Normal Puerperium

Dr. Lizhan
Department of gynecology and obstetrics of
Chaoyang hospital
Capital Medical University
Normal Puerperium
 Definition
1. The time from the delivery of the placenta
through the first few weeks after the
delivery.
2. 6 weeks in duration.
3. By 6 weeks after delivery, most of the
changes of pregnancy, labor, and delivery
have resolved and the body has reverted to
the nonpregnant state.
Normal Puerperium
 The relevant anatomy and physiology
in the puerperium
1. Reproductive organs
1) Uterus
 1000g → 50-100g
 The endometrial lining rapidly regenerates
(16 days)
 The placental site undergoes a series of
changes in the postpartum period
Normal Puerperium
2) Cervix
 it never returns to the nulliparous state.
 the external os is closed to the extent that a
finger could not be easily introduced.
3) Vagina
 shrinks to a nonpregnant state
 resolution of the increased vascularity and
edema occurs by 3 weeks
 the vaginal epithelium appears atrophic on
smear. This is restored by weeks 6-10.
Normal Puerperium
4) Perineum
 swelling and engorgement are completely
gone within 1-2 weeks
 the muscle tone may or may not return to
normal, depending on the extent of injury.
5) Ovaries
 ovulate as early as 27 days after delivery (not
breastfeed ); 12 weeks (most); 7-9 weeks
(mean).
 the suppression of ovulation due to the
elevation in prolactin
Normal Puerperium
6) Breasts
 Lactation can occur by 16 weeks' gestation.
 Lactogenesis is initially triggered by the
delivery of the placenta (E↓P↓and prolactin).
 the prolactin levels decrease and return to
normal within 2-3 weeks (not breastfeeding)
 The colostrum(the first 2-4 days)
 The milk continues to change throughout the
period of breastfeeding to meet the changing
demands of the baby.
Breastfeeding
“Breastfeeding is neither easy nor automatic.”

 Should be initiated ASAP after delivery

 Feed baby every 2-3 hrs to stimulate milk
production
 Production should be established by 36-96 hrs
Normal Puerperium
2. Systemic change
1) Cardiovascular system
 Blood volume returns to nonpregnant levels by
the tenth days of puerperium
 Cardiac output ↑(immediately after delivery) →
slowly declines→ reach late pregnancy levels 2
days postpartum→ normal 2-6 weeks.
2) Hematologic changes
 Hemoglobin concentration↑on the first
postpartum days
 Several clotting factors (fibrinogen) ↑on the first
days
 Normal Puerperium
 Manifestation
1. Fever (24 hours)
2. Pain (uterine contraction)
3. Sweat
4. Lochia
 a large amount of red blood initially flows from
the uterus as the contraction phase rapidly
occurs. (5 weeks)
 lochia rubra; lochia serosa (brownish red, with
a more watery consistency); lochia alba
(yellow)
Normal Puerperium
 Management
1. 2 hours after delivery
 Bleeding
 Uterine contraction
 HR and Bp and R and T
2. 1 weeks after delivery
 Bleeding
Normal Puerperium
3. Emiction and defecate
4. Lochia
5. Episiotomy and Laceration
6. Breast
Thank you!