be and should be investigated a sign of an infection or a retained placenta. The uterus regresses noticeably; after 5-7 days it is solid and is no longer sensitive to pain and extending in the center line of the symphysis up to the navel. After 2 weeks, it is no longer palpable from the abdomen ago and returns typically after 4-6 weeks of pre-pregnancy size back. Contractions of the regressing uterus require in some cases if they are painful (aftermath), a pain medication. Laboratory parameters During the first week takes the amount of urine to be temporary; a possible Lochia must be considered in assessing the results of the urine test. Since the blood volume is redistributed, the HCT can (hematocrit) vary, but tends if the women do not bleed to stay in the area where he has been in the pregnancy. Since the leukocytes rise during labor, post partum a marked leukocytosis (up to 20,000-30,000 / ul) develops in the first 24 hours. The white blood cell count returns to normal within a week. Plasma fibrinogen and ESR (erythrocyte sedimentation rate) remain postpartum increased during the first week. Normal changes after birth parameters first 24 hours the first 3-4 days 5 days After 2 weeks After 4 weeks of clinical heart rate begins to 2 weeks Decreased reduce to value as before pregnancy, as before pregnancy, as before pregnancy, as before pregnancyTemperature slightly elevated Usually pre-pregnancy As before pregnancy How bloody before pregnancy How bloody pre-pregnancy Vaginal discharge (lochia rubra) (Lochia rubra) Pale brown (lochia serosa) * Pale brown to yellowish white (lochia alba) Yellowish-white to normal urine volume Increases Increases Decreasing to volume as before pregnancy, as before pregnancy, as before pregnancy uterus start of regression continued regression hard, no longer sensitive Is not palpable about halfway between symphysis and umbilical abdominal size as before pregnancy mood baby blues Baby -Blues normal after 7-10 days as before Pregnant sheep t As before pregnancy breasts (in non-breastfeeding women) Slightly larger Swollen Decreasing As before pregnancy, as before pregnancy ovulation (in non-breastfeeding women) Unlikely Unlikely Unlikely Unlikely, but possible Possible Laboratory Leucocyte count up to 20,000-30,000 / ul Decrease Decrease in Normal value Normal value Normal value plasma fibrinogen and BSG Increases Increases decreasing to normal value after 7 days Normal value Normal value * The stripping of the eschar to the placenta adhesive surface can lead to a loss of blood of about 250 ml after 7-14 days. Initial treatment, the risk of infection, bleeding and severe pain must be kept as low as possible. The women are usually observed for at least 1-2 hours after the third stage of labor and during labor performed under local anesthesia or general anesthesia (z. B. with forceps, ventouse or caesarean) over several hours or if the birth does not was complete routine. Bleeding (. For more information, postpartum) The stop bleeding is the most important; The measures include uterine massage Occasionally parenteral oxytocin during the first hour after the third stage of labor, the uterus is massaged on a regular basis to ensure that it is contracted, bringing a massive bleeding can be prevented. If the uterus after a massage alone does not contract, immediately after birth the placenta either 10 IU Oxytocin i.m. or i.v. Oxytocin infusion (10 or 20 [up to 80] I.E./1000 ml of the infusion solution) was added to 125-200 ml / h. The drug is given until the uterus is fixed, then reduced or discontinued. Oxytocin should not as an i.v. Bolus be administered because it can lead to severe hypertension. If the bleeding is increased, for increasing the uterine Methergin 0.2 mg IM h or 800 .mu.g misoprostol is rectally given 1 time. Methergine 0.2 mg p.o. every 6 to 8 hours may be continued for up to 7 days when necessary. For all women, the following must be available O2 rhesus negative blood or tested for compatibility blood infusions With a massive blood loss, a blood count before Entlasung is necessary to test whether the women are not anemic during the recovery phase. Has there been any massive blood loss, no blood erforderlich.Ernährung and activity After the first 24 hours, the recovery is happening quickly. Once the woman given birth dietary wishes should be offered her a normal diet. Mobilization is as early as possible encouraged to the full. Recommendations for exercise are individually expressed as a function of other maternal diseases or complications. Normally, you can start with exercises to strengthen the abdominal muscles as soon as the symptoms have subsided birth, which is with vaginal births usually within a day and Caesarean sections later the case. Exercises to slowly erecting running in bed with flexed hips and knees, only lead to the contraction of the abdominal muscles, usually without causing back pain. The benefits of pelvic floor exercises (. Eg Kegel exercises) is not secured; with these exercises but can be started as soon as the patient ready for it ist.Pflege perineum In uncomplicated birth process are showering and bathing allowed vaginal in the early postpartum period but forbidden. The vulva should be cleaned from anterior to posterior. Immediately after birth can help reduce pain and edema in the region of episiotomy or supplied with seam wound ice packs; occasionally lidocaine cream or Spray can be used for pain relief. Later, warm sitz baths can werden.Beschwerden taken several times a day and pain NSAIDs such as ibuprofen 400 mg po every 4-6 hours are effective in both perineal discomfort and during uterine cramping. Acetaminophen 500-1000 mg p.o. every 4-6 hours may also be used. Paracetamol and ibuprofen appear to be relatively safe during breastfeeding. Numerous other analgesics are excreted in human milk. After the operation or the supply of large wounds opioids may be required to alleviate the discomfort. If the pain worsen significantly, women should complications like a Vulvahämatom examined werden.Blasen- and bowel function urinary retention, bladder overstretching and catheterization should be avoided if possible. Especially after discontinuation of oxytocin may lead to an excessive diuresis. The patient should be asked to empty the bladder and monitored to prevent asymptomatic bladder overfilling. A medium-sized, palpable in the suprapubic area tumor or an increase in the uterine fundus above the umbilicus suggests a bladder overstretching. When an Blasenaufstauung a catheterization is required to relieve the symptoms immediately and to avoid lengthy bladder dysfunction. If it comes to Blasenaufstauung, a reclining or intermittent catheter can be indicated. The women are encouraged to empty their bowel before the dismissal, although this advice is often not to follow at a very early dismissal. If no defecation has occurred within 3 days, a mild laxative (z. B. psyllium, docusate, bisacodyl) can be given. Avoiding constipation often helps to prevent hemorrhoids or reduce existing hemorrhoids that can be treated with warm sitz baths. Women with a supply of an extensive dam crack involving the rectum or anal sphincter may be added Stuhlaufweicher (z. B. docusate). Regional anesthesia (spinal or epidural) or general anesthesia may lead to the delay of defecation and spontaneous voiding, the partial mobilization hinausschiebt.Impfung and Rh desensitization women who have no antibodies against rubella should be vaccinated against rubella on the day of dismissal. Women who have not been vaccinated yet against tetanus diphtheria pertussis (TdaP) (ideally it will be given between the 27th and 36.SSW in each pregnancy) and no tetanus and diphtheria toxoid (Td) in the last -Auffrischimpfung have received two years ago, a TdaP booster before discharge from the hospital or birthing center should get, regardless of their breastfeeding status. If family members who have close contact with the newborn, have so far not received Tdap, Tdap should be given to immunize against pertussis. Women with Rh-negative blood who gave birth to a child with Rh-positive blood, but are not sensitized, should avoid sensitization within 72 h after birth Rh0 (D) immunoglobulin 300 micrograms i.m. be given (Fetal erythroblastosis: Prevention) .Brustdrüsenschwellung The enrichment of milk can lead to painful engorgement during early lactation. Breastfeeding helps to reduce the swelling. BeiFrauen who want to breastfeed is recommended following up milk production is adapted to the needs of the infant: pumping by hand under a warm shower or with a breast pump between feedings to ease the pressure temporarily. (However, since this promotes lactation rather, it should be done only when necessary) The child on a regular schedule silent Wearing a comfortable nursing bras 24 hours / day for women who are not breastfeeding, it is recommended: Clinging BH to suppress milk production, because gravity stimulates the “let-down” reflex and stimulates the flow of milk. Waiver of stimulation and manipulation of the nipples, which can increase milk production. High binding of the breasts (z. B. an accurately BH) cold packs, and analgesics as needed followed by wearing a tight bras, in order to suppress the symptoms temporarily occurring during lactation A Unterrückung lactation with drugs is not empfohlen.Psychische faults The first week after birth often occurs a temporary depression (baby blues, postpartum depression). The symptoms (eg. As mood swings, irritability, anxiety, difficulty concentrating, insomnia, crying spells) are generally low and usually subside 7-10 days. Physicians should ask women about symptoms of depression before and after childbirth and to remember that they should pay attention to the symptoms of depression, may be similar to the normal symptoms of a fresh maternity (concentration disorders such. As fatigue,). You should also then counseled women to see a doctor in depressive symptoms that persist> 2 weeks or associated with daily activities, or thoughts of suicide or murder. In these cases, postpartum depression or another mental disorder may be present. In a pre-existing mental disorder, in particular a previous postpartum depression, it is likely that you recurs in childbirth or worsens; the women concerned should be thoroughly monitored. Care at home wife and child can be discharged within 24 to 48 hours; in many family-centered obstetric departments, this happens when no general anesthesia was used and no complications have occurred, already 6 hours after birth. Serious problems are rare, but a home visit, a visit to the office or a call within 24-48 hours is necessary. A routine visit after birth is usually scheduled after 6 weeks in women with an uncomplicated vaginal delivery. In caesarean section or other complications, the check-up should be scheduled earlier. With normal activities can be resumed as soon as the woman to feel capable. After a vaginal delivery intercourse can take place again, if desired, and causes no symptoms; a sore or episiotomy must be, however, previously healed. After cesarean sexual intercourse should take place only after healing of the surgical wound. Family Planning If a woman has been vaccinated upon discharge from the hospital against rubella or chickenpox, pregnancy over a month must be prevented Likewise, it takes place in the interest of the woman when a pregnancy to grant an extensive recovery period of at least 6, better 18 months after birth is prevented. To minimize the chances of pregnancy, contraception should be begun with the dismissal. If women do not breastfeed, it usually comes 4-6 weeks post partum, 2 weeks before the first menstruation to ovulation. However, ovulation may occur sooner; a conception has occurred already 2 weeks postpartum. Women who breastfeed tend to be later ovulation and menstrual bleeding, usually around 6 months post partum; but there are also women who ovulate as early and menstruate (and become pregnant) such as non-lactating women. Women should choose a contraceptive method depends on the specific risks and benefits of various options. The business still influences the choice of contraceptive. Lactating women non-hormonal methods are preferred; among hormonal methods pure oral progestogen-only contraceptives, depot medroxyprogesterone acetate injections and progestin implants are preferred because they do not affect milk production. Estrogen-progesterone contraceptives may interfere with milk production and should only be used when the milk flow has stopped reliable. Not breastfeeding women may use combined estrogen-progestin vaginal rings 4 weeks after birth. A diaphragm should be adjusted (after 6-8 weeks) after complete involution of the uterus; meantime the prevention of foam, jelly and condoms is recommended. Intrauterine devices are generally used 4-6 weeks after birth to minimize the risk of expulsion.

Health Life Media Team

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