Puerperium: The 6 week period after delivery of placenta in which the reproductive tract returns to its pre-delivery state

Physiological changes

Uterine involution

• involutes from 1kg to 100g
• After 3rd stage of labour, uterus is the size of 20 week pregnant - reduces by 1 finger breadth each day
• Becomes a pelvic organ within 10 days

Reproductive tract

• Cervix: Firm by day 3
  • internal os closes at day 3
  • external os closes at week 3
• Vaginal wall: initially swollen and blue, regains tone but may be fragile for 1-2 weeks
• Perineal oedema: may persist for a few days but should resolve

Changes in Lochia

Lochia = vaginal discharge (includes blood, mucous, tissue etc)

• Day 1-3: red (blood and remnant of trophoblastic tissue) - bleeding after 6 weeks is a red flag
• Day 10: Yellow
• Becomes white until 6 weeks
  • An ultrasound is indicated if lochia persists beyond 6 weeks

Cardiovascular system