Physiology

of Puerperium

Prepared by

Dr. Jaklein Refaat

Definition of postpartum period:
It is the period following labor during
which the maternal body, and the genital
organs, return to the pre-pregnant
condition.

Duration of the postpartum period is 40

days or 6-8 weeks (maximum involution).
Another 4-6 weeks is needed for complete
involution.
The postpartum period is much shorter

after abortion. The first ten days are

called the early postpartum period, and
the days after are called the late

postpartum period.
Physiological Changes During
Postpartum period

General physiological changes

Immediately following labor general condition
of the mother is one of physical fatigue.
General physiological changes include vital
signs, skin, kidneys & urinary output, bowel
function & intestinal elimination, blood
picture, body weight, after pains, return of
menstruation.
Vital Signs
Temperature:
The temperature is slightly elevated: 0.5
degrees for the first 24 hours after
delivery
Temperature: cont.
Transient rise in temperature later on is
due to:
Ø absorption of waste products of the
muscular contractions of labor
Ø Milk engorgement, by the 4th day
postpartum
Ø Constipation
Ø Nervous excitation
Pulse:
The pulse is full and slow, about 60-70
beat /min, and is known as physiologic
bradycardia this is happen in the first 24-
48 hours and mainly due to:
ØThe rest period after labor
A rapid pulse may be du to pain, visitors,
excitement, exhaustion, the nursing
infant, hemorrhage or infection
Respiration:

Because of a reduction in the size of the

uterus and relaxation of the abdominal
wall, respiration is more abdominal in
character.
Deviation from normal may suggest
pneumonia or embolism
Blood pressure:
but if hypotension is present,
postpartum hemorrhage may be
suspected.
If hypertension is present, over
140/90 mmhg, postpartum toxemia
may be suspected.
Skin:

q Excessive sweating, particularly in

patients who were subjected to edema
in late pregnancy.This gradually ceases
within the 1st week.
q Skin pigmentation gradually disappears.
Kidneys and urinary output:

v There is usually physiologic Diuresis.

(Polyuria).
v Painful, difficult micturation due to
tears, laceration or episiotomy may
result in reflex retention of urine.
v Lactosuria is common with milk
engorgement on the 4th day at the start
of lactation.
Causes of urinary retention.

vThe mother may experience some

retention of urine in the first few days
after labor due to:
Ø Laxity of the abdominal muscles.
Ø Inability to micturation in the recumbent
position.
Ø Reflex inhibition due to stitched perineum
Ø Atony of the bladder.
Ø Compression of the urethra by edema or
haematoma.
Bowel function and intestinal elimination:

q Thirst is present due to the marked fluid

loss through sweat and urine.

q Tendency to atony of the gastrointestinal

tract, with flatulence and constipation.
Bowel function and intestinal elimination: cont.

q Constipation may be present as a

result of:
Ø Intestinal atony
Ø Anorexia after labor
Ø Loss of fluids
Ø Laxity of the abdominal wall
Ø Hemorrhoids
 Blood picture:

v With proper antenatal care, the amount

of blood loss during the 3rd stage of
labor does not cause anemia.

v Blood volume decrease, Hb% also

diminishes.
Body weight

• Loss of weight is observed during the first

10 days, particularly in the non-lactating
mothers.
• There is about 4-5 kg loss of body weight
(sometimes 8 kg) due to evacuation of
uterine content and Diuresis.
After-pains:

• It is a spasmodic colicky pain in the lower

abdomen during the early postpartum
days due to the vigorous contractions of
the uterus.
• It is more common and more severe in
multipara (due to weak muscle tone),
multiple pregnancy, polyhydramnios,
large-sized infant in diabetic mothers
(increase intra-abdominal pressure)
After-pains: cont.

• After-pains can be precipitated by the

presence of blood clots, a piece of
membranes, or placental tissues.

• After-pains increase during breast-

feeding because the infant’s suckling
stimulates the posterior pituitary gland
to secrete oxytocin that result in more
uterine contraction, causing increase in
after-pains.
Return of menstruation:

•Non-lactating mothers begin to

menstruate again in 6-8 weeks.
•In lactating mothers, menstruation
usually reappear not earlier than 4-5
months, and sometimes as late as 24
months.

•It should be mentioned that ovulation

can commence in the absence of
menstruation, and another pregnancy
can occur.
.
q Lochia:
Ø Is the uterine discharge coming through the vagina
during the first 3-4 weeks of the postpartum.
Ø It is alkaline in reactions,
Ø the amount is more than the menstrual flow, with
fleshy odor.
Ø It contains blood, fibrin, leucocytes, and numerous
non-pathogenic bacteria.
Ø There are three types of lochia:
1- Lochia rubra: the discharge is red in color
due to the presence of a fair amount of blood,
shreds of the deciduas, large amount of
chorion, amniotic fluid, lanugo hair, vernix
caseosa,
2- and ameconium
Lochia serosa: may also
pink yellow discharge be present.
containing less blood
and
Thismore serum, andlasts
discharge extends for another
from 3-4 days.
the 1st postpartum
3- Lochia alba: a creamy or white colored discharge containing
day, to the 4th day (and sometimes to 7th day)
leukocytes and mucus. It remains for the 10th day postpartum
Ø Clinical significance of the abnormal
lochia:
• Fetid lochia( bad odor) denotes the
presence of infection.
• Prolonged or recurrence of lochia rubra
may suggest retained parts of the placenta,
membranes, RVF, sub-involution,or tumors.
The emotional needs of the woman during
postpartum period
Recognition of the mother’s effort made
during labor.
Support and encouragement in her care
for the infant
Attention from family member particularly
from the husband
Someone to listen and help them solve
their dependency – independency conflict.
Physical needs should be properly fulfilled.
Thank you