Puerperium is the period following childbirth during which the maternal body undergoes physiological changes to return to the non-pregnant state. It lasts for 6 weeks (42 days) after delivery.
Phases of Puerperium
|
Phase |
Time Period |
Key Changes |
|
Immediate Puerperium |
First 24 hours |
Uterine contraction, Hemostasis, Lactation
initiation |
|
Early Puerperium |
Up to 7 days |
Uterine involution, Vaginal discharge (Lochia) |
|
Late Puerperium |
6 weeks postpartum |
Return of ovulation, Normalization of hormones |
Physiological Changes in Puerperium
1. Uterine Involution
- Uterus shrinks from 1 kg at delivery to 60 g by 6 weeks.
- Fundal Height Changes:
- Immediately after birth → At umbilicus (20-week size).
- By Day 7 → Halfway between umbilicus & pubic symphysis.
- By 6 weeks → Non-palpable, Normal size.
2. Lochia (Postpartum Vaginal Discharge)
|
Type |
Duration |
Characteristics |
|
Lochia Rubra |
1–4 days |
Red, Blood & Decidual tissue |
|
Lochia Serosa |
4–10 days |
Pink/Brown, Leukocytes & Serous fluid |
|
Lochia Alba |
10–14 days (Can last up to 6 weeks) |
White/Yellow, Mucus & Epithelial cells |
3. Cervical & Vaginal Changes
- Cervix remains soft & partially open for 1 week, then gradually closes.
- Vagina regains tone but remains larger than pre-pregnancy.
4. Endocrine Changes
- Estrogen & Progesterone levels drop rapidly after delivery.
- Prolactin remains high → Suppresses ovulation in breastfeeding mothers.
5. Resumption of Ovulation & Menstruation
- Non-breastfeeding women: Ovulation returns by 6 weeks postpartum.
- Breastfeeding women: Ovulation may be delayed due to prolactin suppression of FSH & LH.
Postpartum Care & Management
1. General Care
- Monitor vital signs & uterine involution.
- Encourage ambulation to prevent venous thromboembolism (VTE).
- Iron & calcium supplementation for 3 months.
2. Perineal Care
- Warm Sitz baths for perineal pain & healing.
- Hygiene & antiseptic application if episiotomy was performed.
3. Contraception in Puerperium
- Progestin-only pills or IUD (Safe in lactating women).
- Avoid combined oral contraceptives (COCs) for 6 weeks postpartum (risk of VTE).
Complications of Puerperium
1. Postpartum Hemorrhage (PPH)
- Primary PPH: Blood loss >500 mL (Vaginal) or >1000 mL (C-Section) within 24 hours.
- Causes: Uterine atony, Retained placenta, Genital tract trauma.
- Management: Uterine massage, Oxytocin, Blood transfusion if severe.
2. Puerperal Sepsis
- Infection within 6 weeks postpartum due to endometritis, perineal wound infection, mastitis.
- Signs: Fever >38°C, Foul-smelling lochia, Uterine tenderness.
- Treatment: IV antibiotics (Clindamycin + Gentamicin).
3. Deep Vein Thrombosis (DVT)
- Increased clotting risk postpartum.
- Signs: Leg pain, Swelling, Redness.
- Prevention: Early ambulation, Compression stockings, LMWH (in high-risk cases).
4. Postpartum Depression & Psychosis
- Baby Blues: Mild mood swings, crying episodes (Resolves in 2 weeks).
- Postpartum Depression: Severe sadness, Anhedonia, Lasts >2 weeks (Needs treatment).
- Postpartum Psychosis: Hallucinations, Delusions, Infanticidal thoughts (Psychiatric emergency).
Summary Table: Puerperium Essentials
|
Feature |
Key Points |
|
Duration |
6 weeks postpartum |
|
Uterine Involution |
From 1 kg → 60 g by 6 weeks |
|
Lochia Changes |
Rubra (1-4 days), Serosa (4-10 days), Alba (10-14
days) |
|
Menstruation Return |
6 weeks (Non-lactating), Delayed if breastfeeding |
|
Common Complications |
PPH, Sepsis, DVT, Depression |
Key Takeaways
- Puerperium is a 6-week recovery phase for the mother.
- Lochia progresses from red to pink to white.
- Ovulation may return within 6 weeks, earlier in non-breastfeeding mothers.
- Postpartum depression requires monitoring & support.
