C H AP TER 8 Normal Labor, Delivery, and Postpartum Care
A B
FIGURE 8-13 A, Mediolateral episiotomy.
Puerperium
The puerperium consists of the period following
delivery of the baby and placenta to approximately 6
weeks postpartum. During the puerperium, the repro -
ductive organs and maternal physiology return to the
prepregnancy state, although menses may not return
for much longer.
ANATOMIC AND PHYSIOLOGIC CHANGES
Involution of the Uterus
Through a process of tissue catabolism, the uterus
rapidly decreases in weight from about 1000 g at deliv -
ery to 100 to 200 g approximately 3 weeks postpartum.
The cervix similarly loses its elasticity and regains its
prepregnancy firmness. For the first few days after
delivery, the uterine discharge (lochia) appears red
(lochia rubra), because of the presence of erythro -
cytes. After 3 to 4 days, the lochia becomes paler (lochia
serosa), and by the tenth day, it assumes a white or
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B, Midline episiotomy.
yellow-white color (lochia alba). Foul-smelling lochia
suggests endometritis.
Vagina
Although the vagina may never return to its prepreg -
nancy state, the supportive tissues of the pelvic floor
gradually regain their former tone. Women who deliver
vaginally should be taught and encouraged to perform
Kegel exercises (intermittent tightening of the perineal
muscles) to maintain and improve the supportive
tissues of the pelvic floor.
Cardiovascular System
Immediately following delivery, there is a marked
increase in peripheral vascular resistance because of
the removal of the low-pressure uteroplacental circula -
tory shunt. The cardiac output and plasma volume
gradually return to normal during the first 2 weeks of
the puerperium. As a result of the loss of plasma volume
and the diuresis of extracellular fluid, a marked weight
loss occurs in the first week.