Intoduction.
Puerperium refers to the period of time following childbirth during which the body
tissue especially reproductive organs revert back approximately to the pre-
pregnancy state both anatomically and physiologically. The retrogressive changes
are mostly confined the reproductive organs with the exception of the mammary
glands and cervix which never exactly close at the external os. This period begins
immediately as soon as placenta is expelled and proceeds for approximately six
weeks or untills the body has completed its adjustment and has returned to near
pre-pregnant state. Some have referred this period as ‘the fourth trimester” though
the time span does not necessarily covers three month. The woman at this period is
termed as puerpera. Involution is the process whereby the genital organs revert
back approximately to the state of pre-pregnancy.
Physiological changes during puerperium.
During pregnancy there is progressive anatomical, physiological and biochemical
change not only confined to the genital organs but also to all systems of the body,
this is principally a phenomenon of maternal adaptation to the increasing demands
of the growing fetus, soon after delivery, certain physiological changes take place
in the puerperium , most actively within 14 days, these occurs to facilitate reverse
of the changes which occur during pregnancy.
Involution of pelvic organs.
UTERUS
Immediately following delivery, the uterus can be felt just below the umbilicus, it
should be central and feel hard on palpation from being well contracted, gradually
the uterus reduces in size until it can no longer be felt above the symphysis pubis
after about 10-14 days, by 6weeks the uterus weighs 60g again as it did before
, pregnancy, there is marked hypertrophy and hyperplasia of muscle fibres during
pregnancy, during puerperium the number of muscle fibres are not decreased but
there are substantial reduction of the myometrial cells. The blood vessels to the
uterus constrict, this reduces blood supply and oxygen reaching the tissues causing
ischaemia, this cause the muscle fibres to become smaller or atrophy. The
myometrium, connective tissue and fat cells are broken down and digested, this
self digestion process is called autolysis, autolysis is called by proteolytic enzymes
and cells called macrophages. Endometrium , following delivery the major part of
the decidua is cast off with the expulsion of the placenta and the membranes via
the vagina. The raw placenta site contracts rapidly and heals by having a protective
layer of leucocytes laid down on it.
CERVIX; Cervix start to contract slowly, it become spongy, bruised, flabby, and
formless, the external os has markedly irregular outline suggestive of multiple
lacerations, the external os admits two fingers for a few days but at the end of first
week narrows down to admit the tip of finger only, the shape of the external os is
permanently changed following the first childbearing, the characteristic dimplelike
os of the nullipara changes to the lateral slit (fishmouth) of the multipara.
VAGINA; the distensible vagina noticed soon after birth takes long time (4-
8weeks) to involute, vagina appears edematous and bruised and small superficial
lacerations may be evident , rugae have been obliterated, it regains its tone but
never to the virginal state, the mucosa remains delicate for the first few weeks and
submucous venous congestion persists even longer, rugae partially reappear at a
third week but never to the same degree as in pre-pregnant state, the vaginal
introitus remains permanently larger than the virginal state, tightening of the
vaginal orifice may require perineal tightening exrcises which may begin soon
after delivery , hymen is lacerated and is represented by nodular tags, the labia
majora nd minora are more flabby in the woman who has born than in the
nullipara.
OTHER PHYSIOLOGICAL CHANGES DURING PUERPERIUM
Lochia.
Refer to vaginal discharge of blood mixed with shreds of decidua, membranes and
mucus during puerperium, this discharge originates from the uterine body, cervix
Puerperium refers to the period of time following childbirth during which the body
tissue especially reproductive organs revert back approximately to the pre-
pregnancy state both anatomically and physiologically. The retrogressive changes
are mostly confined the reproductive organs with the exception of the mammary
glands and cervix which never exactly close at the external os. This period begins
immediately as soon as placenta is expelled and proceeds for approximately six
weeks or untills the body has completed its adjustment and has returned to near
pre-pregnant state. Some have referred this period as ‘the fourth trimester” though
the time span does not necessarily covers three month. The woman at this period is
termed as puerpera. Involution is the process whereby the genital organs revert
back approximately to the state of pre-pregnancy.
Physiological changes during puerperium.
During pregnancy there is progressive anatomical, physiological and biochemical
change not only confined to the genital organs but also to all systems of the body,
this is principally a phenomenon of maternal adaptation to the increasing demands
of the growing fetus, soon after delivery, certain physiological changes take place
in the puerperium , most actively within 14 days, these occurs to facilitate reverse
of the changes which occur during pregnancy.
Involution of pelvic organs.
UTERUS
Immediately following delivery, the uterus can be felt just below the umbilicus, it
should be central and feel hard on palpation from being well contracted, gradually
the uterus reduces in size until it can no longer be felt above the symphysis pubis
after about 10-14 days, by 6weeks the uterus weighs 60g again as it did before
, pregnancy, there is marked hypertrophy and hyperplasia of muscle fibres during
pregnancy, during puerperium the number of muscle fibres are not decreased but
there are substantial reduction of the myometrial cells. The blood vessels to the
uterus constrict, this reduces blood supply and oxygen reaching the tissues causing
ischaemia, this cause the muscle fibres to become smaller or atrophy. The
myometrium, connective tissue and fat cells are broken down and digested, this
self digestion process is called autolysis, autolysis is called by proteolytic enzymes
and cells called macrophages. Endometrium , following delivery the major part of
the decidua is cast off with the expulsion of the placenta and the membranes via
the vagina. The raw placenta site contracts rapidly and heals by having a protective
layer of leucocytes laid down on it.
CERVIX; Cervix start to contract slowly, it become spongy, bruised, flabby, and
formless, the external os has markedly irregular outline suggestive of multiple
lacerations, the external os admits two fingers for a few days but at the end of first
week narrows down to admit the tip of finger only, the shape of the external os is
permanently changed following the first childbearing, the characteristic dimplelike
os of the nullipara changes to the lateral slit (fishmouth) of the multipara.
VAGINA; the distensible vagina noticed soon after birth takes long time (4-
8weeks) to involute, vagina appears edematous and bruised and small superficial
lacerations may be evident , rugae have been obliterated, it regains its tone but
never to the virginal state, the mucosa remains delicate for the first few weeks and
submucous venous congestion persists even longer, rugae partially reappear at a
third week but never to the same degree as in pre-pregnant state, the vaginal
introitus remains permanently larger than the virginal state, tightening of the
vaginal orifice may require perineal tightening exrcises which may begin soon
after delivery , hymen is lacerated and is represented by nodular tags, the labia
majora nd minora are more flabby in the woman who has born than in the
nullipara.
OTHER PHYSIOLOGICAL CHANGES DURING PUERPERIUM
Lochia.
Refer to vaginal discharge of blood mixed with shreds of decidua, membranes and
mucus during puerperium, this discharge originates from the uterine body, cervix
