The puerperium or the postpartum period is the period of time following the delivery of the child during which the body tissues, especially the reproductive system reverts back to the pre-pregnant state, both anatomically and physiologically.

The process of reversion of the genital organs is called 'involution'.

The puerperium or the postpartum period lasts for 6 weeks. It is divided into three phases:

• Immediate Postpartum: the 24-hour period immediately following delivery.
• Early Postpartum or puerperium: upto 7 days.
• Remote postpartum or puerperium: upto 6 weeks.

Anatomy of the Reproductive Organs Immediately after Delivery

The reproductive organs respond to the end of the process of pregnancy and childbirth by an initial period of rest and then a gradual revert back to their normal pre-pregnancy state.

• Uterus: Immediately after delivery, the uterus becomes a hard, immobile structure located just above the pubic bone. It is about 20 cm in length and, in a woman of average height, will reach up to the umbilicus. It is slightly tender when palpated.

  Inside the uterus, the site of attachment of the placenta becomes a small, raised, reddish region of only around 7 - 8 cms in diameter.

• Cervix: The cervix or the mouth of the uterus contracts less slowly than the uterus. Immediately after delivery it becomes an opening of about 2 - 3 cm in diameter with flabby, irregular edges. But at the end of 7 days, the cervical opening becomes much narrower and can admit just the tip of a finger.

• Vagina: After the delivery, the vagina is a loose canal stained with blood. It has flabby walls without much of the rugosity or irregularity normally present. But it heals quite rapidly and by the end of the week almost looks like its pre-pregnant state.

General Physiological Condition

The woman in labor goes through a tremendous amount of stress and strain. And it takes some time for her general condition to settle down to a normal state again.

• Pulse Rate: The pulse rate normally rises during the labor. It continues to be variable in the first two days after delivery, then comes back to normal on the third day. However, any pulse rate more than 100 per minute at any time should be investigated for fever or shock.

• Temperature: The temperature often becomes sub-normal immediately after delivery. This low temperature can cause the patient to shiver in an attempt to raise the body temperature again. It comes back to normal within 24 hours. On the third day, there may be a slight rise in temperature because of the letting down reflex of milk with a consequent mild engorgement of the breasts.

• Changes in the blood: Immediately after the delivery, there is a slight decrease in total blood volume due to dehydration and blood loss. This comes back to normal in 7 days. Hemoglobin stabilizes by the 5th day. WBC count which increases during pregnancy comes back to normal in one week. Platelet count and fibrinogen level however increases at around the 4th to the 10th day after delivery and then comes back to normal in about another 2 weeks.

• Urinary Tract: The urinary tract is placed under a lot of stress during labor. The bladder wall becomes edematous and swollen and the muscles of the urethra becomes loose and flabby due to stretching during the delivery. Pressure by the fetal head also tends to decrease the vitality of the bladder and the urethra. As a result there may be some difficulty in passing urine for the first 24 hours after the delivery.

  But the muscle tone is regained in 1 - 2 days. There is an increased tendency to pass urine in the first two days to eliminate water retained during pregnancy.

• Gastro-intestinal tract: There may be increased thirst during the first few days after delivery since there is increased fluid loss in the lochia, urine and also in sweating. Constipation can occur as a result of dehydration. Pain from the episiotomy wound and general pain in the vaginal and perineal area can also contribute to constipation.

• Weigth Loss: A weight loss of about 4.0 Kg takes place at the time of delivery of the baby, placenta, membranes and liquor amnii. A further loss of about 3Kg takes place during the puerperium due to the elimination of water and decreased size of the uterus.

  So, in a woman with a standard weight gain of 10Kg during pregnancy, there is a weight loss of 7 Kgs after delivery. She will thus have a net weight gain of 3Kg due to pregnancy.

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OTHER TOPICS IN "NORMAL POSTPARTUM":

• Immediately after Delivery
• Involution, Lochia, Menstruation etc.
• Care of the Postpartum period
• Breastfeeding
• Postpartum / postnatal Exercises
• Correct Posture

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