The aim of thesis is focused on impact of early puerperium on cow performance and other healt and production characteristics. Describe basic anatomical structures of cattle reproduction organs, hormonal changes within physiological processes in female body in time of estrus, pregnancy, parturition and lactation too. This thesis evaluate healt status of Holstein cattle herd on lowland farm in two periods and describe differences between them.

Durante o puerpério há muita incidência de doenças reprodutivas acarretando aumento do intervalo entre partos, bem como diminuição na taxa de concepção. A endometrite é uma enfermidade puerperal que se caracteriza por um processo inflamatório superficial do endométrio. Com o intuito de se obter novas ferramentas diagnósticas não invasivas, precisas e que proporcionam resultados precoce à reprodução, faz-se uso da ultrassonografia convencional associada a ferramenta Doppler que fornece informações em tempo real sobre a arquitetura vascular e os aspectos hemodinâmicos dos vasos em diversos órgãos. Este estudo tem por objetivo descrever, através da ultrassonografia Doppler, as alterações hemodinâmicas no útero de fêmeas bovinas causadas pela endometrite. Avaliou-se o trato reprodutivo feminino de vacas entre 25 a 35 dias pós-parto utilizando a vaginoscopia, ultrassonografia convencional e Doppler, além de citologia e exame microbiológico em 89 vacas Holandesas sendo 33 sadias (controle) e 56 com endometrite diagnosticadas por citologia (saudáveis <10% de polimorfonucleares). Os resultados obtidos destacam-se a que animais com endometrite apresentavam aumento de cérvix (p=0,04), e de útero representado pelo corno esquerdo (p=0,02). Porém não foi observado diferença quando comparado os escore de condição corporal (ECC). Quanto a ultrassonografia notou-se que animais com fluido intrauterino (FIU) e conteúdo heterogêneo intrauterino (CHIU) tinham endometrite (p<0,0001), além de correlação com a presença de Trueperella pyogenes e leveduras. Com o modo cores do Doppler obteve-se a vascularização de mesométrio (p=0,004) e endométrio (p=0,025) associada aendometrite. Entretanto não foi observado diferença estatística nas medidas do Doppler espectral (índice de resistividade, pulsatilidade e fluxo sanguíneo). Portanto a busca de novas técnicas, menos invasivas e de rápido resultado, como a ultrassonografia Doppler, podem fornecer respostas satisfatórias quanto a evolução de alterações uterinas e com isso associar os resultados à precocidade reprodutiva. / During the puerperium period there is a high incidence of reproductive diseases resulting in increased calving interval and decrease in conception rate. The endometritis is a postpartum disease that is characterized by a superficial inflammation of endometrium. With the aim to obtain new non-invasive and accurate diagnostic tools, that provide early results in reproduction, it is possible to be used the conventional ultrasound associated to Doppler that provides real time information about vascular architecture and hemodynamic aspects of vessels in several organs. This study aims to describe, through Doppler ultrasound, hemodynamic changes in the uterus of cows caused by endometritis. Were evaluated the female reproductive tract of 89 Holstein cows between 25 to 35 days postpartum using vaginoscopy, conventional ultrasound and Doppler, as well as cytology and microbiological examination. From the 89 animals that were studied, 33 were healthy (control) and 56 with endometritis diagnosed by cytology (healthy <10% polymorphonuclear). The obtained results show that animals with endometritis had increase in cervix (p = 0.04) and the uterus represented by left uterine horn (p = 0.02). However, it was not detected difference when compared the body condition score (BCS). About the ultrasound was noted that animals with intrauterine fluid (IUF) and intrauterine heterogeneous content (IUHC) had endometritis (p <0.0001) correlation with the presence of Trueperella pyogenes and yeasts. With the color Doppler mode it was possible to obtain the vascularization of mesometrium (p = 0.004) and endometrium (p = 0.025) associated with endometritis. However, it was not observed statistical difference in the measurements of the spectral Doppler (resistance index, pulsatility and blood flow). Therefore, the search for new techniques, less invasive and fast result, as the Doppler ultrasound can provide satisfactory answers as the evolution of uterine changes and thereby associate the results to the reproductive precocity.

The purpose of this investigation was twofold. First, to investigate the attitudes and feelings of a group of normal women expecting their first child. Second, to evaluate the effectiveness of a family centred maternity programme in promoting a positive feeling towards the infant and in terms of preparing the mothers for their new role. The subjects were 94 married women who attended prenatal classes with their husbands. They were white, Caucasian, with a mean age of 27 years and a mean level of education of 14 and one half years. The women were raised in North America or the British Commonwealth. All women delivered a single full term infant and experienced no major medical complications of either themselves or their infant during pregnancy, delivery or the postpartum period. Each woman completed a series of questionnaires relating to attitude towards pregnancy, labour and delivery, childbirth, the new baby and the hospital experience. These measures were completed at four points in time; in the ninth month of pregnancy, while in hospital and after one and five weeks at home. In addition, she completed the Depression Adjective Checklists, the Beck Depression Index and the Pleasant Events Schedule in the ninth month of pregnancy and in the sixth week after delivery of her child. The Depression Adjective Checklist was also completed each day that the woman was in hospital. Major comparisons were (a) type of maternity hospital programme experienced — a family centred maternity programme versus a more traditional maternity programme and (b) type of delivery — whether vaginal or caesarian. Multivariate analyses conducted on the set of variables at each time period revealed a significant difference between the two groups of women depending upon which hospital programme they experienced, both while in hospital and after they had been home for one week. Univariate analyses revealed significant difference between the two groups on their responses to the following variables: The women in the family centred maternity programme had a more positive attitude towards their babies while in hospital; considered that they received more experience in how to care for their babies in hospital and perceived that they obtained more help from the hospital in preparing them for their mothering role. There was no difference in attitude towards the baby once the women had been home for one week caring for and interacting with their babies. A repeated measures analysis of variance indicated that there were no differences in the level of depressive affect between the women in the two types of programme over the time periods involved. Multivariate, analyses of the sets of variables at each time period indicated a significant difference between those who had a vaginal delivery and those who had a caesarian section. Those women who had a caesarian section had a less positive attitude towards their labour and delivery. There was no difference between these two groups of women in either their attitude towards their infant or their feelings of self-confidence. A repeated measures analysis of variance revealed that those women who had caesarians were more depressed after the birth of their baby than those women who delivered their baby vaginally. Although the women in the present study were not clinically depressed there were significant correlations between levels of depressive affect and other variables. For example, in the ninth month of pregnancy depressive affect was related to a less positive attitude towards pregnancy; in hospital depressive affect was related to a less positive attitude towards labour and delivery and towards the baby; at six weeks postpartum depressive affect was related to a less positive attitude towards the baby. The discussion centred around the implication of the findings for hospital programmes and prenatal class curricula, current behavioural theories of depression and the myth of maternal instinct. / Arts, Faculty of / Psychology, Department of / Graduate

The reformulated learned helplessness model posits that individuals who make internal, stable and global attributions for undesired outcomes are more likely than others to become depressed when faced with important life events that are perceived as uncontrollable. Seligman, Abramson, Semmel and von Baeyer (1979) found significant correlations between attributional style and concurrent measures of depression in a sample of college undergraduates. The purpose of the present study was to address two questions arising from the Seligman et al. study within the context of the event of childbirth. The first question was whether the relationship between depressive attributional style and concurrent depression found in college undergraduates could be extended to women anticipating the birth of their first child. The second question was whether depressive attributional style would have predictive utility with this group, that is, whether women's prenatal attributional style would be predictive of depression in the first week postpartum. The results provide neglible support for the notion of depressive attributional style as defined by the reformulated learned helplessness hypothesis. Although this study was not designed to test hypotheses based upon any other model of depression, the findings were consistent with Beck's (1967) formulation. Several alternative explanations for the discrepancy between the present findings and those reported by Seligman et al. are discussed. Notably, 17% of this relatively homogeneous sample of primiparous women reported depression of clinical severity during the first week postpartum. / Arts, Faculty of / Psychology, Department of / Graduate

O objetivo do presente trabalho foi analisar a influência dos fatores etários, do puerpério, da castração, bem como a influência do confinamento no lipidograma e nas funções hepática e renal. Foram mensurados os valores séricos de colesterol, triglicérides, ácidos graxos não esterificados (NEFA), β-hidroxibutirato (B-HBO), ureia, creatinina, proteína total, albumina, aspartato-aminotransferase (AST), gama glutamil transferase (GGT), creatina quinase (CK) e glicose. Para realização do experimento foram utilizados 370 bovinos da raça Purunã. Os animais foram dispostos em 4 diferentes experimentos. Os dados foram analisados por ANOVA, usando o procedimento GLM do SAS. Concluiu-se que os constituintes metabólicos foram consideravelmente influenciados pela idade, sexo, puerpério e sistema de criação. Devido à grande quantidade de amostras estrategicamente colhidas, obtidas de diferentes manejos, também foi possível sugerir valores de referência para os análitos, nestes experimentos mensurados, para bovinos da raça Purunã de diferentes idades, sexos, fases do periparto e do puerpério e em confinamento. / The objective of this study was to analyze the influence of age, after childbirth, castration, as well as the influence of confinement on lipid profile and in liver and kidney function. We measured the levels of serum cholesterol, triglycerides, non-esterified fatty acids (NEFA), β-hydroxybutyrate (B-HBO), urea, creatinine, total protein, albumin, aspartate aminotransferase (AST), gamma glutamyl transferase (GGT), creatine kinase (CK) and glucose. For the experiment we used 370 cattle breed Purunã. The animals were assigned to four different experiments. Data were analyzed by ANOVA, using the GLM procedure of SAS. It was concluded that the constituents were considerably influenced by metabolic age, sex, and postpartum creation system. Due to the large amount of strategically collected samples, obtained from different management, it was also possible to suggest values for the analytes, measured in these experiments, Purunã to breed cattle of different ages, sexes, and stages of peripartum and postpartum and confinement.

Einleitung: Bei Milchkühen häufen sich Erkrankungen in der Frühlaktation. Sie gehören zu den wichtigsten Ursachen frühzeitiger Merzung und damit der aktuell unbefriedigenden Nutzungsdauer. Ziele der Untersuchungen: Ziel dieser Arbeit war es, den Stoffwechsel von Milchkühen in der kritischen Übergangszeit vom Trockenstehen zur Laktation (Transitphase) durch drei verschiedene prophylaktische Maßnahmen zu stabilisieren: mittels Huminsäuren Belastungen aus dem Darm einschließlich Endotoxinen zu mindern, mit einem Ammoniumpropionat-Propylenglykol- Gemisch die Energieversorgung zu verbessern sowie mit Dexamethason-21-isonicotinat die Stoffwechselfunktion der Leber zu fördern sowie gleichzeitig Entzündungsprozesse infolge der Kalbung zu hemmen. Materialien und Methoden: Die Untersuchungen wurden in einem sächsischen Bestand an 312 Kühen der Rasse „Holstein Friesian“ randomisiert innerhalb eines Jahres durchgeführt. An jeweils 78 Kühe wurden 300 ml Ammoniumpropionat-Propylenglykol-Gemisch(C3) täglich vom 14. Tag ante partum (a.p.) bis zum 14. Tag post partum (p.p.) oral verabreicht; ebenfalls oral wurden 100 g Huminsäure-Fertigpräparat (HS-FP) bzw. 50 g Huminsäuren-Rohstoff (HS-RS) im selben Zeitraum appliziert, und Dexamethason-21-isonicotinat (DEXA21) wurde einmalig am 1. Tag p.p. intramuskulär in der Dosierung 0,02 mg/kg Körpermasse verabreicht. 78 unbehandelte Kühe dienten als Kontrollgruppe. Die Auswirkungen dieser Maßnahmen auf Gesundheit, Leistung und Stoffwechsel wurden durch klinische Untersuchungen, durch Blutkontrollen am 14. Tag a.p., am 3. und 28. Tag p.p. (Leukozyten, freie Fettsäuren [FFS], Bilirubin, ß-0H-Butyrat[BHB], Glucose, Cholesterol, Creatinkinase [CK], Aspartat-Amino-Transferase [ASAT], Glutamat-Dehydrogenase [GLDH], gamma-Glutaryl-Transferase [GGT], Protein, Albumin, Mg, Fe, Ca, anorganisches Phosphat [Pi], Na, K) sowie durch die Erfassung von Gesundheitsstatus, Milchleistung und Fruchtbarkeit zu bestimmten Zeitpunkten geprüft. Ergebnisse: Die verschiedenen prophylaktischen Maßnahmen hatten keinen signifikanten Einfluss auf Fruchtbarkeits- und Gesundheitsparameter. Bei den absoluten und fettkorrigierten Milchmengen konnten ebenfalls keine statistisch gesicherten Unterschiede zwischen den Versuchsgruppen und der Kontrollgruppe festgestellt werden. Der Milcheiweißgehalt von C3 28 d p.p. sowie der Milchfettgehalt von DEXA21 und C3 100 d p.p. waren signifikant erhöht. Die Ergebnisse der Blutuntersuchungen ergaben hauptsächlich am 3., aber auch am 28. Tag p.p. gesicherte Unterschiede bei wichtigen Stoffwechselparametern wie Glucose, Cholesterol, Bilirubin, Protein, Albumin, Ca, Fe und CK. Die einmalige Gabe von Dexamethason-21-isonicotinat am 1. Tag p.p. hatte den besten Einfluss auf den Leber- und Energiestoffwechsel. In dieser Gruppe waren am 3. Tag p.p. die Glucose-, Bilirubin-, Cholesterol-, Protein, Ca- und Fe-Konzentrationen sowohl gegenüber der KG wie auch gegenüber allen anderen Versuchsgruppen signifikant günstiger. Für die Albumin- und Na-Konzentrationen sowie die CK-Aktivität traf das gegenüber der Kontroll- sowie der C3-Gruppe zu. Der Einsatz der Wirkstoffe mit HS-RS, HS-FP sowie C3 führte ebenfalls zu positiven Effekten auf die Leistung und den Stoffwechsel gegenüber der Kontrollgruppe, jedoch ließen sich diese nur in wenigen Fällen statistisch sichern. Schlussfolgerungen: Die Applikation von Dexamethason-21-isonicotinat einen Tag p.p. stabilisiert signifikant den Stoffwechsel von Kühen nach dem Partus. Gleichartige Effekte auf Milch- und Fruchtbarkeitsleitung sowie die Morbidität konnten nicht gesichert nachgewiesen werden. Für Huminsäure-Rohstoff, Huminsäure-Fertigpräparat sowie Ammoniumpropionat-Propylenglykol-Gemisch waren solche Effekte tendenziell erkennbar, statistisch aber nicht zu sichern. Auch wenn besonders mit Dexamethason-21-isonicotinat der Stoffwechsel in Belastungssituationen kurzfristig stabilisiert werden kann, müssen generell Haltung und Fütterung analysiert sowie Mängel beseitigt werden. / Problem: In dairy cattle diseases are common in early lactation. They are among the main causes of early culling and the current unsatisfactory productive life. Objective: The aim of this work was to stabilize metabolism of dairy cows in the critical transition period from standing dry to lactation by three different prophylactic applications: using humic acids to minimize strain from the gut including endotoxins, using ammonium propionate mixed with propylene glycol to improve energy supply and dexamethasone-21-isonicotinate to promote metabolic function of the liver and at the same time to inhibit inflammatory processes following parturition. Experimental design: The studies were performed in a Saxon dairy farm on 312 cows of the „Holstein Friesian\" breed, randomly performed within one year. 78 cows were administered orally 300 ml ammonium propionate mixed with propylene glycol (C3) daily from 14 days before parturition (a.p.) to 14 days after parturition (p.p.), another 78 cows 100 g of a humic acid drug (HS-FP) or 50 g of humic acid raw material (HS-RS) were administered orally in the same period and dexamethasone-21-isonicotinate (DEXA21) was applied intramuscularly to another 78 cows on the first day p.p. in a dose of 0.02 mg/kg body weight. 78 untreated cows were used as control group. The impact of these administrations on health, performance and metabolism has been measured by clinical examinations and blood tests on 14. day a.p., on 3. and 28. day p.p. (Leukocytes, free fatty acids [ FFS ], bilirubin, beta-0H-butyrate [BHB] , glucose, cholesterol, creatine kinase [CK], aspartate aminotransferase [AST], glutamate dehydrogenase [GLDH], gamma glutaryl transferase [GGT], protein, albumin, Mg, Fe, Ca, inorganic phosphate [Pi] , Na, K) and was verified by detection of health status, milk yield and fertility. Results: The different prophylactic administrations had no significant effect on fertility and health parameters. The absolute and fat- corrected milk yields also showed no statistically reliable differences between experimental groups and control group. Milk protein content in C3 28 days p.p. and milk fat content in DEXA21 and C3 100 days p.p. were significantly increased. Blood control results showed mainly on 3. and 28. day p.p. important differences in metabolic parameters, such as glucose, cholesterol, bilirubin, protein, albumin, Ca, Fe and CK, which are statistically secured. A single dose of dexamethasone-21- isonicotinate on first day p.p. had the best effect on liver and energy metabolism. Three days p.p. glucose, bilirubin, cholesterol, protein, Ca and Fe concentrations performed significantly better in DEXA21 group compared both to control group and all other treatment groups. For albumin and Na concentrations and CK activity that was true with respect to control and C3 group. The use of a humic acid drug, humic acid raw material and ammonium propionate mixed with propylene glycol had positive impact on performance and metabolism compared with control group too, but could be statistically secured in only a few cases. Conclusions: The application of dexamethasone-21-isonicotinate at the first day p.p. significantly stabilizes metabolism in cows after parturition. Similar effects on milk yield and fertility as well as morbidity could not be observed. For humic acid drug, humic acid raw material and ammonium propionate mixed with propylene glycol such effects tended to be recognizable, but cannot be statistically secured. Metabolism can be stabilized in short term stress situations with dexamethasone-21-isonicotinate, general care and feeding must be analyzed and deficiencies have to be eliminated.

A infecção de sítio cirúrgico pós-cesárea corresponde a 8% de todas as infecções pós-parto. Sua magnitude está relacionada ao alto percentual de partos cesáreos, no mundo todo. O puerpério é um período em que há maior atenção ao recém-nascido, podendo passar despercebidas condições que indicam infecção. Objetivos: Descrever o perfil das mulheres submetidas ao parto cesáreo (condições de vida, saúde reprodutiva e perfil sociodemográfico), correlacionando-o à presença de infecção e propor um roteiro que auxilie o enfermeiro da atenção básica a identificar indícios de infecção de sítio cirúrgico pós-cesárea no puerpério. Método: estudo exploratório, descritivo, transversal, retrospectivo, realizado por meio de revisão de prontuários (prontuários geral e Mãe Paulistana e Ficha A do SIAB) de 89 mulheres que tiveram parto cesáreo, de 01/01 a 31/12/2014. Tomaram-se informações de diagnóstico médico de infecção de sítio cirúrgico e situações em que havia, pelo menos, uma condição sugestiva de sinais e sintomas. A análise foi realizada segundo estatística descritiva (teste de Fischer). Resultados: A ocorrência de sinais e sintomas de infecção de sítio cirúrgico pós- cesárea foi verificada em 11 prontuários. Em 16 prontuários, não foram encontrados sinais e sintomas, e 62 prontuários não continham informações ou elas estavam incompletas. Raça/cor e dor em baixo ventre podem indicar infecção, mulheres pardas e negras foram as mais frequentes do grupo que apresentaram sinais sugestivos de infecção, apresentando diferença estatística significativa (p. =0,038). O roteiro para consulta de enfermagem no puerpério pós-parto cesáreo complementa dados que auxilia a identificação da ocorrência de sinais e sintomas sugestivos de infecção de sítio cirúrgico e auxilia a identificação de diagnósticos de Enfermagem. Conclusão: O roteiro pode auxiliar o profissional enfermeiro a reconhecer situações de risco e vulnerabilidade para o desenvolvimento de infecção de sítio cirúrgico pós-parto cesáreo ou outro sinal de complicação pós-parto, contribuindo com a melhoria da qualidade da assistência e segurança do paciente. / The surgical infection after cesarean section applies to 8% of all infections post childbirth. The magnitude of this event is related to cesarean sections high percent in the whole world. The puerperium is the period where there is more attention to the new born and the conditions that points to the infection can be unnoticed. Goals: To describe the profile of women who are submitted to cesarean section (life conditions, reproductive health and socio-demographic profile) correlating it to the presence of the infection and to propose a guide that will help the Basic Attention nurse to identify the surgical infection after cesarean section evidences at the puerperium. Method: exploratory, descriptive, transversal and retrospective study, achieved by medical record review (general records, Mãe Paulistana and Ficha A from SIAB) of eighty-nine women who had cesarean section, from January 01st to December 31st, 2014. Were analyzed medical records that had information about medical diagnosis of infection after cesarean section and conditions that contained at least one high trace of infection after cesarean sections signs and symptoms. The analysis was held through descriptive statistics (Fischers test). Results: The occurrence of signs and symptoms of surgical infection after cesarean section was observed in eleven medical records. In sixteen records wasnt found any reference to these signs and symptoms and sixty-two records didnt had the information or they were incomplete. Race/color, lower womb pain can indicate infection, black and dark women were more frequent among the group that presented high signs of infection, performing a significant statistical difference (p. =0,038). The guide to nurse consulting at puerperium after cesarean section complements the data that helps to identify the signs and symptoms of infection after cesarean section and supports the identification of nursing diagnosis. Conclusion: The guide can help the nurse to recognize situations of risk and vulnerability for the development of infection after cesarean section or any other sign of complication post childbirth complication, contributing to a better quality of patients assistance and safety.

A infecção de sítio cirúrgico pós-cesárea corresponde a 8% de todas as infecções pós-parto. Sua magnitude está relacionada ao alto percentual de partos cesáreos, no mundo todo. O puerpério é um período em que há maior atenção ao recém-nascido, podendo passar despercebidas condições que indicam infecção. Objetivos: Descrever o perfil das mulheres submetidas ao parto cesáreo (condições de vida, saúde reprodutiva e perfil sociodemográfico), correlacionando-o à presença de infecção e propor um roteiro que auxilie o enfermeiro da atenção básica a identificar indícios de infecção de sítio cirúrgico pós-cesárea no puerpério. Método: estudo exploratório, descritivo, transversal, retrospectivo, realizado por meio de revisão de prontuários (prontuários geral e Mãe Paulistana e Ficha A do SIAB) de 89 mulheres que tiveram parto cesáreo, de 01/01 a 31/12/2014. Tomaram-se informações de diagnóstico médico de infecção de sítio cirúrgico e situações em que havia, pelo menos, uma condição sugestiva de sinais e sintomas. A análise foi realizada segundo estatística descritiva (teste de Fischer). Resultados: A ocorrência de sinais e sintomas de infecção de sítio cirúrgico pós- cesárea foi verificada em 11 prontuários. Em 16 prontuários, não foram encontrados sinais e sintomas, e 62 prontuários não continham informações ou elas estavam incompletas. Raça/cor e dor em baixo ventre podem indicar infecção, mulheres pardas e negras foram as mais frequentes do grupo que apresentaram sinais sugestivos de infecção, apresentando diferença estatística significativa (p. =0,038). O roteiro para consulta de enfermagem no puerpério pós-parto cesáreo complementa dados que auxilia a identificação da ocorrência de sinais e sintomas sugestivos de infecção de sítio cirúrgico e auxilia a identificação de diagnósticos de Enfermagem. Conclusão: O roteiro pode auxiliar o profissional enfermeiro a reconhecer situações de risco e vulnerabilidade para o desenvolvimento de infecção de sítio cirúrgico pós-parto cesáreo ou outro sinal de complicação pós-parto, contribuindo com a melhoria da qualidade da assistência e segurança do paciente. / The surgical infection after cesarean section applies to 8% of all infections post childbirth. The magnitude of this event is related to cesarean sections high percent in the whole world. The puerperium is the period where there is more attention to the new born and the conditions that points to the infection can be unnoticed. Goals: To describe the profile of women who are submitted to cesarean section (life conditions, reproductive health and socio-demographic profile) correlating it to the presence of the infection and to propose a guide that will help the Basic Attention nurse to identify the surgical infection after cesarean section evidences at the puerperium. Method: exploratory, descriptive, transversal and retrospective study, achieved by medical record review (general records, Mãe Paulistana and Ficha A from SIAB) of eighty-nine women who had cesarean section, from January 01st to December 31st, 2014. Were analyzed medical records that had information about medical diagnosis of infection after cesarean section and conditions that contained at least one high trace of infection after cesarean sections signs and symptoms. The analysis was held through descriptive statistics (Fischers test). Results: The occurrence of signs and symptoms of surgical infection after cesarean section was observed in eleven medical records. In sixteen records wasnt found any reference to these signs and symptoms and sixty-two records didnt had the information or they were incomplete. Race/color, lower womb pain can indicate infection, black and dark women were more frequent among the group that presented high signs of infection, performing a significant statistical difference (p. =0,038). The guide to nurse consulting at puerperium after cesarean section complements the data that helps to identify the signs and symptoms of infection after cesarean section and supports the identification of nursing diagnosis. Conclusion: The guide can help the nurse to recognize situations of risk and vulnerability for the development of infection after cesarean section or any other sign of complication post childbirth complication, contributing to a better quality of patients assistance and safety.

PhD (Advanced Nursing Science) / Department of Advanced Nursing Science / See the attached abstract below

This diploma thesis explores the ways in which physiotherapeutic procedures and concepts can be used to positively affect puerperium after a physiological childbirth. The beginning of the theoretical part describes the physiology of puerperium, lactation, women's psychological well- being during the postpartum period and postpartum complications. The main part of the thesis focuses on the application of physiotherapeutic methods and concepts during puerperium. The output of this part forms an information handout with exercises appropriate throughout puerperium. In the practical part of the thesis, a questionnaire survey of two groups of women at the end of puerperium took place to objectively evaluate the effect of the information handout. The aim was to find out whether women who are prepared for the puerperium and know how to use targeted exercises to support the regeneration of the body after childbirth experience a milder course of the puerperium, feel psychologically better and evaluate their breastfeeding effectiveness more positively. The experimental group (n = 32) received the information handout during pregnancy and used it in puerperium. The control group (n = 37) did not receive the handout. The standardized Edinburgh Postnatal Depression Scale questionnaire was used to assess the...