THE DEVELOP OF PUERPERIUM

1. Lorena Alvarez Albor
Escuela de enfermería del Hospital Español
Licenciatura en enfermería
PUERPERIUM

2. Puerperium:
Puerperium is defined as the time from the
delivery of the placenta through the first few
weeks after the delivery.
This period usually is considered to be 6
weeks in duration.
By 6 weeks after delivery, most of the
changes of pregnancy, labor, and delivery
have resolved and the body has reverted to
the nonpregnant state.

3. Stages of puerperium
◦ The inmediate puerperium: the first 24 hours after
parturition.
◦ The early puerperium: wich extends until the first week post
partum.
◦ The remote puerperium: includes the period of time
required for involution of the genital organs through the 6
weeks postpartum.

4. Uterus
The pregnant term uterus (not
including baby, placenta, fluids, etc)
weighs approximately 1000 grams. The
uterus recedes to a nonpregnant state,
with a weight of 50-100 grams, during
the 6 weeks after delivery.
Most of the reduction in size and
weight occurs in the first 2 weeks, at
which time the uterus has decreased
enough in size to be located in the true
pelvis.

5. Cervix
◦ The cervix also begins to rapidly
change back to a nonpregnant
state, but it never returns to the
nulliparous state. By the end of
the first week, the external os is
closed to the extent that a
finger could not be easily
introduced.

6. Vagina
The vagina, which was distended
to accommodate the baby,
diminishes in size to a
nonpregnant state, but it does
not completely return to its
prepregnant size. There is
resolution of the increased
vascularity and edema by 3
weeks.

7. Perineum
The perineum has been stretched
and traumatized, and sometimes
torn or cut, during the process of
labor and delivery. The swollen
and engorged vulva rapidly
resolves, and swelling and
engorgement are completely
gone within 1-2 weeks.

8. Abdominal wall
The abdominal wall remains soft
and poorly toned for many
weeks. The return to a
prepregnant state depends
greatly on exercise.

9. Ovaries
◦ The resumption of normal function by the
ovaries is highly variable. It is greatly
influenced by the mother decision whether
to breastfeed the infant.
◦ The woman who decides to breastfeed has
a longer period of amenorrhea and
anovulation than does the mother who
chooses to bottle-feed the infant.
◦ The non-breastfeeding mother may
ovulate as early as 27 days after the
delivery. Most women have had a
menstrual period by 12 weeks, with a mean
time to first menses being 7-9 weeks.

10. Breasts
◦ The changes to the breasts that
prepare the body for breastfeeding
occur throughout the pregnancy. By 16
weeks gestation, lactation can occur.
◦ Lactogenesis is triggered initially by the
delivery of the placenta, which results
in falling levels of estrogen and
progesterone, with the continued
presence of prolactin. If the mother is
not breastfeeding, the prolactin levels
decrease and return to normal within
2-3 weeks.

11. THANKS