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Overview of postpartum care

Author
Pamela Berens, MD
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Kristen Eckler, MD, FACOG

INTRODUCTION

The postpartum period, also known as the puerperium, begins with the delivery of the baby and placenta. The end of the postpartum period is less well-defined, but is often considered the six to eight weeks after delivery because the effects of pregnancy on many systems have resolved by this time and these systems have largely returned to their prepregnancy state. However, all organ systems do not return to baseline within this period and the return to baseline is not necessarily linear over time. In some studies, women are considered postpartum for as long as 12 months after delivery.

Health care providers should be aware of the medical and psychological needs of the postpartum mother and sensitive to cultural differences that surround childbirth, which may involve eating particular foods and restricting certain activities [1].

NORMAL POSTPARTUM ANATOMIC AND PHYSIOLOGIC CHANGES

Shivering — Postpartum shivering (postpartum chills, rigors) are observed in 25 to 50 percent of women after normal deliveries [2,3]. Shivering usually starts 1 to 30 minutes post-delivery and lasts for 2 to 60 minutes. The pathogenesis of postpartum chills is not clear; several mechanisms have been proposed including fetal-maternal hemorrhage, micro-amniotic emboli, bacteremia, maternal thermogenic reaction to a sudden thermal imbalance due to the separation of the placenta, drop in body temperature following labor, use of misoprostol, and an anesthesia-related etiology. No treatment is necessary other than supportive care (eg, warm blanket). Anesthesia-related shivering can be treated pharmacologically. (See "Adverse effects of neuraxial analgesia and anesthesia for obstetrics", section on 'Shivering'.)

Uterine involution — Immediately after delivery of the placenta, the uterus begins to involute (ie, contract). Myometrial retraction is a unique characteristic of the uterine muscle that enables it to maintain its shortened length following successive contractions. Contraction of the interlacing myometrial muscle bundles constricts the intramyometrial vessels and impedes blood flow, which is the major mechanism preventing hemorrhage. In addition, large vessels at the placental site thrombose, which is a secondary hemostatic mechanism for preventing blood loss at this site.

On examination, the fundus should be nontender, firm, and more globular than in its pregnant state. A soft, boggy uterus in the presence of heavy vaginal bleeding suggests inadequate contraction of the uterus (ie, atony). The diagnosis of heavy bleeding is based primarily on the judgment of care providers. Typically hemorrhage implies a degree of bleeding that threatens to cause, or is associated with, hemodynamic instability. (See "Overview of postpartum hemorrhage".)

                                                                        

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