CHAPTER

18

Maternal Physiologic Changes

KEY POINTS
Describe the anatomic and physiologic changes that occur during
the postpartum period.
Discuss 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.
The uterus involutes rapidly after birth and returns to the true
pelvis within 2 weeks.
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.
Assessment of lochia and fundal height is essential to monitor
the progress of normal involution and to identify potential
problems.
Postbirth uterine discharge (lochia), initially is bright red (lochia
rubra) and may contain small clots. For the first 2 hours after
birth, the amount of uterine discharge should be about that of a
heavy menstrual period. After that time, the lochial flow should
steadily decrease.
The cervix is soft immediately after birth. The ectocervix (portion
of the cervix that protrudes into the vagina) appears bruised and
has some small lacerationsoptimal conditions for the development of infection.

Postpartum estrogen deprivation is responsible for the thinness

of the vaginal mucosa and the absence of rugae. The greatly
distended, smooth-walled vagina gradually decreases in size and
regains tone, although it never completely returns to its prepregnancy state.
Significant hormonal changes occur during the postpartal
period.
Kidney function returns to normal within 1 month after birth.
Marked diuresis, decreased bladder sensitivity, and overdistention
of the bladder can lead to problems with urinary elimination.
The return of ovulation and menses is determined in part by
whether the woman breastfeeds her infant.
During the first 24 hours after birth, there is little, if any, change
in the breast tissue. The breasts gradually become fuller and
heavier as the colostrum transitions to mature milk by about 72
to 96 hours after birth.
Few alterations in vital signs are seen after birth under normal
circumstances.
Hypercoagulability, vessel damage, and immobility predispose
the woman to thromboembolism.
Pregnancy-induced hypervolemia, combined with several postpartum physiologic changes, allows the woman to tolerate considerable blood loss at birth.

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