Normal and Abnormal Puerperium

Posted by e-Medical PPT Thursday, July 19, 2012
Normal Puerperium
Definition
The time from the delivery of the placenta through the first few weeks after the delivery.
6 weeks in duration.
By 6 weeks after delivery, most of the changes of pregnancy, labor, and delivery have resolved and the body has reverted to the nonpregnant state.

The relevant anatomy and physiology in the puerperium
Reproductive organs
Uterus
The endometrial lining rapidly regenerates (16 days)
The placental site undergoes a series of changes in the postpartum period
Cervix
It never returns to the nulliparous state.
The external os is closed to the extent that a finger could not be easily introduced.
Vagina
shrinks to a nonpregnant state
resolution of the increased vascularity and edema occurs by 3 weeks
the vaginal epithelium appears atrophic on smear. This is restored by weeks 6-10.
Ovaries
ovulate as early as 27 days after delivery (not breastfeed ); 12 weeks (most); 7-9 weeks (mean).
the suppression of ovulation due to the elevation in prolactin
Breasts
Lactation can occur by 16 weeks' gestation.
Lactogenesis is initially triggered by the delivery of the placenta (E↓P↓and prolactin).
the prolactin levels decrease and return to normal within 2-3 weeks (not breastfeeding)
The colostrum(the first 2-4 days)
The milk continues to change throughout the period of breastfeeding to meet the changing demands of the baby.
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