Puerperium

Definition of normal puerperium

It is the period of adjustment after pregnancy
and delivery when anatomical and
physiological changes of pregnancy are
reversed and the body returns to the normal
non pregnant state.. (reproductive tract returns
to its normal, non-pregnancy state)

6 weeks in duration (periods after birth )

 Physiological changes in Normal
Puerperium
1. Changes in Genital Tract
• Involution of the uterus
 return to the pelvis by about 2 weeks
 be at normal size by 6 weeks
 the weight changes of uterus
 1000g immediately after birth (excluding the
fetus, placenta, membrane and amniotic fluid.
 500g 1 weeks after birth
 300g 2 weeks after birth
 50g 6 weeks after birth
• Lochia
discharge comes from the placental site and
maintains for 4-6 weeks
Lochia rubra
Red in color for the first 3-4 days
Lochia serosa
Pink in color, maintains for 2 weeks
Lochia alba
White in color, maintains for 2-3 weeks
• Changes in Other Pelvic Organs
 Cervix
 it never returns to the nulli-parous state.
 the external os is closed to the extent that a
finger could not be easily introduced.
 It return to its normal state at 4 weeks after
birth

 Vagina
 shrinks to a non-pregnant state
 resolution of the increased vascularity and
edema occurs by 3 weeks
 the vaginal epithelium appears atrophic. This is
restored by weeks 6-10.
•Changes in abdominal wall
 Abdominal wall become flat and flabby.
 Striae gravidarum persist.
 Proper exercise and massage regain tone

• Changes in urinary tract

• Edema & hyperemia of bladder mucosa.
• Diuresis for 2-3 days.

• Menstruation
2. Changes in breast and Lactation
• large, full & engorged veins
• first 2 days colostrum
• Mamogenesis (Mammary duct-gland growth
& dev.)
• Lactogenesis (Initiation Of milk secretion in
alveoli)
• Galactopoiesis (Maintenance of Lactation)
• Galactokinesis (Removal of Milk from Gland)
3. Changes in other systems
 Cardiovascular system
 Blood volume returns to non-pregnant 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.
 Hematologic changes
 Hemoglobin concentration↑on the first
postpartum days
 Several clotting factors (fibrinogen) ↑on the
first days