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the period that begins after the expulsion of the placenta and continues for six to eight weeks. During puerperium almost all the systems and organs that underwent changes during pregnancy and childbirth return to their normal state. The uterus, whose fundus is 15 cm above the pubis after childbirth, contracts and after ten to 12 days disappears behind the pubis. Its weight drops from 1,000 g to 50–60 g by the end of the eighth week. The internal opening of the cervix closes by the tenth day after childbirth; the external opening closes by the end of the third week.
As the uterus contracts, its mucous membrane gradually covers the interior surface of the uterus; complete restoration of the epithelial covering occurs by the end of the third postnatal week. Before completion of this process, the interior surface of the uterus consists of an extensive wound surface, which produces a characteristic discharge known as lochia. The discharge, which is initially bloody, becomes light in color and bloodless by the tenth day. During puerperium, the tonus of the vagina is restored, and abrasions and lacerations of the external genitalia, vagina, and cervix heal. Gradually the overstretched ligaments of the uterus contract, and the fallopian tubes and the ovaries assume their usual state. Lactation begins on the third or fourth day after childbirth.
The general condition of the puerpera is good: the pulse is regular and seldom retarded (physiological bradycardia), and arterial pressure is normal. The body temperature is usually normal; a slight elevation immediately after childbirth may occur. During puerperium, aseptic and antiseptic measures must be strictly implemented, because the wound surface of the uterus, the abrasions and lacerations of the soft tissues of the birth canal, and cracks in the nipples may serve as loci of penetration for infectious agents, which can cause puerperal fever. The external genitalia and the breasts should be cleansed daily during the puerperium.
From the second day after normal childbirth, healthy women are prescribed a set of exercises that tone up the body and promote more rapid contraction of the uterus. If the puerperal period proceeds without complications and the physiological development of the newborn is normal, the mother and infant are discharged from the maternity hospital on the sixth or seventh postnatal day. Women with elevated temperatures, upper respiratory infections, skin abscesses, and other symptoms of infection are hospitalized in a special department of the maternity hospital.
REFERENCEKogan, A. A. ‘Normal’nyi poslerodovoi period.” In Mnogotomnoe rukovodstvo po akusherstvu i ginekologii, vol. 2, book 2. Moscow, 1963.
A. P. KIRIUSHCHENKOV