Obstetrics and Gynecology - A. M. Hromova 2000

Clinical Course and Management of the Postpartum Period
Course of the Postpartum Period
General condition of the postpartum woman and changes in internal organs

During a normal postpartum course, the overall condition of the new mother is satisfactory. Immediately after delivery, she typically feels tired and wants to Sleep. If there is soft tissue trauma in the birth canal, the mother may experience intermittent, subsiding pain in the external genitalia and Perineum (at the sites of tears and abrasions) During the first few days.

Body Temperature remains normal. On the first day, a minor, one-time temperature spike (37,5°-37,7°С) may occur due to nervous and physical exhaustion. The excitability of the Cerebral Cortex, subcortical centers, and Spinal Cord gradually normalizes. Placental Hormones are eliminated from the body (the reaction to human chorionic gonadotropin becomes negative by the end of the first week), and Pregnancy-induced Changes in the Pituitary Gland disappear.

METABOLISM increases during the first weeks of the postpartum period, but subsequently returns to normal. Basal metabolism reaches its usual level by the 3rd to 4th week after delivery.

The Heart assumes its usual position (more vertical than during pregnancy), which is attributed to the descent of the Diaphragm. The volume of circulating Blood decreases, thereby easing the workload of the heart during the postpartum period. Blood pressure is normal, and the pulse is regular with satisfactory volume (70–75 bpm).

Due to the descent of the diaphragm, lung capacity increases, while respiratory volume and rate return to those of non-pregnant women.

Changes in the hematopoietic system gradually disappear during the postpartum period. A slight increase in leukocyte count is often observed in the first days following delivery. These changes soon resolve, and the blood composition normalizes.

The Kidneys function normally. Glomerular Filtration rate and tubular reabsorption return to the values typical of non-pregnant women. Diuresis is somewhat increased. Urinary retention is common in many women during the first days after delivery. The bladder becomes overdistended, and its fundus rises above the Pubic Symphysis. Women may not feel the urge to urinate, or urination may be difficult. This is caused by decreased Muscle tone, edema, and microhemorrhages in the neck of the bladder resulting from its compression between the fetal HEAD and the pelvic wall. Such significant pressure can also damage nerve elements, further impairing urination. A contributing factor is the relaxation of the abdominal wall Muscles, which fail to support the overfilled bladder.

The digestive Organs function normally. The appetite is good and may even be increased in nursing mothers. Constipation is frequently observed due to intestinal atony. Factors contributing to decreased intestinal tone include relaxation of the abdominal wall, limited mobility during bed rest, and poor Nutrition. Dilation of the hemorrhoidal Veins is common, and some women develop hemorrhoids. This venous dilation eventually resolves, and hemorrhoids cause minimal discomfort unless they become incarcerated.