Postpartum

it is the period Following childbirth and delivery of the placenta and membrane. When the body tissue specifically pelvic organs revert back to approximately pre-pregnant date, both anatomically and physiologically this lasts up to 6 weeks from childbirth. This period is divided into 3 segments immediate within 24 hours of childbirth, early up to 7 days, and remote up to 6 weeks.

In the case of abortion same changes occur but they take a little shorter duration than that of delivery.

These changes take place Postpartum.

Involution of the uterus

: from an Anatomical point of view just after delivery uterus measures around 20 cm long, 12 CM broad, and 7.5 CM thick.  Weight is around 1000 grams firm and retracted comes to the size of a non-pregnant uterus weight of around 60g. The cervix contracts slowly it takes a longer time to regain its normal state where as the external oss Never reverts to the Nalliparus state. Physiological point of view the involution process is most marked in the body of the uterus cell reduce in size markedly during the Postpartum. Whereas muscle fibers are not reduced in number.Blood vessels: placental site arteries are constricted by contraction of its wall and its thickening followed by thrombosis of fibrous tissue on the wall they undergo degeneration of Elastic tissue also. Endometrium:  after delivery, the major part of the decidua gets removed with the expansion of the placenta and membranes of course more at the placental site. Regeneration of epithelium occurs at the placental site which takes up to 6 weeks. Clinical assessment is done by palpation of the uterus in relation to Symphysis pubis, bladder and bowel need to be empty before assessment. By the end of the Postpartum uterus should become a pelvic organ.

Involution of other structures and lochia:  broad ligament and round ligament require more time to recover from laxation and stretching the same thing occurs with the floor and pelvic fascia. Remains delicate for the first four weeks and submucosal Venus congestion persists even more. Lokia is the discharge during Postpartum which originates from the uterine body it is alkaline in reaction initially and turns acidic by the end of puerperium lochia rubra last from 1-4 days, Lochia Serosa last from 5 to 9 days, and lochia Alba lasts from 10 to 15 days.

  General physiological changes 

Pulse

For 2 hours after the delivery pulse is likely to rise, which comes to normal by the second day of the postpartum period. The Pulse rate above 100 per minute may be a sign of fever, hemorrhage, or shock. Less than 60 per minute can be due to diminished food intake, lack of exercise, rest, and excessive excretion of the fluid. 

Temperature

Temperature may slightly rise up to 99 degrees Fahrenheit which should come to normal by the completion of 12 hours following delivery. On 3rd day there may be a slight rise in temperature due to breast enlargement but should not last more than 24 hours if it does genito to urinary tract infection can be suspected and should be ruled out and treated. 

Urinary tract:

 because of trauma to the plexus nerve during delivery, the bladder may be distended without the Desire to urinate, and stagnation of urine along with the hampered bladder wall function may contribute to urinary tract infection. That needs to be observed and treated promptly. 

Weight loss:

 It is the Reverse of the weight gain during pregnancy in addition to that it is because of the expulsion of uterine content further loss of around 2 kgs occurs during pregnancy, in addition to that it is because of the expulsion of uterine content for the loss of around 1.5 kgs occurs during Postpartum. Weight loss is mainly due to diuresis fluid loss is approximately 2 liters during the first week of the delivery and 1.5 l during the next 5 weeks after delivery there is a little decrease in the volume of blood cardiac output returns to normal within one week of delivery.

Menstruation anovulation:

 The onset of first mensuration largely depends upon lactation and varies greatly in time. If the patient does not breastfeed her baby it takes a maximum of 12 weeks in 80% of cases. Whereas menstruation me return by the end of 6 weeks. If the mother breastfeeds her baby then menstruation may be suspended in 70% of cases till continued breastfeeding is there, whereas it may start before the cession of breastfeeding in 30% of cases. It works in two ways 1]Amenorrhea:  breastfeeding leads to an increased level of prolactin that in he beats ovarian response to the follicular stimulating hormone which results in less follicular growth that leads to a state of hypostrogen results and no menstruation. 2] anovulation: an increase in prolactin surprises the release of luteinizing hormone which leads to anovulation combinedly we call them lactational amenorrhea.

Breast: 

 along with cleanliness they need to be checked for cracks if they are cracked they should be treated immediately to protect from bacterial mastitis that can  be treated with antibiotics and the baby should be failed from Hell your breast the affected breast milk should be expressed manually until the treatment is complete.

Gastrointestinal tract: 

 due to loss of fluid in labor women may have increased thirst. slight intestinal parasis may lead to constipation, and lack of tone in abdominal muscle contribute to constipation. Milk of magnesia can be given every night as treatment along with dietary fibers and postnatal exercise advice.

Postpartum advice:

  during the first 24 hours sufficient intake of milk and fluid works a lot mother should resume a normal diet at the earliest remembering her own body repair and Naresh mint and nutrition of the baby. Mothers can practice postpartum exercises to tone up abdominal and pelvic muscles the exercise involves breathing exercises, contracting and relaxing abdominal muscles, and contracting and relaxing pelvic muscles diet and exercise in detail will be discussed and upcoming blogs.

Thank you!