Puerperium
Puerperium = The 6-week period afer delivery when the reproductve tract returns to its non-pregnant state
Physiology
Physiological changes in the Puerperium
Genital Uterine size reduces over the 6 weeks
tract - Immediately after delivery – Uterus shrinks down to the level of the umbilicus
- 2 weeks post-partum – Uterus no longer palpable above symphysis pubis
- 6 weeks post-partum – Uterus has returned to its non-pregnant state
Contractions or ‘after pains’ may be felt for 4 days
The internal os closes by 3 days
Lochia (post-partum vaginal discharge from uterus) may be blood stained for 4 weeks but
thereafter is yellow or white
Menstruation in non-lactating women occurs at about 6 weeks
CVS CO and BV decrease to pre-pregnancy levels within a week
Oedema reverses in up to 6 weeks
Blood pressure is usually normal within 6 weeks
Urinary GFR decreases as the vasodilation reduces over 3 months
tract
Blood U&Es return to normal because of the reduction in GFR
In the absence of haemorrhage, haemoglobin and haematocrit rise with
haemoconcentration (as this is diluted due to fluid retention during pregnancy)
The WCC falls
Platelets and clotting factors rise, predisposing to thrombosis
Management (post-partum care)
Immediate management
- Maternal vital signs frequently taken
- Blood loss noted
- Uterine fundus palpated to ensure it’s well contracted
Monitoring
- Daily checking of: Uterine involuton, lochia, temp., BP, HR and perineal wound
- Fluid balance checks should prevent retenton if a woman has had an epidural
- FBC checked before discharge and iron +/- laxatves prescribed if appropriate
Neonatal care
- Topical ophthalmic prophylaxis – to prevent ophthalmic neonatorum
- Vitamin K – prevent haemorrhagic disease of newborn due to physiological defciency of vit K-
dependent clotng factors
MMR vaccine – if non-immune to rubella
Ant-D Ig – if Rhesus negatve and baby is positve
Early ambulaton (whatever mode of delivery)
Adequate pain management
Preparaton for care of newborn – skilled nursing staf should ensure mother is ready before discharge,
including baby care and breasteeding advice
Avoid Coitus – for 2-3 weeks afer delivery. Contracepton required straight away.
Routne visit – Recommended 6 weeks post-partum. Contraceptve, breast feeding, and any other
questons should be answered.
Discharge - Should be dependent on the mother’s wishes. Some like to leave the hospital within 6 hours of
delivery; others will need a few days in hospital.
Puerperium = The 6-week period afer delivery when the reproductve tract returns to its non-pregnant state
Physiology
Physiological changes in the Puerperium
Genital Uterine size reduces over the 6 weeks
tract - Immediately after delivery – Uterus shrinks down to the level of the umbilicus
- 2 weeks post-partum – Uterus no longer palpable above symphysis pubis
- 6 weeks post-partum – Uterus has returned to its non-pregnant state
Contractions or ‘after pains’ may be felt for 4 days
The internal os closes by 3 days
Lochia (post-partum vaginal discharge from uterus) may be blood stained for 4 weeks but
thereafter is yellow or white
Menstruation in non-lactating women occurs at about 6 weeks
CVS CO and BV decrease to pre-pregnancy levels within a week
Oedema reverses in up to 6 weeks
Blood pressure is usually normal within 6 weeks
Urinary GFR decreases as the vasodilation reduces over 3 months
tract
Blood U&Es return to normal because of the reduction in GFR
In the absence of haemorrhage, haemoglobin and haematocrit rise with
haemoconcentration (as this is diluted due to fluid retention during pregnancy)
The WCC falls
Platelets and clotting factors rise, predisposing to thrombosis
Management (post-partum care)
Immediate management
- Maternal vital signs frequently taken
- Blood loss noted
- Uterine fundus palpated to ensure it’s well contracted
Monitoring
- Daily checking of: Uterine involuton, lochia, temp., BP, HR and perineal wound
- Fluid balance checks should prevent retenton if a woman has had an epidural
- FBC checked before discharge and iron +/- laxatves prescribed if appropriate
Neonatal care
- Topical ophthalmic prophylaxis – to prevent ophthalmic neonatorum
- Vitamin K – prevent haemorrhagic disease of newborn due to physiological defciency of vit K-
dependent clotng factors
MMR vaccine – if non-immune to rubella
Ant-D Ig – if Rhesus negatve and baby is positve
Early ambulaton (whatever mode of delivery)
Adequate pain management
Preparaton for care of newborn – skilled nursing staf should ensure mother is ready before discharge,
including baby care and breasteeding advice
Avoid Coitus – for 2-3 weeks afer delivery. Contracepton required straight away.
Routne visit – Recommended 6 weeks post-partum. Contraceptve, breast feeding, and any other
questons should be answered.
Discharge - Should be dependent on the mother’s wishes. Some like to leave the hospital within 6 hours of
delivery; others will need a few days in hospital.
