- 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.
- 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)
- Definition: The birthing process and placental detachment lead to uterine lesions, which discharge a special wound secretion while healing. This secretion, together with the cervical mucus and other components, form the lochia.
- Most women pass lochia for about 4 weeks after delivery; in some cases, it lasts for 6–8 weeks.
|Fundal height postpartum||Lochia|
|Right after birth||Between the navel and symphysis||Blood red|
|After the 1st day||Navel||Blood red|
|3rd day||3 fingerbreadths under the navel (descends 1 fingerbreadth per day)||Blood red to brown-red|
|7th day||Between the navel and symphysis||Brown-red|
|From the 12th–14th day||Symphysis||Yellowish|
|From the 17th–21st day||Symphysis||Yellowish white|
- 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
Directly after birth, colostrum ("early breast milk") is produced. From the 5th day after birth on, the composition of the milk changes and transitional milk replaces colostrum. After the 14th day postpartum, transitional milk is replaced by mature milk. Over the course of lactation, proteins decrease and fat increases. In comparison to cow's milk, breast milk contains considerably more unsaturated fatty acids (especially linoleic acids), and more carbohydrates/lactose. Moreover, it contains roughly the same amount of fat as cow's milk , but fewer salts and minerals.
Mature milk (from the 14th day)
|Unsaturated fatty acids||1.6||1.3|
- 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
- Rare complication leading to a loosening of the pelvic ring, causing pain when walking and severe tenderness of the symphysis; the patient has difficulty standing on one leg
- Diagnosis may be confirmed with an ultrasound or pelvic X‑ray.
- Treatment: analgesics and reduced physical activity for 1–2 weeks
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)