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The period of confinement during birth and 6 weeks after. During this time, the reproductive tract returns anatomically to a normal nonpregnant state. Uterine Changes INVOLUTION OF THE UTERINE CORPUS Immediately after delivery, the fundus of the contracted uterus is slightly below the umbilicus. After the first 2 days postpartum, the uterus begins to shrink in size. | HIGH Postpartum THE PUERPERIUM OF THE NORMAL LABOR AND DELIVERY The period of confinement during birth and 6 weeks after. During this time the reproductive tract returns anatomically to a normal nonpregnant state. Uterine Changes Involution of the Uterine Corpus Immediately after delivery the fundus of the contracted uterus is slightly below the umbilicus. After the first 2 days postpartum the uterus begins to shrink in size. Within 2 weeks the uterus has descended into the cavity of the true pelvis. Endometrial Changes Sloughing and Regeneration Within 2 to 3 days postpartum the remaining decidua become differentiated into two layers 1. Superficial layer becomes necrotic sloughs off as vaginal discharge lochia 2. Basal layer adjacent to the myometrium becomes new endometrium Placental Site Involution Within hours after delivery the placental site consists of many thrombosed vessels. Immediately postpartum the placental site is the size of the palm of the hand. The site rapidly decreases in size and by 2 weeks postpartum 3 to 4 cm in diameter. Changes in Uterine Vessels Blood vessels are obliterated by hyaline changes and replaced by new smaller vessels. Afterpains due to uterine contraction are common and may require analgesia. They typically decrease in intensity by the third postpartum day. Lochia is decidual tissue that contains erythrocytes epithelial cells and bacteria. See Table 7-1. 83 HIGH-YIELD FACTS TABLE 7-1. Lochia Type Description When Observed Lochia rubra Red due to blood in the lochia Days 1-3 When involution is defective late puerperal hemorrhage may occur. Lochia serosa More pale in color Days 4-10 Lochia alba White to yellow-white due to leukocytes and Day 11 reduced fluid content Changes in the Cervix and Lower Uterine Segment At the completion of involution the cervix does not resume its pregravid appearance The external os of the cervix contracts slowly and has narrowed by the end of the first week. The thinned-out lower uterine segment that
