Postpartum Physiology

Learning Objectives
 Describe the anatomic and physiologic
changes that occur during the postpartum
period.
 Discuss the characteristics of uterine
involution and lochial flow, and describe ways
to measure them.
 List expected values for vital signs and blood
pressure, deviations from normal findings, and
probable causes of the deviations
 Postpartum Physiology
Postpartum period
 Interval between the
birth of the newborn and
the return of the
reproductive organs to
their nonpregnant state.
 Fourth trimester of
pregnancy
 Also referred to as the
puerperium
 Last on an average of
about 6 weeks
 Postpartum Physiology
Reproductive System and
Associated Structures
 Uterus
 Involution- the return of
the uterus to a
nonpregnant state after
birth
 Fundus descends 1 to 2 cm
every 24 hours
Subinvolution- is the failure
of the uterus to return to a
nonpregnant state
 Most common causes
are retained placenta
fragments and
infection
 Postpartum Physiology
Contractions
 Oxytocin- strengthens
and coordinates uterine
contractions, which
compress the blood
vessels and thereby
promotes hemostasis
 Postpartum hemostasis-
is achieved primarily by
compression of
intramyometrial blood
vessels as the uterine
muscle contracts, rather
than platelet aggregation
and clot formation
 Postpartum Physiology
Afterpains
 Intermittent uterine
contractions
 Maybe intense at times

 More common in multiparas

 Frequently occurs with

breastfeeding
 Suckling results in release

of oxytocin
 Oxytocin causes
contractions of the lateral
ducts in the breast which
cause contractions of the
uterine muscles
 A postpartum client asks the nurse about the occurrence of
afterpains. The nurse informs the mother that afterpains will
be especially noticeable:

 1.When ambulating
 2.While taking sitz baths
 3.During breast-feeding
 4.Once the client arrives home and activities
are increased
 Postpartum Physiology
Lochia
Rubra
 Last 3 to 4 days
 Consists of blood, mucus,
particles of decidua and
trophoblastic debris
 Bright red

 Serosa
After 3 to 4 days

 Alba
 Consists of leukocytes,
decidua, epithelial cells,
mucus, serum, and bacteria
 After 10 days-up to 6 weeks
 Yellow to white
 Postpartum Physiology
Cervix
 Remains edematous, thin,
and fragile for several days
after birth
 Ectocervix- portion of the
cervix that protrudes into
the vagina
 May appear bruised
 May have some small
lacerations
 Constitutes an optimal
condition for
development of an
infection
 Postpartum Physiology
Vagina and Perineum
 Vagina returns to its
prepregnancy size by 6 to 10
weeks after childbirth
 Rugae reappears within in 3

 Normal estrogen levels and

lubrication return by 6 to 10
weeks
 Episiotomies heal within 2 to

3 weeks
 Hemorrhoids usually decrease

in size within 6 weeks

 Postpartum Physiology

Endocrine System
 Placental hormones
 Human placental lactogen
(hPL) decreases to
undetectable levels in 24
hours
 Hcg decreases after birth and
remains low until after
ovulation
 Estrogen and progesterone
levels decrease markedly after
expulsion of the placenta
 Lowest levels 1 week into the
postpartum period
 Endocrine System
 Pituitary Hormones and Ovarian
Function
 Elevated serum prolactin levels in
breastfeeding women appears to
be responsible for suppressing
ovulation
 Ovulation occurs as early as 27
days after birth in nonlactating
women
 Menstruation usually resumes by
12 weeks after birth

 Mean time to ovulation in women

who breastfeed is about 6 months
 Postpartum Physiology
 Abdomen
 During the first days after
birth, woman’s abdominal
muscles protrude and give
her a still-pregnant look
 6 weeks for the abdominal
wall to return almost to it
prepregnancy state
 Return of muscle tone
depends on previous tone,
proper exercise, and the
amount of adipose tissue
Abdomen
 Postpartum Physiology
Urinary System
 Diuresis occurs within
12 hours after delivery
 Profuse diaphoresis that
often occurs, especially
at night, for the first 2 to
3 days after childbirth
 Fluid loss through
perspiration and the
increased urinary output
accounts for weight loss
In the immediate postpartum period, the nurse monitors the
new mother for which risk related to the urinary system?

 1.Diuresis
 2.Stress incontinence
 3.Urge incontinence
 4.Retention
 Postpartum Physiology
 Urethra and Bladder
 Trauma to the urethra and bladder
may occur during the birth
process
 Decreased voiding, along with
postpartum diuresis, may result in
bladder distention
 Immediately after birth, excessive
bleeding can occur if the bladder
becomes distended
 Adequate emptying of the
bladder, bladder tone is usually
restored 5 to 7 days after
childbirth
 Postpartum Physiology
Gastrointestinal System
 Spontaneous bowel
evacuation maybe delayed
until 2 to 3 days after
childbirth
 Discomfort may be

anticipated due to lacerations,

episiotomies, or hemorrhoids
and may cause a delay in
evacuation
 Operational vaginal birth and

sphincter lacerations may

cause postpartum
incontinence
 May resolve in 6 months
 A postpartum nurse is providing home care instructions to a woman
following delivery of a healthy newborn. The nurse tells the mother that
she should expect normal bowel elimination to return:

 1.1 day postpartum

 2.3 days postpartum
 3.7 days postpartum
 4.Within 2 weeks postpartum
 Postpartum Physiology
Breasts
Breastfeeding Mothers
 Colostrum-before lactation
begins and is yellowish in
color
 Breast milk (true)- after
lactation begins and is bluish
white in color
 Breast may feel warm and
firm
 Tenderness may persist for
about 48 hours after the start
of lactation.
 Nipples are assessed for signs
of irritation such as; cracks,
blisters, or reddening
 Postpartum Physiology
Blood Volume
 Blood volume that increases
during pregnancy is
eliminated within the first 2
weeks after birth
 Blood volume returns to

nonpregnant values within 6

months
 Normal blood loss for vaginal

delivery is 300 to 500 ml

 Normal blood loss for a

C/Section is 500 to 1000 ml

 Postpartum Physiology
Blood Components
 Hgb and Hct levels drop
moderately for 3 to 4 days
 WBC increase to 20,000 to
25,000
 Increased neutrophils and
eosinophils and decreased
lymphocytes ( shifts to the left)
 Clotting factors l,ll, V111, lX,
decrease to nonpregnant level
within a few days
 Fibrinogen and thromboplastin
remain elevated during the first
few days after childbirth
 Postpartum Physiology

Neuromuscular System
 Numbness of thighs, fingers, or hands disappear in several
days
 Back pain usually resolves in a few weeks or months
following birth
 Postpartum headaches may be caused by various
conditions, including; postpartum onset preeclampsia,
stress, and the leakage of cerebrospinal fluid into the
extradural space during an insertion of an epidural
 Headaches last from 1 to 3 days to several weeks depend
on cause and effectiveness of treatment
Varicosities
 Postpartum Physiology
 Musculoskeletal System
 Relaxation of the joints and
the changes in the mother’s
center of gravity in response
to the enlarging uterus
 Joints are completely
stabilized by 6 to 8 weeks
after birth
 Mother may notice a
permanent increase in her
shoe size
 Postpartum Physiology
 Integumentary System
 Chloasma of pregnancy
usually disappears at the end
of pregnancy
 Hyperpigmentation of the
areolae, and linea nigra may
not regress completely after
childbirth
 Spider angiomas (nevi),
palmar erythema, and epulis
generally regress
 Profuse diaphoresis
 Key Points
 The rapid decrease in estrogen and
progesterone levels after expulsion of the
placenta is responsible for triggering many of
the anatomic and physiologic changes in the
puerperium.
 Within 6 weeks after birth, the physiologic
changes induced by pregnancy have reverted
to their normal state.
 Assessing lochia and fundal height is essential
to monitor the progress of normal involution
and to identify potential problems.