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Questions and Answers
What is the typical duration of moderate pain after childbirth?
What is the primary cause of afterpain in multiparas?
What is the function of oxytocin in relation to afterpain?
What is the typical duration of lochia?
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What is the color of lochia alba?
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Why does ovulation not occur immediately postpartum?
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What is the duration of the puerperium period?
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What is the weight of the uterus immediately after delivery?
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When does the uterus return to its non-pregnant state?
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What happens to the cervix after childbirth?
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What happens to the vagina during the puerperium period?
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What happens to the perineum after childbirth?
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What happens to the vaginal epithelium during the puerperium period?
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When is the vaginal epithelium restored to its non-pregnant state?
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What is the average weight loss due to the delivery of the fetus, placenta, and amniotic fluid?
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When can lactation occur during pregnancy?
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What percentage of women who do not breastfeed return to their menstrual periods within 36 weeks?
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What is the primary reason for feeding a newborn every 2-3 hours after delivery?
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Which of the following is NOT a contraindication for breastfeeding?
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What is the main component of colostrum?
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How long does it take for milk to mature after delivery?
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What is the additional weight loss during the puerperium due to?
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What percentage of gestational weight gain is typically lost in the first six weeks after delivery?
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What is a crucial factor in returning the abdominal wall to a pre-pregnant state?
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What is a common guideline for resuming sexual intercourse postpartum?
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What is the primary purpose of pelvic floor rehabilitation during the postpartum period?
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What is a benefit of moderate-intensity exercise during the postpartum period?
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What is the role of a women's health physiotherapist during the postnatal period?
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What is a potential outcome of postnatal exercise?
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What is a benefit of physical therapy during the postnatal period?
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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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