Physiology of the Puerperium and Lactation

Vocabulary terms and historical definitions regarding the physiological changes of the puerperium, management strategies, and the mechanics of lactation.

Puerperium

The period from delivery of the placenta until 6 weeks after delivery, during which physiological changes of pregnancy regress to the pre-pregnancy state.

Uterus weight transition

The reduction of the uterus from a weight of $1000\,g$ at term to its pre-pregnant weight of $50 \text{ -- } 100\,g$.

Lochia rubra

The initial stage of vaginal discharge occurring $0 \text{ -- } 3$ days post-delivery.

Lochia serosa

The stage of vaginal discharge identified in the transcript as occurring between $22 \text{ -- } 27$ days post-delivery.

Endometrium restoration timeline

Regeneration of endometrial glands begins by the seventh day and the tissue is fully restored by day 16.

Mean time to ovulation (lactating)

6 months, as lactation induces amenorrhea; the risk of ovulation in the first 6 months with exclusive breastfeeding is between $1\%$ and $5\%Units$.

Mean time to ovulation (non-lactating)

Occurs as early as 27 days post-delivery, with a mean of $70 \text{ -- } 75$ days.

Prolactin (non-lactating)

Levels fall to the normal range by the third week after birth.

Heart rate (puerperium)

Falls by $14\%$ by 48 hours and becomes normal by 2 weeks.

Cardiac output (puerperium)

Initially remains elevated, falls over 48 hours, and returns to pre-pregnant levels by 24 weeks.

Fibrinogen normalization

Rises in the first week and then normalizes by 6 weeks post-delivery.

Hydroureter and pelvic dilatation

Urinary tract changes that are almost eliminated within $2 \text{ -- } 3$ weeks and completely return to normal by $6 \text{ -- } 8$ weeks after birth.

Thyroid volume (puerperium)

Returns to normal over a 12‐week period after an approximate $30\%$ increase during pregnancy.

Immediate weight loss

A loss of $4.5 \text{ -- } 6\,kg$ following birth due to the baby, placenta, amniotic fluid, and blood loss.

Hair loss (puerperium)

Temporarily occurs as growth slows and more hair is lost than regrown; typically takes 6 months to a year to return to normal.

Puerperal psychological disorders

A category of complications including puerperal blues, puerperal psychosis, and puerperal depression.

Lactogenesis

The process involving two independent mechanisms: milk production and the milk ejection reflex.

Cabergoline

The drug of choice for suppression of lactation, given as $1\,mg$ stat to prevent lactation or $0.25\,mg$ twice daily for 2 days for established lactation.

Bromocriptine

A medication contraindicated for suppressing lactation due to the associated risk of heart attack and stroke.