Normal and Abnormal
Department of Ob & Gy
Ren Ji hospital
1. The time from the delivery of the placenta
through the first few weeks after the delivery.
2. 6 weeks in duration.
3. By 6 weeks after delivery, most of the changes
of pregnancy, labor, and delivery have
resolved and the body has reverted to the
• The relevant anatomy and physiology in the
1. Reproductive organs
1000g → 50-100g
The endometrial lining rapidly regenerates
The placental site undergoes a series of
changes in the postpartum period
it never returns to the nulliparous state.
the external os is closed to the extent that a
finger could not be easily introduced.
shrinks to a nonpregnant state
resolution of the increased vascularity and
edema occurs by 3 weeks
the vaginal epithelium appears atrophic on
smear. This is restored by weeks 6-10.
swelling and engorgement are completely
gone within 1-2 weeks
the muscle tone may or may not return to
normal, depending on the extent of injury.
ovulate as early as 27 days after delivery (not
breastfeed ); 12 weeks (most); 7-9 weeks
the suppression of ovulation due to the
elevation in prolactin
Lactation can occur by 16 weeks' gestation.
Lactogenesis is initially triggered by the
delivery of the placenta (E↓P↓and prolactin).
the prolactin levels decrease and return to
normal within 2-3 weeks (not breastfeeding)
The colostrum初乳(the first 2-4 days)
The milk continues to change throughout the
period of breastfeeding to meet the changing
demands of the baby.
2. Systemic change
1) Cardiovascular system
Blood volume returns to nonpregnant levels
by the tenth days of puerperium
Cardiac output ↑(immediately after delivery)
→ slowly declines→ reach late pregnancy
levels 2 days postpartum→ normal 2-6 weeks.
2) Hematologic changes
Hemoglobin concentration↑on the first
Several clotting factors (fibrinogen) ↑on the
1.Fever (24 hours)
2.Pain (uterine contraction)
a large amount of red blood initially flows
from the uterus as the contraction phase
rapidly occurs. (5 weeks)
lochia rubra; lochia serosa (brownish red,
with a more watery consistency); lochia alba
1. 2 hours after delivery
HR and Bp and R and T
2. 1 weeks after delivery
3. Emiction and defecate
5. Episiotomy and Laceration
• Puerperal Infection
any bacterial infection of the genital tract after
delivery. Incidence: 6%. The most important
cause of maternal death.
• Puerperal Morbidity
temperature 38.0℃ or highter, the temperature
to occur on any 2 of the first 10days
postpartum, exclusive of the first 24 hours, and
to be taken by mouth by a standard technique
at least four times daily.
• Risk factors
4. EP and CS
5. Placenta retain
• Common pathogens
Group A, B, and D streptococci溶血性链球菌
Gram-negative bacteria: Escherichia coli大肠
Bacteroides fragilis group脆弱类杆菌
Acute vulvitis vaginitis and cervicitis
Septic pelvic thrombophlebitis 血栓性静脉炎
Physical examination and PV
1. Nutrition: anemia prevention
2. Antimicrobial treatment
broad-spectrum, high dose, long time
4. Treatment of thrombophlebitis
Late Postpartum Hemorrhage
Uterine bleeding by 24 hours after delivery.
Placenta or membrane or decidua retain
Problems of incision