Physiological Changes in Postpartum Period

Physiological Changes in Postpartum Period (2)
Physiological Changes in Postpartum Period

Normally, there are several physiological changes in some systems toward the mother after delivery. They are:

The Postpartum Period

Reproductive System Change

  1. Uterus
  2. Wrinkling of the uterus (involution)

Involution is a process of returning the uterus to the normal conditions (before pregnancy). With this uterine involution, the outer layer of the decidua surrounding the placental site will become neurotic (withered or dead)

Uterine revolution occurs through three concurrent processes, including:

  • Autolysis. It is a self-destruction process that occurs in uterine muscles
  • Tissue atrophy. Tissues that proliferate in the presence of large amounts of estrogen, experience atrophy as a reaction to the cessation of estrogen production. Further, it accompanies the release of the placenta.
  • Effects of oxytocin (contraction). The intensity of uterine contractions increases as soon as the baby is born. This is thought to occur in response to a very large decrease in intrauterine volume. Giving breast milk as soon as the baby is born will stimulate the release of oxytocin due to baby suction in the breast.
  1. Lokhea

Lokhea is the secretion of uterine fluid during the puerperium (postpartum period). Lokhea contains blood and the remaining necrotic decidual tissue from inside the uterus. Odorous lokhea indicates an infection. Lokhea has a change in color and volume due to the process of uterine involution.

Lokhea is divided into 3 types based on color and time of discharge:

  • Lokhea rubra

Lokhea’s characteristic is red. Release out on the first day until the fourth day of the postpartum period. The liquid contains fresh blood, residual tissue – the rest of the placenta, the uterine wall, baby fat, lanugo (baby hair), and meconium.

  • Lokhea sanguinolenta

This lokhea characteristic is brownish, red, and slimy, and lasts from day 4 to day 7 postpartum

  • Lokhea serosa

Lokhea is a brownish yellow since it contains serum, leukocytes, and tears or lacerations of the placenta. Usually, this lokhea is released on day 7 to day 14 after delivery.

  • Lokhea alba

Lokhea is white and contains leukocytes, decidual cells, epithelial cells, cervical mucous membranes, and dead tissue fibers. Lokhea alba can last for 2 to 6 weeks postpartum

Lokhea that persists at the beginning of the postpartum period shows signs of secondary bleeding that may be caused by the loss of placental residue or membranes. Continuing alba or serous Lokhea can indicate endometritis, especially if accompanied by pain in the abdomen and fever. When an infection occurs called “purulenta lockhea”. Not smooth expenditures are called “static lockhea”.

  1. Changes in the cervix

The usual change is the shape of the cervix that is slightly gaping like a funnel, immediately after the baby is born. This form is caused by the uterine corpus. It can cause contractions, it is as if between the corpus and cervix in the form of a ring.

This cervix characteristic is blackish red since it is filled with blood vessels. The consistency is soft, sometimes there are lacerations or small injuries. Due to the small tears that occur during dilation, the cervix will not be able to return to the way such as becoming pregnant. The cervical estuary dilated to 10 cm during labor will close slowly and gradually. After the baby is born, the hand can enter the uterine cavity. After 2 hours, it can only enter 2 to 3 fingers. In the 6th-week postpartum, the cervix has gradually closed again.

  1. Vulva and Vagina

Vulva and vagina are suppressed, and very large stretches during labor. In the first few days after the process, these two organs remain in a loose state. After 3 weeks, the vulva and vagina return to normal and rugae in the vagina will gradually reappear, while the labia become more prominent.

During the puerperium, there is usually a wound in the birth canal. Generally, the wound in the vagina is not as extensive and will heal by itself, unless there is an infection. Infection may cause cellulitis that can spread until sepsis occurs.

  1. Perineum

After giving birth, the perineum becomes loose because it was previously stretched by the pressure of the baby moving forward. At post-natal day 5, the perineal muscle tone has returned, although it is slightly loose from the condition before becoming pregnant.

Changes in the Digestive System

Usually, the mother will experience constipation after labor. Scientifically, the digestive organs experience pressure that causes the intestines to be an empty and excessive discharge of fluid (during labor).

Also, it causes a lack of fluid and food intake and lack of physical activities.

To return to normal bowel movements, it can be overcome by a high-fiber diet, increased fluid intake, and initial ambulation. If these don’t work, medication can be given in 2 to 3 days. Besides constipation, the mother will also experience anorexia. It occurs because a decrease in the secretion of the digestive gland and affect changing in secretions, and decrease in caloric needs which causes a lack of appetite.

Changes in Urination System

After labor, it is usually difficult for the mother to urinate in the first 24 hours. Possible causes of these cases are sphincter spasm and edema of the bladder neck due to compression (pressure) between the head of the fetus and the pubic bone during labor. Large amounts of urine will be produced in 12 to 36 hours postpartum. The level of the hormone estrogen which is holding water will decrease. This condition is called “diuresis”. A dilated ureter will return to normal within 6 weeks.

The bladder during the puerperium becomes less sensitive and the capacity increases. As a result,  any urination remains behind the residual urine (normal is less than 15 cc). In this case, the remaining urine and trauma to the bladder during labor can cause infection.

Musculoskeletal System Changes

The uterine muscles that contract after parturition will make a blood vessel between the uterine muscles pinched. This process will stop bleeding after the placenta is born. Ligaments, pelvic diaphragms, and fascia slowly stretch during labor will shrink and recover. So often the uterus falls backward and becomes retroflexed since the rotundum ligament becomes loosened. It is not uncommon for women to complain of “wasting down” after childbirth due to ligaments, fascia, and supporting tissues of the genital tool to become saggy. Normally, it will be stable after 6 to 8 weeks postpartum.

To restore the supporting tissues of the genital, as well as the muscles of the abdominal wall and pelvic floor, it is recommended to do certain exercises.

Changes in the Endocrine System

  1. Placental hormones

Placental hormones decrease rapidly after labor. Human Chorionic Gonadotropin (HCG) decreases rapidly to 10% in 3 hours until the 7th-day postpartum.

  1. Pituitary hormone

Blood prolactin will increase rapidly. In women who do not breastfeed, prolactin decreases within 2 weeks. FSH (follicle stimulating hormone) will increase on week 2 and LH (Luteinizing Hormone) remains low until ovulation occurs.

  1. Hypothalamic-pituitary ovary

The length of a woman’s menstruation is also influenced by breastfeeding factors. Often this first menstruation is anovulatory because of low levels of estrogen and progesterone.

  1. Estrogen levels

After delivery, there is a decrease in estrogen levels so that prolactin activity which is also being increased can affect the mammary gland in producing milk.

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