PHYSIOLOGICAL PUERPERIUM: WHAT IT CONSISTS OF, WHAT IT IS FOR, CLASSIFICATION - MEDICINE - 2025

The physiological puerperium is the period following delivery or cesarean section (surgery). It begins after the delivery of the placenta and extends until the anatomophysiological recovery of the woman.

It is a stage of variable duration, between 6 and 8 weeks or 45 and 60 days, in which breastfeeding begins and adaptation occurs between the mother, the newborn and their environment. This is what in popular knowledge is called "quarantine."

Mother and son. Image via: pixabay.com

In this period, the woman's organism returns to the conditions prior to gestation or pregnancy. All the functional adaptations that occurred during pregnancy disappear and the organs return to their previous functional condition.

Ideally it is a period in which the mother, the baby and their environment should be in a calm environment and with family support, especially from the couple. The mother's diet should be rich in fruits, fibers and proteins.

What is the physiological puerperium?

As it is the period that follows childbirth, in the early stages the mother has to take personal hygiene care to avoid puerperal infections and avoid problems in the breasts, thus ensuring adequate breastfeeding.

If the delivery was vaginal, the mother will be able to move normally within a few hours of having finished. If you have had an episiotomy (incision of the perineum to avoid tears during childbirth) you should wash the wound with soap and water and keep it dry until it heals.

When the delivery has been by cesarean section, immediate postpartum recovery is a little slower since it requires post-surgical recovery. However, the woman will be able to move quickly (24 hours) with some initial difficulties due to postoperative discomfort.

Caesarean section (Source: Salimfadhley at English Wikipedia via Wikimedia Commons)

In the latter case, you will have to take care of the surgical wound until the stitches are removed and the wound heals properly, following the recommendations of the treating physician.

Breastfeeding the child during the puerperium is of great importance for both the baby and the mother. This is not only due to the emotional ties that are established, but also due to the important physiological effects that occur.

On the one hand, the mother, through the colostrum (first milk secretion 3 to 5 days), passes the child a series of immunoglobulins that will protect him from many infectious diseases in the first two months of life. Then, while breastfeeding, a series of uterine contractions occur in the mother that accelerate the postpartum recovery of the uterus.

Ovulation

During this period the mother will have blood losses that are initially abundant and that will later become a serous transudate that will last throughout the puerperium for about three to six weeks. These fluids or bleeds are called lochia.

In women who do not breastfeed, the return of cyclical ovarian function can be expected from the second month after delivery, with ovulation about 9 to 10 weeks after delivery. In breastfeeding women, high levels of the hormone prolactin cause lack of ovulation.

However, if the woman does not want to get pregnant again, she should consult her doctor to take the appropriate measures.

What is it for?

The puerperium serves for the recovery of the woman's body and the reestablishment of the conditions prior to pregnancy.

Many of the changes that occur in the puerperium are due to an abrupt cessation of hormonal production and others due to loss of the low-resistance placental shunt and blood loss during delivery.

Cardiovascular system

Loss of the placental circuit requires rearrangement of the cardiovascular circuit. By the third day of the puerperium, the mother's blood volume drops to 85% of the volume it maintained during pregnancy. These changes influence the renal and hepatic elimination of hormones.

After about six weeks, the total blood volume has decreased by 40% from the values ​​it had during pregnancy. The red cell mass increases by 15% in the first week of the puerperium, to normalize about 3 to 4 months later.

In the first week of the puerperium, an increase in platelets, leukocytes and some coagulation factors also occurs. Regarding body water, there is a loss of 1 to 2 liters of extracellular fluid in the first week and 1 to 1.5 liters per week in the following 5 weeks.

Female reproductive system

In the female reproductive system, the size and weight of the uterus decreases. A series of uterine contractions take place that reduce bleeding and eliminate necrotic tissues. Likewise, these allow to reduce the size of the organ until, in about six weeks, the pre-pregnancy weight is reached.

After episiotomy, the vagina is edematous, smooth, and flaccid. From the third week on, the edema disappears and vaginal folds begin to appear. Between the sixth and eighth weeks the repair of the vaginal introitus and the walls of the vagina is completed.

When delivery occurs and the placenta is eliminated, there is a sudden decrease in placental steroids and lactogens, which disinhibits the action of prolactin on the mammary glands and milk synthesis begins. The breasts increase in size and appear engorged and tight.

Digestive system

In the postpartum period, as the pressure exerted on the digestive system by the uterus and the fetus disappears and the size of the uterus decreases, the viscera are rearranged in the abdominal cavity.

In the first week there may be a bit of constipation, but after the second week motility improves and gastric emptying increases, with which reflux and heartburn or heartburn disappear. The liver metabolic function recovers its pre-pregnancy values ​​from the third week.

Urinary and renal system

The kidneys remain enlarged until the first month of the puerperium, as does the dilation of the ureters. Kidney function returns to pre-pregnancy values ​​after the first week of the puerperal period.

During the puerperium there is an increase in diuresis due to the elimination of excess fluid from the extracellular compartment.

Weightloss.

There is an immediate weight loss due to the discharge of the child, the placenta, the amniotic fluid and insensitive losses during delivery. These losses cause a reduction of about 5 to 6 kg in weight in the immediate puerperium.

Then, in the first week they lose 1 to 2 kg of weight and in the subsequent five weeks they lose between 1 to 1.5 kg per week. The reason for this weight loss has to do with the elimination of body water, as explained above.

Classification

From a clinical point of view, the puerperium comprises three successive periods:

- The immediate puerperium, which includes the first 24 hours after delivery.

- The mediate puerperium, this extends from the second day to the end of the first week and for some authors until the tenth day.

- The late puerperium concludes around 40-45 postpartum. It corresponds to the time necessary for the complete recovery of the female genital organs and the return of the woman to her pre-pregnancy condition.

References

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