introduction Estrogen and progesterone levels decrease markedly after expulsion of the placenta, reaching their lowest levels 1 week into the postpartum period. The estrogen levels in non lactating women begin to increase by 2 weeks after birth, and higher by postpartum day 17. If trauma to the urethra and bladder occur during the birth process, the bladder wall becomes edematous, often with small areas of hemorrhage. Birth-induced trauma increased bladder capacity and the effects of anesthesia combine to cause a decrease in the urge to void.

1. GENERAL PHYSIOLOGICAL
CHANGES DURING PUERPERIUM

2. General Physiological changes
Endocrine system
Placental hormones
• Expulsion of the placenta results in dramatic
decreases of hormones produced by placenta.
• The placental enzyme causes the diabetogenic
effects of pregnancy to be reversed, resulting in
significantly lower blood sugar levels in the
immediate postpartum period

4. • Estrogen and progesterone levels decrease
markedly after expulsion of the placenta,
reaching their lowest levels 1 week into the
postpartum period.
• The estrogen levels in non lactating women
begin to increase by 2 weeks after birth, and
higher by postpartum day 17.

8. Cont...
• Non-lactating mother should use contraceptive
measures after 3 weeks and the lactating
mothers after 3 months of delivery.

10. Urinary system
• If trauma to the urethra and bladder occur
during the birth process, the bladder wall
becomes edematous, often with small areas
of hemorrhage.
• Birth-induced trauma increased bladder
capacity and the effects of anesthesia
combine to cause a decrease in the urge to
void.

11. Conti..
• In addition to pelvic soreness from the forces
of labor, vaginal laceration, or an episiotomy
which they reduce the voiding reflex.
• Bladder tone is usually restored 5-7days after
childbirth .

12. Gastrointestinal tract :
• Increased thirst in early puerperium is due to
loss of fluid during labor, in lochia and
perspiration.
• Constipation is a common problem for the
following reasons: delayed gastrointestinal
motility, mild ileus following delivery, together
with perineal discomfort.
• Some women may have the problem of anal
incontinence.

14. Vital signs
• Temperature, may increase to 38c during first 24
hours as a result of dehydration.after 24 hours
the woman should be afebrile.
• Respiratory function returns to nonpregnant state
by 6-8 weeks after birth.
• A small transient increase in both systolic and
diastolic blood pressure lasting about 4 days after
birth

15. • Pulse, it returns to nonpregnant rate by 8-10
weeks after childbirth.

16. Fluid Loss
• There is a net fluid loss of at least 2 liters
during the 1st week and an additional 1.5
liters during the next 5 weeks.
• The amount of loss depends on the amount
retained during pregnancy, dehydration
during labor and blood loss during delivery
• The loss of salt and water are larger in women
with preeclampsia and eclampsia

17. Blood Values
• Immediately following delivery, there is slight
decrease of blood volume due to blood loss
and dehydration. Blood volume returns to
nonpregnant level by the 2nd week.
• Hematocrit and hemoglobin, they increased in
level by the seventh day afterbirth.
• RBC volume values returns to normal by 8
weeks postpartum.

18. Neurologic function
• Discomfort and fatigue are common.
• After pain and discomfort from the delivery,
laceration, episiotomy and muscle ache are
common.