Medical Archive

Introduction

?? ? 4~6???

Reproductive tract involution

W+	Anatomy	Physiology
1?	1kg, ??? ?? ?? ??
2?	True pelvis ?? ??? (500g)
3?	???? ?? ??	Coitus ??, ?? ?? (P only)
4?	?? ? ???? ?? (100g)
5?
6?	?? ???? ?? ??.	IUD, OC ??. ?? ?? (??? 2-18??)

Starts ovulation at 6-12 weeks (2-18 months with breastfeeding)
Starts menses at 8-14 weeks

Birth canal

Uterus

???? ?? ?? ?? ??? ??? ?
Sub-involusion
???? ??? ???? ???? ??? ? ??????? ???
????? (Ergonovine) + ???

Sonographic findings

Clinical aspects

• Postpartum fever
  • ?38.0? exclusive of the 24 hours after delivery.
  • Chills and shivering
• ??(afterpain)
  • ??? ??? ?? ??. ????? ?
  • ??? oxytocin ??? ???? ?? ??.
• ??(lochia)
  • Gradual process of endometrial shedding and regeneration which can last up to 8 weeks after delivery. ‘?? ?? ???’
  • Heavier and more prolonged than normal menses.
  • Clinical course
    • Lochia rubra (??): ?? 3-4? ?
    • Lochia serosa (???): ?? 4-14? ?
    • Lochia alba (??): ?? 11?-6?
    • May persist for as long as 2-3 months
  • Differential diagnosis with delayed postpartum hemorrhage
    • Passage of large blood clots
    • Increased pad counts
    • Signs and symptoms of anemia (eg, dizziness, chest pain) d/t acute blood loss
• Breast milk excretion and milk letdown

Placental site involution

Subinvolution

????? ???? ?? ??.

Late postpartum hemorrhage

Urinary tract

• ??? ??? ???? ???? ???? ? Urine volume ?
• ??? ??? ???? ?? ????? ?

?? ??? ??
Bladder Cx ?
Constipation ?
Venous thromboembolism ?

Postpartum urinary retention

• Pathophysiology
  • ?????? ????? ?? ??? – oxytocin? ?? ????
  • Epidural anesthesia
• Diagnosis
  • Inability to void ?6 hours after vaginal delivery
  • Inability to void ?6 hours after catheter removal following c-sec.
• Clinical features
  • Inability to sense the need to void
  • Loss of micturition reflex
  • Bladder atony (eg, palpable overdistended bladder)
  • Overflow incontinence (eg, involuntary dribbling of urine)
• Urethral cathetrization for diagnosis and treatment
  • A postvoid residual volume of ?150mL is consistent with urinary retention.
  • Most patients regain bladder function after catheterization.

Peritoneum and abdominal wall

Blood and blood volume

Hematological and coagulation changes

Pregnancy-induced hypervolemia

Postpartum diuresis

Lactation and breastfeeding

???? ?? ????? ?? ? ??. Milk? vit.K? ??!

Endocrinology

P, E, placental lactogen, prolactin, cortisol, insulin ? ??
?? ? P? ?? ?? ?, oxytocin? letting down, milk ejection ?

Increased prolactin -> induce lactation and inhibits GnRH.

B/c lactation suppresses ovulation, it’s a natural form of contraception for the first 6 months postpartum if the mother is breatfeeding exculsively.

Immunologic

E.coli? ????IgA ??
T-cell? ??? ???? ??? ????.

Breaest engorgement

?? ? ??? 3~5?: ??? ??? ???? ??. Pain
?? ?? ???? bromocriptin? X (CVD??? ?)
??? ????, ????, ???

Milk fever

?? ?? ? 24??, ?? ??, ????. ??? ??.

Contraception for breast feeding women

?? ?? ??? ?, ?? 3? ?, ?????(P)?
P+E ????? 6???. ?? ?? ?????. (IUD? 6? ??)

Contraindicataion to breast feeding

• Infection
  • Active untreated tuberculosis
  • HIV infection
  • Herpetic breast lesions
  • Active varicella infection
  • (CMV, HBV, HCV ?? ??? ??!)
• Medicine, substance
  • Active substance use disorder
• Chemotherapy or radiation therapy
• Infants with inborn errors of metabolism
  • Galactosemia – absolute contraindication
  • Others – may breastfeed intermittently but require close monitoring of metabolite levels.

Drugs secreted in milk

?? ??? – ???? ?? ?? ??? ?, ?? ??? ?

Multiple dose	?? ??	Cytotoxic drug	(??? ?) ?? ??
Single dose	???? ?? ? ? (??)	Radio-isotopes	?? ? ?? ?? ????

Hospital care

?? ? ? 1???? 15??? ??/?? ??. Early ambulation ??!

Perineal care

?? ?? ? ? ?? ? ?? ?? ?? bulbar hematoma ?????.

Bladder function

i. Oxytocin ? ?????? ???? ????? ????.
ii. ?? 4?? ? ?? ??. ?? ? ???? ?? cat. ????.
iii. 200cc ??: ?? ?? ??. 24hr cath. / 200cc ??: ??? ?? CIC (+?? anti)

Pain, mood, and cognition

Depression – ?? ? ?? ?? ?? ? ??. 1/4 ??. Postpartum blue? ?? ??.

Neuromusculoskeletal problems

Musculoskeletal injuries

Pubic symphysis diastasis

• Point-tenderness to palpation over the pubic symphysis and sometimes have a waddling gait
• Management
  • Conservative with supportive care (eg, pelvic support, physical therapy)
  • Most patients recover within the first 4 weeks postpartum.

Immunizations

Hospital discharge

Contraception

??? ??? ??
a. ?? ???? 6~8? ??
b. ??? ??? 2~18?? ?? (??? ?. ?? ??? ?? ??? ? ??.)

Home care

Coitus

Late maternal morbidity

Morbidity	Percenta
Fatigue	59
Breast problems	36
Anemia	25
Backache	24
Hemorrhoids	23
Headache	22
“Blues”	21
Constipation	20
Suture breakdown	16
Vaginal discharge	15

Follow-up care