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The vulva returns to its pre-pregnancy state after vaginal delivery.
The vulva returns to its pre-pregnancy state after vaginal delivery.
False
Multipara experience mild pain due to tonic uterine contraction.
Multipara experience mild pain due to tonic uterine contraction.
False
Lochia rubra has a brownish red color.
Lochia rubra has a brownish red color.
False
Ovulation occurs immediately postpartum.
Ovulation occurs immediately postpartum.
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Breastfeeding can cause uterine contraction and afterpain.
Breastfeeding can cause uterine contraction and afterpain.
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Afterpain typically lasts for more than 2 days in multipara.
Afterpain typically lasts for more than 2 days in multipara.
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Lochia alba has a yellowish brown color.
Lochia alba has a yellowish brown color.
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Primiparas experience severe afterpain due to vigorous uterine contractions.
Primiparas experience severe afterpain due to vigorous uterine contractions.
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At week 6 postpartum, only 15% of women have lochia.
At week 6 postpartum, only 15% of women have lochia.
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Gonadotrophin releasing hormone (GnRH) is stimulated by prolactin hormone postpartum.
Gonadotrophin releasing hormone (GnRH) is stimulated by prolactin hormone postpartum.
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Menstrual cycles resume when ovulation is restored.
Menstrual cycles resume when ovulation is restored.
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Breastfeeding always leads to immediate ovulation.
Breastfeeding always leads to immediate ovulation.
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50-75% of women return to periods within 36 weeks of delivery.
50-75% of women return to periods within 36 weeks of delivery.
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Colostrum is high in fat and low in protein.
Colostrum is high in fat and low in protein.
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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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Breastfeeding can be initiated as late as 2 weeks after delivery.
Breastfeeding can be initiated as late as 2 weeks after delivery.
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HIV infection is not a contraindication for breastfeeding.
HIV infection is not a contraindication for breastfeeding.
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Physiologic weight loss is approximately 3 kg.
Physiologic weight loss is approximately 3 kg.
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Galactosemia is not a contraindication for breastfeeding.
Galactosemia is not a contraindication for breastfeeding.
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Breast cancer treatment is not a contraindication for breastfeeding.
Breast cancer treatment is not a contraindication for breastfeeding.
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It is recommended to wait for six months after delivery before resuming sexual intercourse.
It is recommended to wait for six months after delivery before resuming sexual intercourse.
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Pelvic floor rehabilitation can help improve sexual function.
Pelvic floor rehabilitation can help improve sexual function.
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Postnatal exercise can help alleviate postnatal depression.
Postnatal exercise can help alleviate postnatal depression.
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Women's health physiotherapists focus solely on manual therapies.
Women's health physiotherapists focus solely on manual therapies.
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It is recommended to engage in high-intensity exercise immediately after delivery.
It is recommended to engage in high-intensity exercise immediately after delivery.
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Abdominal Wall returns to a pre-pregnant state immediately after delivery.
Abdominal Wall returns to a pre-pregnant state immediately after delivery.
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Postnatal exercise can help reduce body weight.
Postnatal exercise can help reduce body weight.
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Gestational weight gain is lost at a constant rate postpartum.
Gestational weight gain is lost at a constant rate postpartum.
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Physical activity during the postpartum period can improve cardiovascular health.
Physical activity during the postpartum period can improve cardiovascular health.
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Postnatal exercise has no impact on sleep quality.
Postnatal exercise has no impact on sleep quality.
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The uterus can be palpated at or near the umbilicus 2 weeks postpartum.
The uterus can be palpated at or near the umbilicus 2 weeks postpartum.
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The weight of the uterus immediately postpartum is approximately 500g.
The weight of the uterus immediately postpartum is approximately 500g.
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The cervix resumes its pre-gravid shape after childbirth.
The cervix resumes its pre-gravid shape after childbirth.
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The vaginal epithelium appears atrophic on smear after 6 weeks postpartum.
The vaginal epithelium appears atrophic on smear after 6 weeks postpartum.
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The perineum takes more than 3 weeks to return to its non-pregnant state.
The perineum takes more than 3 weeks to return to its non-pregnant state.
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The uterus weighs 300g at the end of the first week postpartum.
The uterus weighs 300g at the end of the first week postpartum.
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The body has fully reverted to its non-pregnant state by 3 weeks postpartum.
The body has fully reverted to its non-pregnant state by 3 weeks postpartum.
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The vagina does not return to its non-pregnant state after childbirth.
The vagina does not return to its non-pregnant state after childbirth.
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The uterus returns to its non-pregnant state within 1 week postpartum.
The uterus returns to its non-pregnant state within 1 week postpartum.
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The external os is closed to the extent that a finger can be easily introduced after childbirth.
The external os is closed to the extent that a finger can be easily introduced after childbirth.
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Study Notes
Normal Puerperium
- Definition: The time from the delivery of the placenta through the first few weeks after delivery (6 weeks postpartum)
- Importance: By 6 weeks after delivery, most of the changes of pregnancy, labor, and delivery have resolved and the body has reverted to the non-pregnant state
Uterus
- Size: Immediately after delivery, the uterus can be palpated at or near the umbilicus, reducing to 500g after 1 week, 300g at the end of 2 weeks, and 100g or less thereafter
- Weight: Most of the reduction in size and weight occurs in the first 2 weeks
- Tissues revert to a non-pregnant state, but never return to the nulliparous state
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
- Shrinks to a non-pregnant state
- Resolution of the increased vascularity and edema occurs by 3 weeks
- The vaginal epithelium appears atrophic on smear, restored by weeks 6-10
- Tissues revert to a non-pregnant state, but never return to the nulliparous state
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
- Duration: Moderate pain for 2 days, mild pain by the 3rd day postpartum
- Causes:
- Multipara: The uterus contracts vigorously at intervals
- Primiparas: The uterus tonically contracts
- Infant suckling (breastfeeding): Oxytocin release → uterine contraction → afterpain
Lochia
- Duration: Variable, lasts about 5 weeks, with 15% of women having lochia at week 6 postpartum
- Types:
- Lochia rubra: Red, variable duration
- Lochia serosa: Brownish-red, more watery consistency, decreases in amount
- Lochia alba: Yellow
Ovulation and Menstruation
- There is no ovulation immediately postpartum due to prolactin hormone inhibiting gonadotrophin releasing hormone (GnRH) release from the hypothalamus
- Ovulation is restored after a duration depending on whether the woman is breastfeeding or not
- Menstrual cycles resume when ovulation is restored
Breastfeeding
- Changes to the breast that prepare for breastfeeding occur throughout pregnancy
- Lactation can occur by 16 weeks' gestation
- Colostrum: High in protein and immune factors, first 2-4 days after delivery
- Mature milk: Contains all the necessary nutrients, changes throughout the period of breastfeeding
- Initiation: Should be initiated as soon as possible after delivery, feeding every 2-3 hours to stimulate milk production
Contraindications to Breastfeeding
- Alcohol use and street drugs
- Certain medications
- Active untreated tuberculosis (TB)
- Infections: HIV, Cytomegalovirus, and hepatitis B virus
- Women with active herpes simplex virus
- An infant with galactosemia
- Mother undergoing breast cancer treatment
Physiologic Weight Loss
- Mean weight loss from delivery of the fetus, placenta, and amniotic fluid is 6 kg
- Additional loss of 2 to 7 kg during the puerperium due to contraction of the uterus, loss of lochial fluid, and loss of excess intra- and extracellular fluid
- Approximately one-half of gestational weight gain is lost in the first six weeks after delivery, with a slower rate of loss through the first six months postpartum
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
- Emotionally ready
- Physical readiness usually takes ~3 weeks
Concerns - Puerperal Period
- Physical activity and exercise during the postpartum period
- Pelvic floor rehabilitation:
- Prevent and manage pelvic organ prolapse
- Prevent and manage urinary incontinence
- Improve sexual function
- Benefits of postnatal exercise:
- Restores physical health
- Improves sleep quality
- Relieves stress
- Prevention of depressive disorders
- Reduced body weight
- Stimulates lactation
- Alleviates postnatal issues such as diastasis recti, urinary incontinence, pelvic organ prolapse, and pelvic girdle pain
Role of Women's Health Physiotherapist
- Physical therapy can improve health outcomes for new mothers in the postnatal period
- Benefits:
- Improve mood
- Improve cardio-respiratory fitness
- Promote weight loss
- Reduce the risk of postpartum depression and anxiety
- Enhance psychological well-being
- Improve sexual health and sexual dysfunction
- Lead to better outcomes assessing quality of life
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Description
A quiz on the normal puerperium period, covering the definition, importance, and physical changes during the first six weeks after delivery.
