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Overview of the postpartum period: Physiology, complications, and maternal care

Pamela Berens, MD
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Vanessa A Barss, MD, FACOG


The postpartum period, also known as the puerperium, refers to the time after delivery when maternal physiological changes related to pregnancy return to the nonpregnant state. In addition to physiologic changes and medical issues that may arise during this period, health care providers should be aware of the 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]. This topic will provide an overview of issues related to the postpartum period. Many of the specific issues are discussed in detail in separate topics.


There is consensus that the postpartum period begins upon delivery of the infant. The end is less well defined but is often considered the six to eight weeks after delivery because the effects of pregnancy on many systems have largely returned to the 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. For this reason, some authors describe women as postpartum for as long as 12 months after delivery.


Shivering — Postpartum shivering or chills are observed in 25 to 50 percent of women [2,3]. Shivering usually starts 1 to 30 minutes postdelivery and lasts for 2 to 60 minutes. The cause is not known; it may be a response to a fall in body temperature following labor, fetal-maternal bleeding, micro-amniotic emboli, placental separation, anesthesia, bacteremia, or administration of certain drugs (eg, misoprostol).

Treatment — Treatment is supportive with warm blankets and/or warm air. Anesthesia-related shivering can be treated pharmacologically. (See "Adverse effects of neuraxial analgesia and anesthesia for obstetrics", section on 'Shivering'.)

Uterine involution

Signs and symptoms — Immediately after delivery of the placenta, the uterus begins to return to its nonpregnant size and condition, a process termed uterine involution. Contraction of the interlacing myometrial muscle bundles constricts the intramyometrial vessels and impedes blood flow, which is the major mechanism preventing hemorrhage at the placental site. Myometrial retraction (brachystasis) is a unique characteristic of the uterine muscle that enables it to maintain its shortened length following successive contractions. In addition, large vessels at the placental site thrombose, which is a secondary hemostatic mechanism for preventing blood loss. Inadequate myometrial contraction will result in atony (ie, a soft, boggy uterus), which is the most common cause of early postpartum hemorrhage. (See "Overview of postpartum hemorrhage", section on 'Focal or diffuse atony'.)

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Literature review current through: Dec 2017. | This topic last updated: Jan 02, 2018.
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