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At 2 weeks postpartum, the uterus is located at or near the umbilicus.
At 2 weeks postpartum, the uterus is located at or near the umbilicus.
False
The uterus weighs around 100g or less at the end of the 1st week.
The uterus weighs around 100g or less at the end of the 1st week.
False
The cervix returns to its pre-gravid shape after childbirth.
The cervix returns to its pre-gravid shape after childbirth.
False
The vagina returns to its nulliparous state after childbirth.
The vagina returns to its nulliparous state after childbirth.
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The perineum takes around 3-4 weeks to recover from swelling and engorgement.
The perineum takes around 3-4 weeks to recover from swelling and engorgement.
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The vaginal epithelium appears atrophic on smear at 6 weeks postpartum.
The vaginal epithelium appears atrophic on smear at 6 weeks postpartum.
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The uterus reaches its non-pregnant weight within the first week after delivery.
The uterus reaches its non-pregnant weight within the first week after delivery.
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The cervix is open to the extent that a finger can be easily introduced at 2 weeks postpartum.
The cervix is open to the extent that a finger can be easily introduced at 2 weeks postpartum.
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The vagina takes around 2-3 weeks to shrink to a non-pregnant state.
The vagina takes around 2-3 weeks to shrink to a non-pregnant state.
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The uterus returns to its nulliparous state after childbirth.
The uterus returns to its nulliparous state after childbirth.
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The uterus contracts tonically in multiparas to cause afterpain.
The uterus contracts tonically in multiparas to cause afterpain.
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All women experience lochia for about 5 weeks postpartum.
All women experience lochia for about 5 weeks postpartum.
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Lochia rubra has a brownish red color and a watery consistency.
Lochia rubra has a brownish red color and a watery consistency.
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Ovulation occurs immediately postpartum due to the decrease in prolactin hormone.
Ovulation occurs immediately postpartum due to the decrease in prolactin hormone.
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The muscle tone of the vulva always returns to normal after delivery.
The muscle tone of the vulva always returns to normal after delivery.
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Afterpain is typically severe enough to require an analgesic for the entire postpartum period.
Afterpain is typically severe enough to require an analgesic for the entire postpartum period.
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Gapping of the vulva remains for 2-3 weeks and then disappears completely.
Gapping of the vulva remains for 2-3 weeks and then disappears completely.
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Only multiparas experience afterpain.
Only multiparas experience afterpain.
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Breastfeeding can be initiated 16 weeks after delivery.
Breastfeeding can be initiated 16 weeks after delivery.
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Lochia alba has a brownish red color and a watery consistency.
Lochia alba has a brownish red color and a watery consistency.
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Infant suckling does not cause uterine contractions or afterpain.
Infant suckling does not cause uterine contractions or afterpain.
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Colostrum is produced only after the first week of delivery.
Colostrum is produced only after the first week of delivery.
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Ovulation is restored immediately after delivery, regardless of breastfeeding.
Ovulation is restored immediately after delivery, regardless of breastfeeding.
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All women will have a menstrual period within 12 weeks of delivery.
All women will have a menstrual period within 12 weeks of delivery.
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Breastfeeding is contraindicated in women undergoing treatment for breast cancer.
Breastfeeding is contraindicated in women undergoing treatment for breast cancer.
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Galactosemia is a contraindication for breastfeeding.
Galactosemia is a contraindication for breastfeeding.
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Mature milk continues to change throughout the period of breastfeeding to meet the changing demands of the baby.
Mature milk continues to change throughout the period of breastfeeding to meet the changing demands of the baby.
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The average weight loss after delivery is 13 kg.
The average weight loss after delivery is 13 kg.
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HIV is a contraindication for breastfeeding.
HIV is a contraindication for breastfeeding.
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Breastfeeding is easy and automatic for all women.
Breastfeeding is easy and automatic for all women.
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Approximately one-half of gestational weight gain is lost in the first three months after delivery.
Approximately one-half of gestational weight gain is lost in the first three months after delivery.
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The abdominal wall returns to a pre-pregnant state immediately after delivery.
The abdominal wall returns to a pre-pregnant state immediately after delivery.
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Sexual intercourse can resume when the uterus returns to its pre-pregnant state.
Sexual intercourse can resume when the uterus returns to its pre-pregnant state.
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Moderate-intensity exercise of 20 to 30 minutes per day on most or all days of the week is recommended during pregnancy.
Moderate-intensity exercise of 20 to 30 minutes per day on most or all days of the week is recommended during pregnancy.
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Pelvic floor rehabilitation can prevent and manage pelvic organ prolapse and urinary incontinence.
Pelvic floor rehabilitation can prevent and manage pelvic organ prolapse and urinary incontinence.
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Postnatal exercise has no effect on lactation.
Postnatal exercise has no effect on lactation.
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Physical therapy can worsen health outcomes for new mothers in the postnatal period.
Physical therapy can worsen health outcomes for new mothers in the postnatal period.
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Physical therapy can reduce the risk of postpartum depression and anxiety.
Physical therapy can reduce the risk of postpartum depression and anxiety.
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Women's health physiotherapists are not involved in postnatal care.
Women's health physiotherapists are not involved in postnatal care.
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Postnatal exercise has no effect on postnatal depression.
Postnatal exercise has no effect on postnatal depression.
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Study Notes
Normal Puerperium
- Puerperium is the time from delivery of the placenta to 6 weeks postpartum
- By 6 weeks, most changes of pregnancy, labor, and delivery have resolved and the body has reverted to a non-pregnant state
Uterus
- Immediately after delivery, the uterus can be palpated at or near the umbilicus
- By 2 weeks postpartum, the uterus should be located in the true pelvis
- The uterus shrinks rapidly in the first 2 weeks, with a significant reduction in size and weight
- Weight: 1000g immediately postpartum, 500g at 1 week, 300g at 2 weeks, and 100g or less thereafter
Cervix
- The external os is closed to the extent that a finger could not be easily introduced
- The external os never resumes its pre-gravid shape; it becomes a large, transverse, stellate slit after childbirth
Vagina
- The vagina shrinks to a non-pregnant state, with resolution of the increased vascularity and edema by 3 weeks
- The vaginal epithelium appears atrophic on smear, restored by weeks 6-10
Perineum
- Swelling and engorgement are completely gone within 1-2 weeks
- The gapping of the vulva that occurs during vaginal delivery remains for 2-3 weeks then gradually disappears, but never returns to the pre-pregnancy state
- Muscle tone may or may not return to normal, depending on the extent of injury
Afterpain
- Moderate pain for 2 days, mild pain by the 3rd day postpartum
- Occasionally severe enough to require an analgesic
- Causes: uterine contractions, infant suckling (breastfeeding)
Lochia
- Duration: variable, lasts about 5 weeks
- At week 6 postpartum, only 15% of women have lochia
- Types:
- Lochia rubra: red, variable duration
- Lochia serosa: brownish-red, more watery consistency, decreasing in amount
- Lochia alba: yellow
Ovulation and Menstruation
- No ovulation immediately postpartum due to prolactin hormone inhibiting GnRH release
- Ovulation restored after a duration depending on whether the woman is breastfeeding or not
- Menstrual cycles resume when ovulation is restored
- Breastfeeding: variable duration, ovulation may be as early as 27 days after delivery
- 50-75% of women return to periods within 12 weeks, the rest may not have periods until stopping breastfeeding
The Breasts
- Changes prepare for breastfeeding throughout pregnancy
- Lactation can occur by 16 weeks' gestation
- Colostrum: high in protein and immune factors, 1st 2-4 days after delivery
- Milk: matures over the first week, containing all necessary nutrients
Breastfeeding
- Initiation: neither easy nor automatic, should be initiated as soon as possible after delivery
- Feed the baby every 2-3 hrs to stimulate milk production
- Contraindications: alcohol use, certain medications, active untreated tuberculosis, infections, and galactosemia
Physiologic Weight Loss
- Mean weight loss from delivery of fetus, placenta, and amniotic fluid: 6 kg
- Additional loss of 2-7 kg during the puerperium
- Approximately one-half of gestational weight gain is lost in the first six weeks
Abdominal Wall
- Remains soft with poor tone for many weeks
- Return to a pre-pregnant state depends greatly on exercise
Sexual Intercourse
- May resume when red bleeding ceases, vagina and vulva are healed, physically comfortable, and emotionally ready
- Physical readiness usually takes ~3 weeks
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Description
Learn about the normal postpartum period, from the delivery of the placenta to the first few weeks after delivery. Understand the physical changes and importance of this period.
