• Clinical science

Postpartum period (Puerperal period)

Abstract

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.

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

  • Begins right after birth and the delivery of the placenta
  • 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.
    • Lochia rubra: blood red; approx. the first 4 days after birth
    • Lochia serosa:brown‑red; watery consistency, lasts approx. 2–3 weeks
    • Lochia alba: whitish; lasts approx. 1–2 weeks

Time

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
10th day Symphysis Brown-red
From the 12th–14th day Symphysis Yellowish
From the 17th–21st day Symphysis Yellowish white

Lactation and breastfeeding

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)

g/100 mL

Cow's milk

g/100 mL

Proteins 1 3.4
Carbohydrates 7 4.6
Fat 3.8 3.7
Calories (kcal) 66 65
Unsaturated fatty acids 1.6 1.3
Salts/minerals 0.2

0.8

  • Benefits of breastfeeding
  • Contraindications for breastfeeding
  • Breast engorgement
    • Etiology
      • Interstitial edema at the beginning of lactation a few days after birth
      • Imbalance of supply and demand of breast milk
      • Tight‑fitting bras
    • Symptoms: tenderness, firmness, and fullness of the breast
    • Treatment
      • Frequent breast-feeding with optimal nursing techniques
      • Warm compresses prior to breast feeding, cold compresses in between breast feeds
      • Analgesics
      • Careful expression of breast milk by hand or with a breast pump to alleviate pressure

Weight loss

  • 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.

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

Postpartum complications

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)

References:[6][7][8][9][10]