- Clinical science
The postpartum period refers to the six to eight week period after the birth of a baby in which the body recovers from the changes caused by pregnancy and birth. During this time, women are susceptible to complications including infection, thrombosis, insufficient postpartum recovery, and postpartum depression. Based on the fundal height measurement and the lochia (postpartum vaginal discharge), the examiner can detect possible pathologies. During the postpartum period, the body also undergoes several physiological changes, such as the beginning of the lactation process and the discharge of lochia and uterine involution.
Low‑grade fever, shivering, and leukocytosis are common findings during the first 24 hours postpartum and do not necessarily indicate an infection.
- Begins right after birth and the delivery of the placenta
- Afterpains: painful cramps from contractions of the uterus following childbirth
- The uterus returns to its normal size by the 6th–8th week postpartum.
- Fundal height: Method of measuring the size of the uterus, from the fundus to the top of the symphysis
Lochia (postpartum vaginal discharge)
- Most women pass lochia for about 4 weeks after delivery; in some cases, it lasts for 6–8 weeks.
- Lactogenesis: increased estrogen and progesterone; during pregnancy, resulting in hypertrophy of the breast
- Galactogenesis: After delivery of the placenta; , hormone levels decrease and prolactin activates milk production and milk ejection (let‑down).
- Galactopoiesis: Infant suckling leads to further release of oxytocin and prolactin. Milk production is maintained in particular by prolactin.
- Galactokinesis: ↑ Oxytocin levels stimulate myoepithelial cell contraction and milk ejection. Infant suckling maintains oxytocin levels and thus milk flow.
- Breast milk composition
- Benefits of breastfeeding
- Contraindications for breastfeeding
- Symptoms: tenderness, firmness, and fullness of the breast
- Approx. 13 pounds is the mean weight loss after delivery of the baby, amniotic fluid, and placenta.
- Lochia discharge and uterine contractions make for an additional weight loss of approx. 5–15 pounds during the postpartum period.
Subinvolution of the uterus
- Impaired retraction of the uterine muscles
- Can cause severe bleeding
- Placental remnants; that have not yet been expelled may lead to prolonged or periodic hemorrhage.
- These remnants also lead to uterine subinvolution.
- Definition: inflammation of the endometrium, possibly also including the myo- and parametrium
- Etiology: Mostly polymicrobial (2–3 ascending organisms, e.g., Gardnerella vaginalis, Staphylococcus epidermidis, group B Streptococcus and/or Ureaplasma urealyticum) that are usually found in the normal vaginal flora
- Pathophysiology: lochia retention → ideal breeding ground for infection → postpartum endometritis/postpartum endomyometritis → postpartum sepsis
- Risk factors
- Clinical findings
- Diagnostics: Primarily a clinical diagnosis; tests may help support and differentiate the diagnosis
- Antibiotic treatment: IV clindamycin and gentamicin
- If there are any retained products of conception: curettage to remove retained products
- Hysterectomy in case of life-threatening complications, no response to conservative therapeutic measures
- Deep vein thrombosis
Ovarian vein thrombosis
- About 90% of cases occur on the right side.
- Usually occurs on the 3rd–5th day after birth, often together with endometritis
- Etiology: a combination of hypercoagulability during pregnancy and the postpartum period, as well as endothelial microlesions during labor and slowed blood flow in the ovarian veins
- Symptoms: localized pain in the lower abdomen; (mostly on the right), possible fever (septic ovarian vein thrombosis), and headache
- Diagnosis: doppler ultrasound
- Treatment: therapeutic heparin; antibiotics may be necessary
- (Aseptic) sinus vein thrombosis
7 W's of postpartum fever: Womb (endometritis), Wind (atelectasis, pneumonia), Water (UTI), Walk (DVT, pulmonary embolism), Wound (incision, episiotomy), Weaning (breast engorgement, abscess, mastitis), Wonder drugs (drug fever)