Normal Puerperium If with postpartum complications:

The period known as the puerperium includes the days leading up to and immediately
following the delivery of the placenta. Typically, this time frame is thought to last for six
weeks. Most pregnancy-related alterations, labor-related changes, and postpartum changes
have passed by six weeks after delivery, and the body has returned to its pre-pregnancy
form.
Uterus
- weighs approximately 1000 g. In the 6 weeks following delivery, the uterus recedes to a
weight of 50-100 g.
Most of the reduction in size and weight occurs in the first 2 weeks, at which time the uterus
has shrunk enough to return to the true pelvis.
The endometrial lining rapidly regenerates, so that by the seventh day endometrial glands
are already evident.
The size of the placental bed decreases by half, and the changes in the placental bed result
in the quantity and quality of the lochia that is experienced.
The red discharge (lochia) progressively changes to brownish red, with a watery consistency
(lochia serosa).
Cervix
MASTITIS
Mammary gland irritation is referred to as mastitis. Typical signs
include a warm, erythematous, and sensitive region of the breast.
Breast abscesses should be taken into consideration when the
exam reveals a painful, firm, perhaps fluctuant mass with
overlaying erythema.
The underlying causes of mastitis include milk stasis and
damaged nipples, which facilitate the entrance of skin flora.
Additionally, primiparity, insufficient breast emptiness, and poor
nursing technique are linked to mastitis. It may take up to three
weeks for the infection to go away, but it should do so in 10 days.
Sometimes mastitis resolves without the need for medical
intervention.
PUERPERAL INFECTION
A puerperal infection, also called a postpartum infection, affects
the uterus and the tissues around it. This typically occurs following
the trauma of a vaginal or cesarean delivery.

The cervix also begins to rapidly revert to a non-pregnant state, but it never returns to the The majority of postpartum patients are typically identified within
nulliparous state. 10 days of giving birth. The full development of certain cases,
nevertheless, can take up to 6 weeks.
Vagina

The vagina also regresses but it does not completely return to its pre-pregnant size. POSTPARTUM HEMORRHAGE

Perineum - massive blood loss during or after the third stage of labor.
Average blood loss during normal vaginal delivery is 500 ml, and
The perineum has been stretched and traumatized, and sometimes torn or cut, during the 1000 ml during cesarean delivery.
process of labor and delivery. The swollen and engorged vulva rapidly resolves within 1-2
weeks. Most of the muscle tone is regained by 6 weeks, with more improvement over the - Early postpartum hemorrhage is described as that occurring
following few months. within the first 24 hours after delivery. Late postpartum
hemorrhage most frequently occurs 1-2 weeks after delivery but
Abdominal wall may occur up to 6 weeks postpartum.
The abdominal wall remains soft and poorly toned for many weeks. Early postpartum may result from:
Ovaries - Uterine atony
The resumption of normal function by the ovaries is highly variable and is greatly influenced - Retained products from conception
by breastfeeding the infant.
- Uterine rupture
Breasts
- Uterine inversion
The changes to the breasts that prepare the body for breastfeeding occur throughout
pregnancy. - Placenta accreta

- Lower genital tract lacerations

- Coagulopathy
Signs and Symptoms: - hematoma
Physiological: Uterine involution or uterine atony, lochia Causes of late postpartum hemorrhage
rubra, hemorrhage
- retained products of conception
Physiological: Postpartum Blues
- infection
Progressive- Filling or engorgement
- sub involution of placental site

Management: - coagulapathy

Medical Management:

Uterine atony: Pharmacological methods, surgical treatment

Hemorrhage: Uterine massage, uterotonic agents’ administration (oxytocin, ergot

alkaloids, and prostaglandins), and blood transfusion

Engorgement: Pharmacological methods (taking pain relievers)

Nursing Management:

Uterine involution or uterine atony: Assess the fundal height

Lochia: Monitor perineal pad and evaluate lochia character

Hemorrhage:

Perform assessment to determine amount of bleeding, condition of the uterus,

maternal vital signs.

Place the patient in a side lying position to avoid pooling of blood underneath her.

Assess lochia frequently to determine the amount discharged is still within the normal
limits.

Postpartum blues:

Offer supportive care.

Encourage patient to express her feelings and thoughts

Involve the mother to all decisions and have control on taking care of the baby.

Filling or engorgement:

Teach the patient non-pharmacological methods such as warm compress, breastfeed

every three hours, massage breast during breastfeeding or pumping, and avoid tight
bras.

Assess mother’s milk production.


Name: Narda
Age: 29 yrs old
System
Changes
May have difficulty
voiding because of
decreased abdominal
pressure or trauma of
the bladder. Glomerular
filtration rate decreases
to normal by 6 weeks,
women can have
difficulty sensing when
they have to void after
receiving an epidural or
spinal block. Difficulty
voiding can be
increased by perineal
trauma. Urinary
retention is a major
cause of uterine atony.
Delayed of bowel
evacuation post partly
may be due to muscle
tone, lack of food plus
enema during labor,
dehydration and fear of
pain from perineal
tendered due to
episiotomy or laceration.
After birth, the estrogen
and progesterone levels
stop dramatically which
can contibute to the
“baby blue” (mood
swings, anxiety,
sadness or irritability
which resolve within a
week or so of birth) or
postpartum depression.
The diuresis that is
evident between the
second and fifth days
after birth, as well as the
blood loss at birth, acts
to reduce the added
blood volume a woman
accumalated during
pregnancy. This
reduction occurs so
rapidly, In fact, that the
blood volume return to
its normal pre-
pregnancy level by the
first or second week
after birth.
After birth, the stretch
marks on a woman’s
abdomen (striae
gravidarum) still appear
reddened and maybe
even more prominent
than during pregnancy.
During first 2 weeks,
abdominal wall remains
relaxed. Woman has
still-pregnant
appearance. Return to
prepregnancy state
takes 6 weeks. Depends
on previous tone, proper
exercise, and amount of
adipose tissue Diastasis
recti abdominus.
POSTPARTAL MATERNAL CHANGES
The important physiological events that occur
during the puerperium include, among others, the
return of the reproduction organs and the levels
of the female hormones to approximately their
pre-pregnant state
Physiological Psychological VS Changes Progressive Retro
Changes Changes Changes Progressive
Reproductive System: Maternal Concerns & Temperature - Patient Lactation: - Shrinkage and descent
Feelings: may show a slight of the uterus into its
After birth, the fundus increase in temperature The secretion from the prepregnancy position in
contracts downward into Taking- In Phase - 1-3 during the first 24 hours breast called colostrum the pelvis.
the pelvis one days after delivery, after birth it caused by increases after
centimeter each day. passive and dependent, dehydration or childbirth. The high - Sloughing of the uterine
After two weeks the difficult making decision. excessive intrapartum levels of estrogen and lining and development of
uterus will have blood loss. It is not sign progesterone make the lochia
contracted and return Taking- Hold Phase- 4- breast tissue
7 days, after delivery, of infection. - Contraction of the cervix
into the pelvis. unresponsive to
has more energy, prolactin. However, it and vagina
Uterus – returns to its demonstrate
Pulse – Normal post- still begins to secrete - Recovery of vaginal and
normal size through the independence, receptive partum physiologic milk through the
gradual process of to infant care. pelvic floor muscle tone.
bradycardia (50-70) activation in the
involution because of cardiac mammary glands. It
Letting Go Phase- 8
Involution involves 3 days after delivery, strain. starts on the third or
processes: assumption of mother fourth day postpartum
- It may be elevated for wherein it is activated by
role, acceptance of a few hours after
1. Contraction of muscle neonate’s real image. suckling or stimulation of
fibres childbirth due to the nipples. Breasts are
excitement or pain. By typically soft and non-
2. Catabolism or the end of the first week,
Development Parental tender first 2 days
breaking down of the pulse rate will return
Attachment& Bonding postpartum. If a woman
myometrial cells doesn’t breastfeed,
3. Regeneration of the Skin-to-skin contact Respiratory- it changes breast engorgement and
uterine epithelium soon after birth immediately after milk production start to
facilitates the early delivery due to decrease subside within 2-3 days
Typically descends from attachment and binding postpartum.
in pressure on the
umbilicus by 1 cm per phase. This should diaphragm and Engorgement can occur
day ideally occur within the reduction in pulmonary from 2-4 days
first hour of any birth, blood volume.
Afterpains – Involution postpartum, breasts are
even cesarean
involves Contractions, hard and tender to
deliveries, as soon as - The respiratory rate
multiparous women may
the mother and baby are also begins to fall back
be more aware of them Return of Menstrual
stable and last until to the pre-pregnancy
completion of the first within 2 to 3 days. Period:
Cervix – Returns to pre-
pregnancy state by 6 breastfeeding (Moore, It is common for
weeks Bergman, Anderson, et
Blood Pressure- patient’s period changed
al., 2016).
Elevated BP may after giving birth. Some
Vagina – Following birth
Looking directly at the experiences heavier or
is edematous and thin indicate pregnancy
newborn’s face, with induced hypertension. painful periods while
with few rugae, rugae
direct eye contact others become easier.
return in 3-4 weeks &
(termed an en face - Total blood volume About a month after
mucosa thickens with
position), is a sign a doubles during giving birth, periods may
return of ovarian and
woman is beginning pregnancy, putting be irregular but may
estrogen production
effective attachment. additional strain on the return to normal over
Lochia – the vaginal blood vessels. Usually, time. For non-lactating
discharge that occurs the patient’s blood women, menstruation
after birth. Larger pressure levels off after usually returns within 7-
amount with vaginal delivery, but this can 9 weeks postpartum.
delivery than c-section take time. The return of
menstruation is much
Types more unpredictable with
women who breastfeed.
Lochia Rubra – deep-
red, occurs during first With the lactating
woman menstruation
3-4 days
usually returns between
Lochia Serosa – pink / 2-18 months.
brown, 3-10 days
postpartum
Lochia Alba – white,
occurs days 10-14, but
can last for 3-6 weeks
for some women
Perineum – often
edematous and bruised
for the first days
following birth Pelvic
floor muscles are
stretched, restoring tone
can take 6 months –
kegel exercises should
be encouraged