• Clinical science

Postpartum period (Puerperal period)

Summary

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.

Normal postpartum changes

Low‑grade fever, shivering, and leukocytosis are common findings during the first 24 hours postpartum and do not necessarily indicate an infection.

Uterine involution

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.
    • Lochia rubra: blood red; approx. the first 4 days after birth
    • Lochia serosa: brown red; watery consistency, lasts approx. 2–3 weeks
    • Lochia alba: yellow white; lasts approx. 1–2 weeks

Weight loss

References:[1][2][3][4][5]

Lactation and breastfeeding

Physiology

Breast milk composition

Breast milk contains all the required nutrients (except vitamin D and vitamin K) for infants up to 6 months of age.

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 [6]

Contraindications to breastfeeding [6]

Complications and problems

  • Inadequate milk production or intake
  • Breastfeeding jaundice
  • Breast milk jaundice
  • Mastitis
  • Galactocele
  • Nipple pain, trauma, or dermatitis
  • Breast engorgement
    • Etiology
      • Primary: initial swelling due to increased milk production postpartum (during the transition from colostrum to mature milk)
      • Secondary: insufficient removal of breast milk (e.g., due to infrequent feeds, poor attachment, ineffective suckling, abrupt cessations of breastfeeding)
    • Symptoms: tenderness, firmness, and fullness of the breast
    • Management
      • Frequent breastfeeding with optimal nursing techniques
      • Warm compresses prior to breastfeeding; cold compresses between feeds
      • Analgesia
      • Careful expression of breast milk by hand or with a breast pump to alleviate pressure.
    • Complications: mastitis

Postpartum complications

Uterine complications

Thromboembolic complications

Psychiatric complications

Other complications

  • Urinary insufficiency
  • Urinary retention
  • Pelvic instability
    • 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)

References:[7][8][9][10][11][12]