Puerperium

Puerperium, also called the postpartum period, is the interval after childbirth during which the maternal reproductive organs return to their pre-pregnant state. It spans approximately six weeks (about 42 days), though the pace varies.

Physiology: The uterus undergoes involution through contraction and remodeling at the placental site, aided by oxytocin. The fundus typically decreases in height from the abdominal level (often around the umbilicus) on day 1 to the pelvic level by about day 7 and should be non-palpable by 2–3 weeks. Lochia is initially rubra (red) for several days, then serosa (pink-brown) around day 3–10, and finally alba (yellow-white) up to 4–6 weeks. Hormonal changes, including a fall in estrogen and progesterone and a rise in prolactin, initiate lactation, with colostrum in the first days and mature milk within a few days.

Anatomy: The cervix gradually closes; the vagina and perineum recover from delivery-related injuries. Blood volume and hematologic indices normalize over several weeks.

Care and complications: Most women recover without major problems. Common issues include postpartum hemorrhage, endometritis, wound or urinary tract infections, thromboembolism, and anemia. Routine postpartum care includes monitoring fundal height and lochia, vital signs, pain management, perineal care, breastfeeding support, and counseling on contraception and mental health. The puerperium ends when reproductive organs return to their nonpregnant condition, typically around six weeks postpartum, at which time a postpartum check is usually scheduled.