Postpartum physiology | Reproductive system physiology | NCLEX-RN | Khan Academy
Physiology of the postpartum period: involution of organs and systems
The physiology of the postpartum period is such that within a month and a half after the birth of a baby, the organs and systems of a woman, which have undergone changes during gestation and childbirth, restore their function. Their involution occurs and these changes most fully affect the genitals, especially the uterus. This does not apply to the mammary glands, as for them, on the contrary, the flowering time associated with lactation begins.
Early postpartum . Its duration is 2-4 hours after the completion of the delivery process. The medical staff is actively watching the woman during this time. The midwife monitors the discharge from the genital slit, uterine contractions, measures blood pressure and assesses the general condition of the woman.
If tissue cells were damaged during childbirth - tears, cracks, or the perineum was dissected with a scalpel, then suturing is performed under local anesthesia.
In the future, the seams are regularly treated with a solution of brilliant green and removed on the fifth day. The woman is forbidden to sit down for another 14 days, and all this time it is recommended to feed the baby lying down.
Late postpartum . Its duration varies from 1.5 months to 2 months, during which all organs and systems of the parturient woman undergo a complete evolution.
Moments after the release of the placenta, the muscles of the uterus begin to contract strongly, which leads to a decrease in its size. During this period, the cervix looks like a thin-walled sac, in which the external pharynx gapes wide, and the torn edges hang down into the vagina.
Immediately after the birth of the newborn, the fundus of the uterus is palpated 2–3 cm below the navel line. But after just a couple of hours, it begins to rise and by the end of the second or third day the body of this organ bends anteriorly.
From the inside, the uterus looks like an extensive wound surface. The musculature contracts, narrowing the vascular lumens and helping to stop bleeding. One of the clinical signs of the pathology of the postpartum period is a slow process of the reverse formation of the uterus.
During the subinvolution of thisRgan may develop severe purulent-septic inflammation. And due to a decrease in contractile activity, the infectious process spreads further and further.
To prevent such complications, women are regularly examined on the chair and, if necessary, cleaned.
The inner shell of the organ begins to heal as a result of the disintegration and rejection of elements of the decidua layer, which looks like a sponge. They come out with blood clots and blood clots. Such tearing layers of tissue form lochia.
Stages of bleeding in the long-term postpartum period:
- in the first couple of days of lochia have a bloody structure. The composition is dominated by erythrocytes;
- on the third or fourth day of the postpartum period, their character becomes blood-serous. There is a predominance of leukocytes;
- after 7 days, the uterine discharge is enriched with mucus, decidual cells and squamous epithelial cells. The number of erythrocytes is minimal;
- after 5-6 weeks, the secretion of lochia stops.
Reparation of the cervix and other genital organs
The internal pharynx is the first to contract and restore, and the cervical canal itself completes its formation by the 10th day. Closure of the external os of the cervix occurs by the end of 21 days, as a result of which it takes on the appearance of a gap.
It takes about 6 weeks to epithelize the vaginal portion of the cervix of this organ.
The normal postpartum period involves the acquisition of the previous tone of the muscular walls of the vagina after 3 weeks.
The muscles of the anterior abdominal wall involution within 1–1.5 months. In the ovaries, the progress of regression of the corpus luteum ends and follicles begin to mature. Due to the release of a large volume of prolactin along with breast milk, menstrual flow is absent for the first few months or during the entire period while lactation is observed.
Non-lactating women begin to menstruate 1.5–2 months after delivery. The endometrium undergoes polyferation processes. In the future, ovulation is also restored, which depends on breastfeeding, that is, the number of feedings per day and the time of introduction of complementary foods. Hyperemia and edema of the tissues of the fallopian tubes gradually disappear. By the 10th day, the tubes together with the uterus take their usual position in the horizontal plane.
Prolactin provides blood flow to the mammary glands. Milk secretion is regulated by the nervous and endocrine systems. Thyroid and adrenal hormones have a stimulating effect, and the more often the baby is applied to the breast, the more powerful the reflex is realized.
Oxytocin released during sucking contributes to the contraction of smooth muscles of the myometrium. Reduced blood loss, involution of the uterus occurs normallyohm tempo.
With the first drops of colostrum secreted by the mammary glands, the child receives immunoglobulins, including antibodies to infectious agents, which he shares with his mother.
Lactoflora entering the child's intestines from the halo zone contributes to the formation of natural microflora. It is very important to provide your baby with colostrum, which will prepare his digestive tract for the assimilation of mature milk. It contains hormones, especially corticosteroids, enzymes, etc. The mature milk itself is designed to meet all the needs of a newborn.
Involution of other organs and systems
In most parturient women, within 1.5 months after the birth of the child, the ureters and renal pelvis are dilated, which is a prerequisite for the development of urinary tract infections.
Normalization of renal blood flow and return to the initial level of reabsorption in the tubules is carried out 1.5 months after delivery. Reduced gastrointestinal motility is restored in the coming weeks, at the same time protein synthesis in the liver normalizes.
The lungs change their vital capacity quickly compared to pregnancy.
The residual volume increases, the oxygen demand decreases. By the end of 6-7 weeks, the metabolism, electrolyte and fluid balance are restored. If there are no complications of the late postpartum period, the woman in labor feels well.
She has a normal body temperature and the same can be said about her pulse rate and blood pressure. The quality and quantity of lochia is normal, lactation is sufficient. There may be retention of urination and stool, engorgement and swelling of the mammary glands, the appearance of cracks and abrasions of the nipples. The prevention of infectious complications is the hygiene of the late postpartum period.
Disinfection of beds, diapers and other equipment is required.
Chambers must be washed and ventilated, treated with UV radiation. A woman in labor must adhere to the rules of personal hygiene: go to the shower every day, change bras and shirts. It is recommended to change bed linen every three days. It is necessary to wash with soap at least 4-5 times a day and regularly change the gaskets, using home-made cloth rather than store-bought products.
Before each feeding, the mammary glands should be treated with warm water and soap, covered with a headscarf, and a diaper should be placed on your knees if you plan to feed a newborn in a sitting position.
If the mother and child are in the ward together, and feeding is carried out on every request, this contributes to the rapid adaptation of both in the period after childbirth and early discharge from the hospital.
In the absence of indications for further stay within the walls of the maternity hospital, a woman in labor with a child is discharged for 5-6 days.
It is advisable to visit a gin doctoran ecologist 7 days after discharge, maximum - 1.5 months after delivery. The doctor will assess the state of the internal genital organs, recommendations for contraception and will be able to say whether the body is ready for intimacy. Usually, I recommend starting sex life after the complete cessation of the secretion of lochia. If hemorrhoids occur, the doctor will prescribe special suppositories.
You also need to eat a healthy and balanced diet to prevent constipation.
It is recommended to plan your next pregnancy no earlier than 24 months after the end of lactation.