• 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, 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
  • 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.
    • 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

Lactation and breastfeeding

  • 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]