- 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, the body undergoes several physiological changes, such as uterine involution, discharge of lochia, and the beginning of the lactation process. Women are also susceptible to complications during the postpartum period, such as infection, thrombosis, insufficient postpartum recovery, and postpartum depression. The fundal height measurement and the appearance of lochia (postpartum vaginal discharge) provide important clues to possible underlying conditions.
- Begins immediately 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.
Lochia (postpartum vaginal discharge)
- Definition: The birthing process and placental detachment lead to uterine lesions, which discharge a special secretion when healing. This secretion, together with the cervical mucus and other components, forms the lochia.
- Most women pass lochia for about 4 weeks after delivery; in some cases, this lasts for 6–8 weeks.
- Mean weight loss after delivery of the baby, amniotic fluid, and placenta: approx. 6 kg (13 lbs)
- Additional weight loss due to lochia discharge and uterine involution: approx. 2–7 kg (5–15 lbs)
- Lactogenesis: process of mammary epithelial cell differentiation and milk production in the mammary gland that begins midpregnancy as a result of increased estrogen and progesterone levels
- Initiation of lactation: Following delivery of the placenta; , abrupt ↓ progesterone levels → ↑ prolactin → stimulation of milk secretion
- Maintaining lactation requires suckling, which stimulates the secretion of:
Breast milk composition
- Colostrum: the first milk produced during late pregnancy until 3–4 days postpartum; rich in proteins and immunoglobulins
- Mature milk, composed of:
Because breast milk does not contain sufficient amounts of vitamin D and vitamin K, supplementation is vital! All newborns should receive intramuscular vitamin K at birth. Vitamin D should be supplemented with 400 IU per day in all breastfed or partially breastfed infants.
Benefits of breastfeeding 
Contraindications to breastfeeding 
- Absolute contraindications
- Temporary or relative contraindications
Complications and problems
- Inadequate milk production or intake
- Nipple pain, trauma, or dermatitis
- Symptoms: tenderness, firmness, and fullness of the breast
- Complications: mastitis
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 myometrium and parametrium
- Etiology: mostly polymicrobial (2–3 ascending organisms, e.g., Gardnerella vaginalis, Staphylococcus epidermidis, group B Streptococcus, and/or Ureaplasma urealyticum, all of which 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 clinical; in some cases, the following tests can be used to confirm the diagnosis:
- Antibiotic treatment: IV clindamycin and gentamicin
- Uterine curettage to remove retained products of conception.
- Hysterectomy in case of life-threatening complications or no response to conservative therapeutic measures.
- Further complications
- Deep vein thrombosis
- Cerebral venous thrombosis
Septic pelvic thrombophlebitis
- Definition: : a rare condition characterized by inflammation and thrombosis of the pelvic veins that most commonly occurs in the postpartum period
- Risk factors
- Clinical features: Onset is usually within one week of delivery.
- Treatment: antibiotics (e.g., clindamycin, gentamicin) and anticoagulation (e.g., LMWH or UFH)
- Complications: Pulmonary emboli are rare.
- Urinary insufficiency
- Urinary retention
- A 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
The 7 Ws of postpartum fever: Womb (endometritis), Wind (pneumonia), Water (UTI), Walk (DVT, pulmonary embolism), Wound (incision, episiotomy), Weaning (breast abscess, mastitis), Wonder drugs (drug fever)