Postpartum period of it. What is postpartum contraception? What you need to know about bleeding in the postpartum period

Date: 21.04.2019

All women with incense and fear await the onset of childbirth. After all, at this moment the long-awaited baby appears on the light, but the process of its exit leads strong pain from bouts and fence. Many women think that childbirth ends with the yield of the baby. However, in fact, there is a period that requires careful medical observation. This stage is called postpartum. What he includes in itself, and what risks are present on it - read further.

What is this postpartum

The birth of a child is definitely happiness. Studying a few hours in the fights and athletes, the woman launches new life. Her body is exempt from a child who weighs a few kilograms. However, this difficulties do not yet end. Woman preserves postpartum periodwhich can last from one and a half to two weeks.

The postpartum period is considered to be started after the child will appear and will be released. This stage continues for as many as 6 weeks and requires close observation of medical staff. Since it is at this time serious complications may arise.

The postpartum period for a woman is not even easier for pregnancy. The fact is that at this moment the organs become in place, and the body is restored, and at this stage difficulties and complications may arise.

During the postpartum period, the woman's body is still quite weak. At this stage, you need to take care, otherwise complications may occur. During the postpartum period, the body is restored after pregnancy. All organs become in place, and the uterus becomes normal sizes.

Birth - for women are also a big stress. Therefore, for some time after this process, its body is still in shock state. All this is called the postpartum period. Let's see more about what happens with a woman in the first 6, and sometimes 8 weeks after childbirth.

Early postpartum

Early postpartum stage lasts 120 minutes after childbirth. All this time, a woman is not transferred to the ward, she is under the closer supervision of medical staff.

Despite the small duration of this stage, it is the most dangerous. After all, it was during it that the most serious complications may arise, which can even lead to full outcome. To this not happened, and there is a medical staff.

Maintaining an early postpartum period:

After childbirth, the woman is measured. Ice put on the uterus (the ice warmer usually is used). Previously, it was done without disaster, now the ice is used only by testimony.
Next, a woman is offered to go to the toilet in a small one. If it does not work, it's yourself, then bladder Artificially empty through the tube.
Next, inspecting the genitals. If in the process of childbirth, the crotch women was adorn or overt, then the seams are superimposed under local anesthesia. Now for these purposes is used self-soluble ketgut.
Next, the ability of the uterus to reduce. The higher the reduction, the lower the risk of bleeding. If the uterus can not shrink independently with sufficient intensity, the woman is introduced special drugs and the cold is superimposed.

In the postpartum you can feel a strong chills. It is not scary! The whole thing in the gods transferred to you, which represent a large stress for the body.

You need to try to relax and think only about good. The medical staff located next to you will make everything you need to save your health.

The baby in the neonatal period is also subject to some actions from obstetrics. They are needed to preserve his health.

Postpartum period for a newborn:

The newborn is put on the belly of the mother. It is necessary that he inhabited by Flora. If for some reason it is impossible to put a baby on mom, it is placed on dad.
The child is cropped by the umbilical cord. A special clamp hangs on the umbilical.
The kid is inspected for generic injuries. The integrity of bones is checked, the presence of hematomas and other indicators.
If there were some anomalies in the process of childbirth, the child can introduce special preparations.

After the maternity hospital and the child are viewed, the baby is placed on the belly of mom and is covered with diapers. In this form, they lie in the rhodtle for a while. Next, mom and child goes to the ward. There they will stay at least three days.

Late postpartum period

Late (the longest) postpartum stage begins when early. At this stage, the woman is at home, but periodically observed at the gynecologist.

Many women after discharge from the maternity hospital do not consider it necessary to be observed in the postpartum period at the gynecologist. However, timely examination will help to identify and adjust the pathology of the rehabilitation process.

IN late period After childbirth, all organs are in place and acquire former sizes and shapes. The duration of this period is longer than the early stage.

Some facts about late postpartum period:

After childbirth, a woman stand out for some time. These are bleeding. In the first three days, they are bloodflowers and are abundant. From 4 to 7 day, they remind a sucrovitz, and not stand out so abundantly. Next they are very scanty, and bright. Usually, the suckers are highlighted over 10 -14 days.
In the first 10 days after childbirth, the uterus is lowered. Every day she changes its position by 1 cm. Thus, if in the first 24 hours after the formation of the uterus is at the level of the navel, then on the 10th day it is hidden behind the pubic.
The uterus is constantly reduced and decreases in size. Her walls due to this thicken. If in the first day, the weight of the uterus can reach 1 kilogram, then by the end of the postpartum period it weighs only 60-70 grams.
During this period, diminished in the size of the muscles of the uterus. Additional cells disappear, and the nervous network decreases. Unnecessary cells are utilized.
In the postpartum period, the wounded surface of the uterus is regenerated. Its most of it will heal for two weeks after graduating, however, for healing a placental platform, at least 5 weeks is required.
Also, all organs are in place. Muscles take the former shape. The vagina and the floor slot are reduced in size.

The full function of the ovaries is restored only after the woman will stop feeding the baby with breasts. All other changes occur within 6-8 weeks.

Despite the fact that the organs and functions of the woman in the postpartum period are completely restored, marked about childbirth remain forever. The uterus increases slightly in size, the neck acquires a cylindrical shape, stretch marks appear on the skin.

Possible complications in the duration of the postpartum period

The postpartum conventional period usually lasts 6-8 weeks. Throughout this time, a woman must regularly visit the gynecologist, who will be able to notice the complications of the development of the uterus on time and prevent complications.

At the first suspicion of any anomaly, a woman should consult a doctor who can send it to surrender analyzes or the passage of ultrasound. Remember, the earlier you to identify the disease, the more chances you will eliminate it without consequences.

Possible complications in the postpartum period:

Too slow recovery of the uterus;
Abundant bleeding after childbirth;
Inflammation of the uterus that can occur in a variety of reasons;
After cesarean section Perhaps the discrepancy of the seams in the uterus.

There are other complications that sometimes may arise in the postpartum period, but these are considered the most frequent. Any of them require immediate medical intervention. If you miss the symptoms of such anomalies, then you will make sure to earn serious complications that will lead to infertility or lethal.

How the postpartum period occurs (video)

The postpartum period is a rather complicated stage in the life of a woman. At this time, the body is restored, and the organs acquire the previous form. It is very important during this period to listen to the signals of your body and to take place in a timely manner. Do not neglect your health, inspected the doctor on time and be healthy.

Occurs Reverse development of organs and systems which qualified accordingly in connection with pregnancy and childbirth.

Duration of the postpartum period (including individual features), as a rule, is 6-8 weeks. The exception is the dairy glands and the endocrine system, which function in a special way during the entire period of lactation. The resumption time of the menstrual function after genera depends on the lactation period and varies widely. After the cessation of breastfeeding, the menstrual function resumes. However, the onset of ovulation is possible, and, consequently, pregnancy during the first months after childbirth. In non-nimble breasted women, the restoration of menstrual function occurs on average after 45-50 days.

Immediately after the birth of the lane (the arrogant shells together with the placenta) there is a significant reduction in the uterus. In the uterine cavity there is a small amount of blood clots. Due to the rapid decrease in the volume of the uterus of the cavity wall, they have a folded nature, and in the future gradually smoothed. The inverse development of the uterus depends on the general condition of the body of women, endocrine influences, age, quantity and duration of childbirth, availability inflammatory processes In the uterus.

Immediately after the breeding, the uterus weighs about 1000 g, the bottom is usually determined at the navel level. As the postpartum period, the involution of the uterus occurs, accompanied by a gradual decrease in its mass and volume. Over the first week of the postpartum period, the mass of the uterus is halucing. By the end of the 2nd week, it weighs 350 g, and by the end of the 3rd - 250 g. By the end of the 6-8th week after the birth, the inverse development of the uterus stops. The uterus of the giving birth woman has a lot of 75-50 g.

Epithelization of the inner surface of the uterus ends by the end of the 10th day of the postpartum period. During the same period, the remnants of the decidual shell and blood clots are rejected under the action of enzymes.

The most pronounced changes in the walls of the uterus are noted at the location of the placenta (placental platform), which is a wound surface with tombed vessels. Healing in the area of \u200b\u200bthe placental site occurs only by the end of the 3rd week.

Detacked from the uterus on different days of the postpartum period has a different character and is called Lochia. In the first 2-3 days after the birth of Lochi are blood dischargeFrom the 3-4th day until the end of the first week, they become serous-succained, and from the 10th day they acquire the form of liquid yellowish-white discharges. From the 3rd week the mucus from the cerval canal is mixed. At the 5-6th week of excretion from the uterus stop.

If no reasons are delayed by a loyalty in the uterine cavity, the focus is formed, which is a serious prerequisite for the development of infection and the formation of inflammation of the uterus (endometritis).

The final formation of the cervix takes place by the 12-13th week of the postpartum period. Due to the redistribution and supervisors in the side sections during childbirth, the outer zev of the cervical cervix acquires the type of transverse gap, and the neck itself becomes a cylindrical form, unlike the conical, which it was before pregnancy at the primordin.

The lumen of the vagina in the born woman, as a rule, does not return to its initial state, but becomes wider.

The muscles of the perineum, if they are not injured, restore their function and acquire the usual tone within 10-12 days of the postpartum period. The muscles of the anterior abdominal wall gradually restore their tone by the 6th week of the postpartum period.

The formation and maintenance of lactation is carried out by influencing the milk gland of such hormones as estrogens, prozterone, prolactin and oxytocin.

Applying a newborn to the chest for the first hour after birth is a positive effect on the formation of lactation and cutting the uterus due to the reflex irritation of the nipples of the breast and the increased separation of prolactin and oxytocin. In addition, the completeness of the emptying of the breast is positively affected by the production of these hormones as a result of feeding or complaining. Adequate milk release is an important factor in successful lactation. The removal of milk from the alveoli due to the effect of oxytocin is necessary to continue lactation. Therefore, regular feeding and emptying of the breast improves the secretion of milk.

The secret of the mammary glands, which stands out in the first 2-3 days after delivery, is called a colostrum. The colostrum differs from milk to a much smaller fat content, it is more rich in proteins and salts, but poor carbohydrates. Energy value The colostrum is very high. The total content in the breasts of immunoglobulins, which are mainly antibodies of classes A, M, G, exceeds their concentration in breast milk, being active protection for the newborn. In general, the dairy glands are part of immune system, contributing to ensuring the protection of a newborn from infections. The colostrum also contains a large amount of substances that are necessary structural elements cell membranes, nerve fibers, etc. in colostrum in large quantities Contains trace elements, vitamins, enzymes, hormones. The presence of biogenic stimulants in the colostrum, immunoglobulins determines its important physiological significance in the process of initial nutrition of the newborn, and most importantly, it contributes to the normal formation of the microflora of the gastrointestinal tract, which will ensure the prevention of infectious inflammatory diseases in newborns.

From the 3-4th day of the postpartum period, the dairy glands begin to allocate milk, which is accompanied by their heat, and in a number of cases and lifting body temperature. With each subsequent day, the amount of milk increases. With sufficient lactation, about 800-1000 ml of milk per day is distinguished.

Breast milk is the best kind of food for an infant. The number and ratio of the main components that make up milk provide optimal conditions for digestion and suction in the gastrointestinal tract of the child. Distinction between female and cow Milk Very substantially. The biological value of female milk proteins is 100%. Part breast milk Enter protein fractionsIdentical serum. In breast milk proteins, much more albumin. The effect of food proteins on protein content in milk is limited. The admission of proteins with food to a greater extent affects the total amount of milk produced than the content of protein in it.

It should be emphasized that the changes occurring in the postpartum period of the blood coagulation system in combination with the trauma of the vessels and the small mobility of a woman represent a high risk of thromboembolic complications in the postpartum period, especially after the operational delivery.

Immediately after delivery, there is a decrease in the tone of the bladder and the decrease in its capacity, which often determines the difficulty and impairment of urination. At the same time, the parental may not feel the urinary urges or it becomes fractional and painful.

In the postpartum period, due to a certain decrease in the tone of the smooth muscles of the gastrointestinal tract, constipation may be observed, which disappear during rational nutrition and active image Life.

Features of the postpartum period

In the maternity hospital immediately after the birth of a child, even before processing the umbilical cord, it should be put on the belly of the mother and attach to the chest. After processing a cord residue healthy child Apply to the chest. After some time, after that, a soft marlevary wet moistened with sterile vaseline or vegetable oil, the skin of the child is purified from original lubrication, mucus and blood. In the case of severe contamination by the mixonial waters of the child, under the jet of flow water at a temperature of 37-38 ° C. Skin folds in the neck area, in the armpits and in the inguinal areas are treated with 1% alcohol solution iodine. Weighing newborn produce on special scales. Also the growth of the child, the circle of his head and chest is also measured. Head circumference is measured along the line of the abnormal arc to a small spring, the circle of the chest - along the line passing through the nipples.

In the maternity hospital immediately after childbirth, all the maternity hospitals produce the inspection of the cervix and soft tissues generic canal With the help of mirrors. If you detect the body channel injury, they must be sewn.

In the first 2-4 h after childbirth, the parental should be in the maternity hospital under the constant supervision of the doctor and midwife. This is due to the fact that most often complications associated with the pathology of contractual activity of the uterus after childbirth, as well as with anomalies of attachment of the placenta, are manifested in the form of bleeding in the first hours after delivery.

One of the main tasks of adequate postpartum period is to prevent the purulent-inflammatory diseases of the mother and the newborn. Pedilines with various signs of infection in the early postpartum period, it is necessary to isolate into the observation department maternity hospital. In the postpartum department, the Children's Children must watch the doctor and midwife. In this case, the general condition of the patient is estimated, the pulse is measured, arterial pressure, body temperature (twice a day) is observed for the state of the outer genital organs, uterus, the mammary glands, the nature of the selection and physiological shipments.

With the normal number of the postpartum period, the general state of the feminine does not suffer. In this case, the normal body temperature and the pulse frequency are noted, the proper involution of the uterus occurs, the amount and quality of succeeds corresponds to the periods of the postpartum period, the mammary glands function normally, producing a sufficient amount of milk.

Special attention is paid to the nature of the selection of sex tract and changes in the height of the bottom of the uterus. When evaluating the loh, it is necessary to determine their color, character and quantity. The standing height of the bottom of the uterus above the lamp is measured by a centimeter ribbon, while the bladder should be emptied. The bottom of the uterus immediately after delivery is located 4 cm below the navel, the next day the bottom of the uterus is somewhat lifted and located at the level of the navel due to the restoration of the tonus of the muscles of the pelvic bottom. On the 4th day after childbirth, the bottom of the uterus is usually determined at half the distance between the navel and the Lone. On the 8-9th day, the bottom of the uterus can still be palpable at the level of the lamb or 2 cm above it. On average, for every day, the bottom of the uterus is lowered by 2 cm. By the 10th day of the normal postpartum period, the bottom of the uterus over Lone is no longer determined. Regular emptying of the bladder and intestines contributes to the active involution of the uterus.

For painful feelings Due to the contraction of the uterus, the use of painkillers and antispasmodic agents is possible. In nursing the breasts, the involution of the uterus is faster.

In the postpartum period, it is advisable to perform and ultrasound research (ultrasound). At the same time determine the length, width, front-rear size of the uterus.

In the first 8 days after delivery, the uterus decreases mainly due to changes in length, width and, to a much lesser extent, the front-rear size. In the study of the uncertainty, its contents are also evaluated. So, by the 3rd days of the postpartum period in the uterine cavity, echographic signs of the presence of a small amount of blood clots and residues of decidual tissue are found, which are most often located in the upper sections of the uterine cavity, and by the 5-7th days are shifted to the lower uterine departments with In order to subsequently leave her cavity.

After cesarean section, the reduction in the uterus in length is much slower than during childbirth through natural generic paths. In addition, after an abdominal delivery, the imperturbation of the front wall of the uterus is observed, especially pronounced in the seam area.

Upon lagging in the uterus in reverse development, which is called the sibling of the uterus, is prescribed ice to the bottom of the abdomen, oxytocin 1 ml 1-2 times per day intramuscularly, igloreflexotherapy. It is necessary to observe the doctor and the implementation of ultrasound to exclude inflammation of the uterus (endometritis).

Slow reverse development of the uterus and selection delay sometimes be due to folding postpartum uterus Forgot. It is enough to lie down the parent's 2-3 times a day on the belly of 10-15 minutes, as appear abundant discharge; The uterus is well reduced.

With the active postpartum period, healthy maternity parents should get up 6 hours after childbirth. They can engage in special gymnastics, must strictly observe personal hygiene rules, take souls daily, change bedding every 2-3 days.

The nutrition of the nursing mother should be a calorie (3200 kcal), balanced with due amount of proteins, carbohydrate fats, vitamins and trace elements. In the first 2 days after childbirth, food should be easily friendly. From the 3rd day after the intestinal emptying, a conventional diet is prescribed with a predominance of lactic acid, protein products, fresh fruits and vegetables. Food should be rich in vitamins and microelements. It should be excluded from the diet of sharp, oily, fried, smoked dishes, canned food, sausages, alcohol and potential allergens for a child (chocolate, citrus).

In the first days after childbirth, especially long or accompanied operational intervention, the pupils often observed urination delay; The intestine is also not always emptied independently. Both phenomena depend apparently from some overexcitation sympathetic innervation intestines and womework bladder.

When urination delay, it can be tried to cause a reflex exposure using a reflex exposure by opening a tap with water. You can also put a warm height on the supoclastic area. In the absence of the effect of these events, the bladder is emptied with a catheter, and subsequently used oxytocin and prozerne 1 ml 1 -2 times a day intramuscularly. In the absence of an independent chair on the 3rd day after delivery, a cleansing enema is prescribed or allowed inside the laxative.

With the normal course of the postpartum period, the dairy glands should be evenly dense, painless, and when pressed on the nipples in the first 2 days, mosper should be released, and in the following days - Milk. It is necessary to carefully examine the nipples, on the surface of which there should be no cracks.

Before each feeding, the parental should wear a golk and wash his hands with soap. It is also necessary to wash the mammary glands with warm water with children's soap before and after each feeding, ranging from the nipple and ending middleweedand dry sterile diaper.

After feeding the residues of milk, it is necessary to write to the complete emptying of the breast to eliminate stagnation. This contributes to the improvement of lactation and is the prevention of infection of the mammary glands.

With the appearance of significant heat, which is often on the 3-4 days after childbirth, the doctor's prescription is limited to drinking, laxatives are prescribed, diuretic products, nospa.

In accordance with modern ideas, breastfeeding newborns is based on the following principles.

Applying the mother's baby's baby immediately after birth, which, in fact, starts the lactation process. At the same time, milk in the breast is produced under the action of prolactin, and the milk iron is emptied under the influence of oxytocin. At the same time, the secretion of prolactin and, accordingly, the milk products are enhanced with the empty of the breast.
Joint stay of the mother and child in the postpartum department to reduce the contacts of the newborn with other children in order to prevent possible infection. At the same time, there is also a direct possibility of feeding a child for the first requirement, which also prevents dopping children with water or glucose. With a joint stay, the pore quickly acquires the necessary skills of care of newborns under the guidance of medical personnel.
Only breast milk should be used as the main and sole product for feeding the newborn. It is unacceptable for the use of nipples, horns and "pacifiers", as it leads to a weakening of sucking newborns and, accordingly, the incomplete emptying of the breast and decrease in the production of prolactin.
Feeding a newborn breasted in its first requirement, without night intervals.

It is necessary to contain outdoor genitals clean, since the lochies not only contaminate them, but also cause skin irritation, which contributes to the penetration of infection in the vagina and in the uterus.

In this regard, not less than 3-4 times a day disinfectant solution (Manganese-sour potassium 1: 4000; 0.02% chlorhexidine solution) wash the outer genitals, crotch and the inner surface of the hips, while the liquid should not fall into the vagina. After that, the skin is thoroughly dried with sterile materials.

Bookmarks from diaper in the crotch area are useless and even harmful, as they turn into a kind of compresses from the loyal, which prevents the outflow of the discharge from the vagina and creates favorable conditions for the development of infection.

In the event that the seams are superimposed on the crotch area, due to its rupture as a result of injury or after dissection, it is necessary that they are dry, the seams should be lubricated 1-2 times a day with alcohol and a 5% alcoholic solution of iodine. The seams are most often not removed, since synthetic residual threads use for these purposes.

With the normal number of the postpartum period, the patient may be discharged from the maternity hospital after vaccination BCG. For 3-4 days under the supervision of a female consultation by a doctor.

Postpartum period called the period from the moment of birth of the last (placenta and food shells) Until that moment when the reverse development (involution) of those organs and systems that were subject to change due to pregnancy end. It lasts from 6 to 8 weeks. Woman after childbirth is called a purse.

Postpartum period The deadlines are divided into early and late postpartum period.

Early postpartum period The first 2-4 hours after childbirth, during which a woman is in a rhodtle under the supervision of a doctor and midwife. This is due to the fact that most often complications associated with violation of the cutting of the uterus, the remnants in the Makele of the placenta, are manifested by the appearance of bleeding in this watch.

Immediately after childbirth, the uterus weighs about 1000 g, its height at the navel level. During this period, the doctor inspection of the cervix in the mirrors and soft tissues of the generic canal. Inspection is necessarily carried out to all the maternity hospitals. When the injuries of the body channel tissues are detected (cervical breaks, the walls of the vagina, the crotch), if necessary, impose seams under local or general anesthesia. The type of anesthesia depends, above all, from the size and place of breaks. Subsequent seams must be kept dry, process 2-3 times a day with alcohol and a diamond greenery solution. Normally, the seams are removed by 5-7 days.

During everything early postpartum period The doctor monitors common state Row birth, the character of the pulse, arterial pressure, the state of the uterus. From time to time he spends a massage of the uterus through the front abdominal wall to remove the blood clots accumulated in it.

After 2 hours, if the state of the woman does not inspire concerns, they are transported to the postpartum ward on the groundwater.

Late postpartum period

This is the time from the moment of the woman's transfer to the postpartum separation before the moment when a change in the body will disappear caused by pregnancy and childbirth. It lasts from 6 to 8 weeks.

Over the first week, the mass of the uterus decreases twice, that is, it reaches 500 g. By the end of the second week, it weighs 350 g, by the end of the third - 250 g. By 6-8 week, the inverse development of the uterus stops. The uterus of the giving birth woman has a lot of about 75 g.

The involution of the uterus is due to the rebirth of muscle elements into fat. The decay of muscle fibers is accompanied by cell death, but not all. Only part of the fibers (50%) dies, the other half forms new myometrium cells.

Postpartum discharge From the genital tract (blood, mucus, melted organic elements) are called - Lochi. Total amount Lochi for 6-8 weeks reaches 500-1500 g. They have a kind of harsh smell.

In the first 2-3 days of Lochi, they have a blood nature, a blood-by-serous appearance is taken by 4-5 days. A week after giving births, Lochi have a grayish-white look, by the end of the third week of the postpartum period of allocation almost stop.

Dairy glands begin to actively develop during pregnancy. In the postpartum period in the mammary glands, the formation of a newborn needed for feeding. In the first 2-3 days of the dairy glands allocate colosure, from 3-4 days - milk.

The value of the colostrum in feeding the newborn is truly huge. It prepares gastrointestinal Child to the absorption of real milk. The colostrum differs from milk a much lower content of fat and carbohydrates, it is more rich in proteins and salts. The presence of a huge number of maternal immunoglobulins and biologically active substances determine the formation of newborn primary immunity. Therefore, it is so important early (already in the rhodtle) applying to the chest.

Women's milk contains 88% water, 1.13% protein, 7.28% sugar, 3.36% fat. Milk has substances necessary to meet all the needs of the newborn.

The process of becoming lactation occurs as follows: from 3-4 days of the dairy glands begin to allocate milk, which is accompanied by their loading, sometimes with a small one-time rise temperature. With each subsequent day, the amount of milk increases. Good lactation is characterized by highlighting up to 800-1000 ml of milk per day.

For excessive heat of the mammary glands It is necessary to provide their position, which can be provided with a good bra. In addition, you need to restrict drink; After each feeding, completely grind the residues of milk; If the mammary glands are not empty enough, seek help from the midwife.

IN postpartum period may be observed two physiological temperature lifting . The first is noted within 12 hours after delivery, it is explained by the overstodium of a woman in the process of childbirth, as well as entering blood after the enhanced muscle operation of lactic acid.

The second increase in temperature is 3-4 days after generics, it is explained by the fact that it is precisely to this period of microorganisms from the vagina to penetrate into the uterus, in which the processes of healing of the mucous membrane are far from completed. Defensive reaction Against the introduction of microorganisms in tissue is expressed, in particular, a short-term one-time increase in temperature to 37.5º.

IN postpartum period There may be violations of the bladder function (urination delay), intestines (stool delay), slowing the involution (reverse development) of the uterus.

For urination delay They are trying to call it reflexively (create a sound reflex, opening a crane with water, watering the area of \u200b\u200bthe urethra with warm water), put the warm heating of the abdomen. If these measures do not help, assign medicationsWhen the above-mentioned procedures are unsuccessful, the bladder is empty using a catheter.

For absence of independent stool For 3 days after delivery, a cleansing enema is prescribed or given a laxative; The diet is adjusted.

In the first 2 days after childbirth, food should be easily friendly and high-calorie (cottage cheese, sour cream, semolina, Kissel, cookies). From the 3rd day, an ordinary diet with adding milk, fresh fruits and vegetables is prescribed after emptying the intestine. Food should be rich in vitamins in which the organism needs both mother and the child. It is necessary to avoid sharp dishes, canned food, sausages, greasy meat, alcohol.

Slow out involution of the uterus - This is a lag of the uterus in reverse development. In this case, ice on the bottom of the abdomen, cutting agents, is prescribed.

Currently, in almost all maternity hospitals, the brigade of medical workers is adopted, in which a neonatologist and children's nurse must be included. Children's doctor (Neonatologist) carefully follows the progress of childbirth and begins to engage in a child, as soon as his head is born.

To avoid mucus in the top airways A soft rubber sterile can be removed mucus from nasal strokes and mouths. The newborn is born slightly shiny, makes the first breath, makes a cry, moves with handles and legs and starts to quickly pose. And at this moment it is placed on the belly of Mom, in order for her to see and touched her child. This is very useful not only for the child (in this way his first contact with the outside world), but also for the moral state of the mother, she, seeing the baby, reassuringly calm down, which favorably affects the flow of childbirth and the postpartum period. Currently, it is practiced in almost all maternity hospitals.

During this time, as a rule, the pulsation ceases in the umbilical cord (first in the arteries, and then in Vienna), before it is not recommended to mention it. As soon as the pulsation of the vessels of the umbilical cord is stopped, at a distance of 10-15 cm from poucher ring We apply a clamp, the second clamp is placed on 2 cm in front of the first. The umbilical cord is wiped with 95-degree alcohol and cut.

Immediately after birth prevention of Blenorei (child eye lesions by gonococci), since the possibility of infection of the newborn when passing through the generic pathways is not excluded. Currently, a 30% sodium sodium solution (albucid) is used for this purpose. The eyelids of the newborn wipe with sterile cotton swabs (separately for each eye) from the outer angle to the inner. Pull the lower eyelid of each eye and applied to the twisted eyelids 1 drop of solution. At the birth of the girl, the same solution in the amount of two drops are buried in vulva. The newborn is washed with warm water, removing mucus, blood, mingonium, carefully wipe on a warm sterile diaper, put on a heated changing table and start processing umbilical cord. The residue of the umbilical cord is again treated with alcohol, at a distance of 0.5 cm from the umbilical ring is superimposed by a clip for 1-2 minutes, then the clamp is removed, and the entire plastic bracket is applied to its place and the residue of the umbilical cord is imposed. Bedtooth tissue above brackets are cut off, blood is removed. The residue of the umbilical is treated with a 5% potassium permanganate solution and the sterile gauze bandage is applied to it.

After graduating from the processing, obstetrics with a swab, moistened with sterile sunflower oil, removes the remnants of lubrication from the skin of the child, especially in places of natural folds (inguinal folds, axillary pits). Then the newborn is weighed, measured its length (from the top of the top to the heels), the size of the head, the circle of the shoulder belt.

The bracelets are put on the knobs of the newborn, on which the surname, name, mother's patronymic, date, hour and year of birth of a child, its floor, body weight and length, the number of mother genera, the newborn room. The child wrapped in sterile warm diapers and blanket.

In many maternity hospitals, the child's attachment is currently practicing to the mother's chest in the maternity hospital 15-20 minutes after his birth, if there are no contraindications. And it is not done not because the child is hungry, and then that the child's body receives the mother microflora and many useful protective factors (maternal immunoglobulins) from the colostrum. The first drops of breast milk have miraculous properties, they are in the full sense of the word with a child health. At the same time, a neonatologist's doctor talks with her mother, he informs her about the state of the baby (his assessment on the apgar's scale), about the births on the body or face, gives the first recommendations.

Child condition in the first minute and 5 minutes after birth rate scale apg. The newborn evaluation system was proposed in 1953 by Virginia Apgar. Using this method, it is possible to objectively to judge the condition of the child. Most newborns at the first minute receive an estimate of 7-8 points due to some sinusiness and reduced muscle tone. After 5 minutes, the score rises to 8-10 points.

Evaluation in the ballast points of the newborn after birth along the scale of apgar

PARAMETER	0 points	1 point	2 points

Frequency of heartbeat ice / min	Absent	Less than 100.	Over 100.
Breath	Absent	Breathing irregular, its frequency is reduced	Normal, loud cry
Reflexes (reaction to irritation soles)	Absent	Grimace	Cough
Skin painting	Total Pallor or Skin Blue	Pink Body Color and Limit Blue	Pink
Muscular tone	Absent	Easy degree of limb flexion	Active Movements

The newborn child is considered to be donated if his period intrauterine development Compiled a full 37 weeks, the mass of the body is equal to or exceeds 2500 g, and height 45 cm. Medium weight Funny Boy - 3400-3600 g, Funny Girl 3200-3300 G. The average body length is 49-52 cm.

Funny baby screaming loudly, he has active movements, well-pronounced muscular tone and sucking reflex. His skin is pink and elastic. The subcutaneous fat layer is well developed. Bones of skull elastic, side spring closed, ear shells Elastic. Nails come for finger tips. Girls have large sex lips close small, the boys are omniced in the scrotum.

The next 2 hours after childbirth, the child along with the mother is in the maternity hospital under the supervision of a doctor and midwives, and then, if there are no contraindications for a joint stay, they are transferred to the postpartum ward.

The postpartum period is called the period that begins after the dishellion of the placenta and lasts about 8 - 10 weeks after childbirth. After childbirth, doctors watch the woman very intently. Postpartum diagnostics is very important. What doctors pay attention to the postpartum period, which surveys are prescribed and why is it all done?

Postpartum period

The postpartum period is a period of not only the physical, but also emotional restructuring of the body. The length of this period is the difference within 6 - 10 weeks, but begins immediately after delivery. While finding a woman in the postpartum department, it usually measures blood pressure, body temperature, pulse. Particular attention was riveted to the discharge from the vagina and the reduction of the uterus. If all the indicators are normal, after 2 hours, the purse is sent to the postpartum separation. There, the observation of these and other parameters lasts about 3 to 4 days.

Matter in the postpartum period

Perhaps the most significant changes in the body of a woman after childbirth occur with the uterus. It begins to cut intotensively and quickly decrease in size immediately after delivery. For completeness, you can imagine how shrinking it is: by the end of pregnancy, the uterus, as a rule, weighs approximately a kilogram, and after 8 weeks after the birth, its weight reaches 50 - 100 grams!

After childbirth, the uterus turns out to be a navel level. The doctor on the touch checks its condition, ideally in the postpartum period to the touch dense and painless. Every day, the uterus is declining very intensely and a day, approximately, its height drops 2 cm. And by the 10th day leaves for pubic bones. The cuts of the uterus are very important, so the doctor proves her daily, determining, it is normal or not. In the case of any complications, the doctor is prescribed drugs contributing to the reduction of the uterus. As a rule, women who have a cut in the uterus are sluggish, oxytocin is introduced. Before extracting women spend ultrasound diagnostic (Ultrasound), by means of which is determined, the state of the uterus or not. It is also important that there is no blood clots in the uterus or not separated particles of the placenta. If this happens, the woman will be assigned to clean and its extract will be delayed on the day.

If the childhood of the woman occurred through the cesarean section, it requires a slightly longer and thorough postpartum observation. In addition to the standard examination criteria, control over the intestinal peristalistic and inspection of the seams is added. Keep in mind that due to the presence of seams, the uterus is difficult to shrink, it is slower. Therefore, the process of recovery after cesarean section lasts a little longer.

Selection from the vagina in the postpartum period

After separating the placenta from the walls of the uterus, the uterus is one big wound. The mucous membrane of the uterus is completely restored only by the end of the 10th day. Immediately after the birth, the active contraction of the uterus begins, blood from the torn vessels is flooded. In the first days after the generation of the discharge from the vagina, with active contraction of the uterus, quite abundant. Gradually, the abundance goes and the allocation of the vagina acquire a somewhat different character - they become bright, yellowish. It happens, as a rule, by the end of the second week after childbirth. It is usually terminated by the end of 5-6 weeks after delivery.

Analyzes in the postpartum period

A general analysis of blood, which is produced in the postpartum compartment, allows you to evaluate the general condition of the woman. Low hemoglobin speaks of possible anemia, which occurs in women as a result of a rather significant blood loss. Also, the analysis makes it clear about the presence or absence of inflammatory processes, allergic reactions. Urine analysis is done in order to eliminate gestosis or urinary system disease.

Arterial pressure in the postpartum period

If a woman was transferred to prestrast, especially in his hard form, then in the first days after childbirth, it will have a high blood pressure. In such cases, a woman should appeal to the oculist to eliminate damage to the organs of vision. The physician will be examined by the eye, he will check the state of the vessels and retina. Also increased pressure may indicate hypertensive disease, and reduced - about anemia or hypotension.

Bubble and intestines in the postpartum period

The uterus in the postpartum period should be reduced very intensely, but the crowded bladder or intestines to this process are very prevented, so doctors are followed from a timely emptying. Immediately after childbirth, the woman is removed with a catheter. Problems with intestinal peristalsis usually arise due to painkillers introduced by a woman. It's theirs by-effectBut it passes quite quickly. In the first days after childbirth, a woman cannot be stuck, especially if in the area of \u200b\u200bthe crotch or internal genitals, seams were applied. Also after delivery there is an exacerbation of hemorrhoids, in these cases it is also impossible to strain. Therefore, after giving birth to this process can help laxative or glycerin candles. It is also recommended to post meals: help in this case can rub or crushed food, in the same way in food should be used more vegetables.

Chest in the postpartum period

After the birth of the child begins the active activity of the mammary glands. Initially, the primary milk is produced - colostrum. It has a transparent whitish color. But it is not necessary to underestimate it. Mososy - the most important food of the kid in the first days of life. It is determined in the process of forming immunity and digestion kid. The usual, all habitual milk comes, as a rule, on three days.

Acknowledge, the arrival of milk - the process is quite painful and unpleasant. The first attempts to feed the baby are rare bring physical pleasure. Nipples only adapt to their new and long-awaited role, so the cracks are normal. At first it is important to establish breast-feeding. In this good assistant will become breastsos for you. Use it before feeding the baby, slightly seen (pair of pressing) of milk so that the child is easier to suck. This need will disappear enough quickly. For healing cracks of nipples various ointments, we can advise you such as "Bapten". Also more often suite air baths for the chest, it contributes to the active healing of cracks.

Features of the postpartum period at home

After discharge, the woman must keep track of their well-being independently. In the case of the seams, they must be removed by 6-7 days. In the presence of seams, a woman should process them daily, for example, with green. It is also recommended to wash as often as possible. When seams, it is recommended to use special "postpartum" disposable underwear and gaskets. Their special breathable properties contribute to the speedy healing of seams.

After 6-8 weeks after childbirth, a woman should visit the gynecologist's office, for inspection and consultation on subsequent contraception.4

After the birth of the post, the parents enters the postpartum period. The first 2 hours after childbirth are called the early postpartum period. This period is very short and compared to childbirth is easier for a woman, but nevertheless you need to consider it very responsible for observation of a woman at this time. After childbirth, a woman is called a purse.

Immediately after the birth of the lane, the uterus is significantly reduced by its size due to the reduction of the walls. The walls of the uterus thicken and she acquires spheroid shape. Front I. rear walls Squirt to each other. The body and cervix are located in relation to each other at an angle, open the kleonda. The uterine axis is rejected by the kaper from the pelvis axis. In the uterine cavity there is a small amount of blood clots and fragments of the decidual shell.

The cervix has the appearance of a thin-walled, soft bag.
Widely gaping outdoor zev - with donkeys and abrasions. The crooked canal can freely skip in the uterus hand brush. Immediately after the breeding of the uterus weighs 1000-1200, due to the stretching and relaxation of the binder and fixing apparatus of the uterus, as well as the muscles of the pelvic bottom, an amplified displacement and mobility of the uterus is noted. The filled bladder easily raises it up, so you should remember the need to empty the bladder.

Maintaining an early postpartum period:

Row birth to Azu after giving births is tired, which naturally after severe physical and emotional tension, But she had so many tonic substances, she was so shocked by this that happened that it was unlikely to fall. A healthy woman e sleep, and the midwife does not allow the woman to fall asleep, how can it lead to the uterus hypotension.
Drowsiness and vomiting are a sign of brain hypoxia and may be a consequence of large blood loss, including internal.

Turning off the uterine-placental circle of blood circulation, lowering intra-abdominal pressure, hormonal changes Reflected on functions of cardio-vascular system. The pultsee, blood pressure is somewhat student, or normal, or a somewhat decreases or rises. Body temperature is usually normal. It is possible a short-term increase in temperature (not higher than 37.5 ° C) communications with a nervous and physical voltage.

In the early postpartum period there is a threat of bleeding due to insufficient or poor cutting of the uterus, due to the violation of hemostasis in the placental vessels. With an excessive blood loss, hell is reduced, pulse is studied, skin Covers Pale, and, as already mentioned, drowsiness is felt.

All this time, the pore after physiological birth Located under the supervision of midwives.
Under the pelvis is placed the vessel or the calm-shaped basin to account for blood loss. On the stomach above the pubis is mounted ice and severity. The midwife monitors the general state of the maternity hospital, checks the pulse, copes well-being, measures blood pressure, draws attention to the color of the skin.

It is necessary to control the state of the uterus, determining its consistency, the height of the bottom in relation to the navel, monitor the volume of blood loss. The uterus should be dense, painless, the bottom of it should be on the 2 transverse fingers below the navel to guarantee the safety. In the presence of risk factors for bleeding and with poor cutting in the uterus, it makes it an outer massage and introduce uterotonic agents (oxytocin, methyl ergometrine). Early attachment of the child to the chest is an additional factor in the prevention of postpartum bleeding.

In assessing the general blood loss, the amount of blood released in the last and early postpartum periods is taken into account. Blood is drained into a measuring vessel and determine the volume of blood loss. Normally, blood loss is 250-300 ml, or 0.5% of body weight.

In the early postpartum period, an inspection of soft tributes. In aseptic conditions (after treatment with a disinfecting solution of external genital organs, the inner surface of the hips and pubis), the doctor and midwife after disinfection of the hands inspect the external genital organs and the crotch (sex lips, the clitoris area, the entrance to the vagina and the lower third of the vagina - with sterile tampons) . Inspection of the neck and walls of the vagina are carried out with the help of large vaginal mirrors and ended clamps.

All discovered gaps are immediately sewn. Unfinished breaks are often the cause. postpartum complications, mainly bleeding and infections. In the future, unimposed breaks can lead to omitting and falling out of the uterus, chronic inflammation cervix, erosions, ecropions and others pathological conditionswhich can then create a background for the development of cervical cancer. Therefore, the immediate restoration of the integrity of detected breaks is an essential event to prevent all these complications.

Data on the status of the last, generic paths, duration of childbirth in terms of periods and child data is entered into the history of childbirth and children's history, as well as a guide to the registration of childbirth.

After 2 hours, the Rigor, along with the child, is translated to the postpartum separation. Before the translation and upon admission to the postpartum branch, pay attention to the height of the uterus, its consistency, the nature of the bloody discharge from the vagina, measure the pulse, temperature, blood pressure. The lounge is placed in the ward along with the child, while the cyclicality of filling (women who born in one day are placed in one ward). The midwife of the postpartum branch immediately introduces a woman with a feeding regime at the request of the child, teaches the correct applying to his chest, conducts a conversation about the mode and personal hygiene, the first hours of their parental stay on the postpartum branch of the midwife especially carefully care and observation.

Late postpartum period, changes in the body of a parental:

Late postpartum period begins after the end of the early postpartum period and continues until 6- weeks. This is the time during which reverse development occurs, or involution, genital organs. Involution occurs in all organs that have undergone changes to the time of pregnancy and in childbirth. If a woman feeds the child with his milk, then the inverse changes in the lactic glands occur after the lactation stops, then the entire phases of the ovarian and uterine cycles and the functions of the regulatory centers are restored.

The uterus day after day decreases in size due to the cuts of the walls. The bottom of it is lowered during the first 10 days daily by 1-2 cm (or 1 transverse finger). In the first day after childbirth, the bottom of the uterus can remain at the level of navel whether to fall on 1 transverse finger below. On the second day - on 2 transverse fingers below, on the third day - on 3 transverse fingers. On the 4th day, the bottom of the uterus is usually located in the middle of the distance between the navel and the pubic. On the 5th - 6th day - on 3 transverse fingers above the pubis, and on the 10th day - hidden behind the pubic.

Due to the cutting of the uterus in the first day of the wall, it is thicken, the front and rear walls come closer, the uterus becomes a spherical shape, after 1 week the mass of the uterus decreases to 500-600 g, after weeks - up to 350 g, after 3 weeks - up to 200 g, to The end of the lateral period of the uterus is reduced almost to the initial level, and its mass becomes 60-70. Muscular cells, increased during pregnancy, are gradually declining in size, additional cells disappear, the suck of a suck is reduced. Nervous structures Subjected to gradual decay and disposed of a parental organism.

With a bladder filled with urinary bubble, the uterus is usually located above, so for more objective assessment It is necessary to offer a pity to empty before inspection of the bladder. The first days after childbirth from the uterus actively move away. Due to the reduction of the uterus, blood clots are removed, fragments of the decidual shell, in addition, a secret with a wound surface is distinguished. The purification of the inner surface of the uterus is ensured by phagocytosis and proteolytic enzymes.

Postpartum discharge is called Lochi. In the first three days after childbirth, there is a bloody and rather abundant, on the 4-7th day they become less abundant and blurred and called suburbs, for the 8-10th day they have a suburban-serous character and pretty scanty. In subsequent days there may be oscillations of scanty dark discharges, but there should be no bright bleeding.

In the region of the wound surface of the mucous meter, regeneration processes occur. The slower regeneration occurs in the area of \u200b\u200bthe placental site. This process takes about 5-6 weeks. In the rest of the mucosa, the regeneration is already completed by the 11-13th day after delivery.

After the regeneration phase, the remaining phases occur consistently mastechnic cycleBut their duration can be much longer in time. By the end of the postpartum period, the mucosa of the uterus is completely restored.

An hour after the birth, the neck can still pass his hand, after 12 hours - no more than 2-3 fingers, on the 3rd day of the postpartum period inner zev of the cervix with difficulty skipping the fingertip. Fully the cervix is \u200b\u200bformed by the end of the 3rd week.

Bundles of the uterus are gradually reduced and acquire the former look together with a decrease in the size of the uterus. Swelling of pipes decreases, which also occupy the former place. The vagina and the floor slot are gradually reduced. Small cracks after delivery are usually epithelized by the end of the first week. The pelvic bottom muscles are gradually restored.

In the ovaries after childbirth, regress is completed yellow BodyAnd the process of ripening follicles begins again. Menstruation can occur after 1 or 2 months after childbirth, but there may be a lactation amenorrhea. The first months after childbirth, there are usually annevulatory cycles, against the background of natural feeding of ovulation may not be, however, in some women pregnancy comes even against the background of amenorrhea, so it is necessary to choose an acceptable method of contraception for a woman.
Reverse changes occur with hemodynamics, blood formation, urinary, respiratory system, leather, musculoskeletal system, nervous and endocrine systems, metabolic processes.

Despite the completion of involution, signs former birth stay for life. The uterus becomes several large sizes, the neck has no conical, but a cylindrical shape, the outer zev instead of the point acquires slim-shaped formA traces of stretch marks remain on the abdominal wall, although they are reduced in size and become whiten.

With insufficient skin elasticity and a large number of stretch marks of the belly, and sometimes breasts, becomes a flabby. Dairy glands are prepared for lactation during pregnancy. Active secretory activity begins only after delivery. In the first days, colostrum is produced in very small quantities. The heat of the mammary glands and the production of milk is observed from the 3-4th day of the postpartum period. The production of milk is due to increased production of prolactin, or a luteotropic hormone, which is produced in the front of the pituitary gland (the same hormone prevents the resumption of menstruation). The amount of milk does not depend on the magnitude of the mammary glands and even on the amount of iron tissue.

The secretory cells of the mammary glands allocate milk in dairy moves that merge into larger milk passages. Each large slices has a duct with a nipple outlet. The muscular-connective sphincter prevents the permanent leaking of milk. Some parents have milk leaking between feeding.