Puerperal Disorders

Puerperal Disorders

DOI: 10.4018/978-1-7998-4357-3.ch007

Abstract

Unfortunately, the complexities of human pregnancy and birth make it a risky endeavor. The most vulnerable time for maternal death is the post-partum period during which 60% deaths and 65% deaths are reported. Around 62.3% deaths are estimated to occur in post-partum period. Unfortunately, post-partum period is the most neglected period. In the developing world, while 65% of all women have some form of antenatal care, 53% get intra-natal care; only 30% get post-partum care. Women continue to need care and support after childbirth. Postpartum checkups can make all the difference for an abnormal bleeding or infection. Living away from services or being unable to afford those services prevents a woman from acquiring the knowledge needed after birth to look after herself or to receive the life-saving antibiotics and the attention she may need after delivery.
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Key Facts

  • In the sub-acute postpartum period (puerperium), 87 to 94 percent of women report at least one health problem (Glazener et al, 1995; Thompson et al, 2002).

  • Long term health problems (persisting after the delayed postpartum period) are reported by 31 percent of women (Borders, 2006).

  • Prevalence of Post-traumatic Stress Disorder (PTSD) following normal childbirth (excluding stillbirth or major complications) is estimated to be between 2.8 and 5.6 percent at six weeks postpartum (Olde et al, 2006).

  • Maternal collapse is an acute life-threatening event in which the mother falls unconscious at any stage of pregnancy or up to 6 weeks of postpartum due to cardio-respiratory or neurological compromise. The effective resuscitation determines the outcome for both the mother and the foetus.

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Introduction

A puerperal disorder or postpartum disorder is a disorder which presents primarily during the puerperium or postpartum period. The postpartum period is the most critical and yet the most neglected period in the lives of both mothers and the newborns, as is described by World Health Organization (WHO). Most of the maternal and neonatal deaths occur during the postpartum period (WHO, 2014).

In the scientific literature, this term is usually abbreviated as Px, where x is a number of day; “Day P5” is read as “the fifth day after birth”. There is no confusion with the medical nomenclature that uses “G P” for number and outcomes of pregnancy i.e. gravidity and parity.

A postpartum or postnatal period commences immediately after the birth of a child as the body of the mother returns to its non-pregnant state, including the levels of hormone secretion and the size of the uterus (Kansky, 2016). The first six weeks after childbirth are commonly termed as puerperium or puerperal or immediate postpartum (Romano et al, 2010).

A woman who gives birth in a hospital may leave it as soon as she is medically stable, as early as few hours of postpartum, although the average stay in a hospital for the vaginal birth is one to two days. Average postnatal stay in a hospital in case of caesarean section is three to four days (National Health Service, 2016). During this period, the mother is monitored for the bleeding, functioning of bowel and bladder as well as care of the newborn. The health of the newborn is also under surveillance (Vernon, 2007). Typically, early postnatal hospital discharge is defined as discharge of the mother and newborn from the hospital within 48 hours of delivery.

The postpartum period can be divided into three distinct phases; the initial or acute phase, which lasts 6 to 12 hours after childbirth; sub-acute postpartum period, which lasts 2 to 6 weeks and the delayed postpartum period, which can last up to six months (Romano et al, 2010).

In the sub-acute postpartum period, 87 to 94 percent of women report at least one health problem (Glazener et al, 1995; Thompson et al, 2002). Long term health problems (persisting after the delayed postpartum period) are reported by 31 percent of women (Borders, 2006).

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