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Chapter: Maternal and Child Health Nursing : Urinary System

Psychological changes in pregnancy, labour and puerperium

Because of the proximity of the uterus, cervix and vagina to the bladder and urethra their functions are correlated during child bearing and childbirth.

Psychological changes in pregnancy, labour and puerperium

 

Because of the proximity of the uterus, cervix and vagina to the bladder and urethra their functions are correlated during child bearing and childbirth.

 

In Pregnancy

 

1.           Increased Frequency: In the first 12 weeks of pregnancy, while the enlarging uterus is still a pelvic organ, the bladder can not fill up to its full capacity so the woman urinates frequently. This is described as physiological. Also during the last 4 weeks of pregnancy when the fetal head lies in the pelvis there is recurrence of increased frequency. In the middle weeks of pregnancy frequency in association with dysuria is due to urinary infection.

 

2.           Acute Retention: Is a rare condition but sometimes occurs in about the twelfth week of gestation if the uterus is extroverted.

 

3.           Incontinence: This sometimes occurs in late pregnancy when the head is deeply engaged in the pelvis.

 

In Labour

 

Increased Frequency: More common with OccipitoPosterior Position (OPP). Pressure on the sacral plexus of nerve causes excess stimulation of the nerve to the bladder. There is increased desire but can not actually do it.

 

Acute Retention: The pressure on the nerve plexus mayconversely cause lack of sensation stimulus to the bladder. In labor the urethral stretches from 4cm to about 15cm or more thus almost occluding the lumen completely. This makes micturation and even catheterization difficult.

 

Incontinence: If the bladder is not emptied at the end of firststage of labor there is dribbling of urine with each expulsive contraction during the second stage.

 

A full bladder causes delay in the first and second stages of labor. Bruising of the bladder may occur and on the urethral in addition to overstretching. Full bladder can lead to non-

separation of the placenta and PPH (Post Partum Haemorrhage).

 

In Puerperium

 

The Frequency: There is increased secretion of urine in thefirst 48 hours of puerperium. Frequency at this time is physiological. Some times it may be due to infection or lax muscle tone.

 

1.           Acute Retention in puerperium may be due to:

 

2.           Posture: Complete bed rest with use of bed pan.

 

3.           Privacy: May be embarrassed by people around.

 

4.           Pain: fear of pain following perineal tear or difficult labor on the nerve of the bladder during labor.

 

5.           Lax muscle tone: as a result of over distention of the bladder. Abdomen should be palpated daily to rule out sub involution of the uterus and signs of infection.

 

Incontinence may result from trauma like Vesico-Vaginal Fistual (VVF). But stress incontinence is more common as in the multigravida, it results form lax pelvic floor muscles and weak sphincters.

 



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Maternal and Child Health Nursing : Urinary System : Psychological changes in pregnancy, labour and puerperium |


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