TAILIEUCHUNG - THE PUERPERIUM

The puerperium, arbitrarily designated as the 6 weeks following childbirth, is the period of adjustment after pregnancy, when lactation usually occurs and the mother’s body returns to the nonpregnant state. | The puerperium arbitrarily designated as the 6 weeks following childbirth is the period of adjustment after pregnancy when lactation usually occurs and the mother s body returns to the nonpregnant state. PHYSIOLOGIC EVENTS OF THE PUERPERIUM CARDIOVASCULAR AND BLOOD Cardiac output peaks immediately after delivery at which time it is 80 above the prelabor value in most normal patients. This is accompanied by elevated venous pressure and increased stroke volume. Rapid changes toward normal nonpregnant values occur thereafter particularly during the first week with a gradual decline during the next 3-4 weeks to prepregnancy values. The HCT rises 5 above the predelivery value in patients having an uncomplicated vaginal delivery. This occurs despite the average blood loss of 500 mL as a result of renal elimination of both intravascular and extravascular fluids that have accumulated during pregnancy. Indeed blood volume decreases by 20 by the 5th postpartum day. Following cesarean delivery there is an 5 drop in hematocrit by the 5th day postpartum as a result of the average blood loss of 1000 mL. The average puerperal fluid loss is 4 kg 9 pounds . Gradual weight loss follows. Most women with normal blood values during pregnancy and an average blood loss at delivery show a relative polycythemia during the 2nd week postpartum. Iron supplementation is not necessary for normal nonlactating postpartum women if the HCT or hemoglobin concentration 5 days after delivery is about the same as the normal predelivery value. 275 Copyright 2001 The McGraw-Hill Companies. Click Here for Terms ofUse. BENSON PERNOLL S 276 HANDBOOK OF OBSTETRICS AND GYNECOLOGY The normal slightly hypercoagulable state found during pregnancy is further enhanced during the puerperium thus predisposing to thrombosis. By 3-5 days after delivery platelet adhesiveness will have increased considerably with lesser increases in platelet count and factor V and VIII values. Despite fibrinolytic activity also .

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