What Happens During the Puerperium Period?
Puerperium meaning is the time from the delivery of the placenta appearing in the first week after the delivery. This period usually goes for 6 weeks in duration. Post 6 weeks of the delivery, changes due to pregnancy, labor, and delivery are sorted out. Puerperium is also the postpartum period which is also called the "fourth trimester" is referred to the time the woman goes through after the delivery. This is the time when maternal physiologic changes related to pregnancy return to the previous version. In addition to the physiologic changes and medical attention, health care providers will be aware of the psychological needs. There are certain restrictions the mother goes through in terms of foods and restricting certain activities.
What is Puerperium or the Postpartum Period?
The normal Puerperium definition is quite similar to the above one. There is a common consensus that the postpartum period begins only after the pregnancy period is over. It is often considered six to eight weeks after delivery. However, all systems of the organ do not return to the base in these weeks. According to American College of Obstetricians and Gynecologists, postpartum care extends up to 12 weeks post-delivery.
Puerperal Sepsis
There are different signs of Puerperium, and one such is puerperal sepsis, an infective condition in the mother following childbirth. This is the third most common problem faced by mothers who delivered a kid. According to WHO, there are more than 15% of deaths annually due to this postpartum delivery issue. Many who survive to end up facing long-term health problems like chronic pelvic inflammatory disease (PID) and others. Many doctors use puerperal infection rather than puerperal sepsis. There are three types of postpartum infection a woman can face-
Endometritis: an infection of the uterine lining
Myometritis: an infection of the uterine muscle
Parametritis: an infection of the areas around the uterus
Symptoms of Puerperal Infection:
Different mothers will face different symptoms. This includes-
Fever
Pain in the lower abdomen
Foul smell in vaginal discharge
Chills
Feeling nausea
How this Infection Takes Place?
Although, due to the introduction of antiseptics the cases of puerperal infection have come down, the skin flora such as Streptococcus or Staphylococcus and other bacteria can end up infecting. The infection usually starts in the uterus after the delivery. It happens when the amniotic sac is infected.
What are the Risk Factors?
The risk of developing an infection is usually different among women. Some may face infection and some may not. The chance of contracting infection is-
3 percent during vaginal delivery
15 percent in scheduled cesarean deliveries
20 percent of non-scheduled cesarean deliveries performed after labor begins
Other than these, there are other factors that can make women face the infection. These are as follows.
Obesity
Bacterial Vaginosis
Multiple Vagincal exams
Monitoring of fetus internally
Causes of Puerperal Infection:
As mentioned above, there are different causes of this infection. This infection is bacterial on the genital tract occurring after the birth of the baby. Some of the common bacterial problems you will face are- streptococci, staphylococci, Escherichia coli (E.coli), clostridium tetani, clostridium welchii, chlamydia, and gonococci.
Some of the Infections Postpartum Delivery Can Have are-
Nosocomial Infections: These bacteria can come from the hospital environment from the patient's own flora.
Endogenous Bacteria: You will find these bacteria traces present in the vagina and rectum which doesn't cause any disease.
Exogenous Bacteria: These are the bacteria found in the vaginal area. This can happen outside due to touching by unclean hands, STD, or any unhygienic substance inserted into the vagina.
Diagnosis of Puerperium Infection
There are different diagnoses of this life-threatening infection if there is no clinical inclusion. Some of the diagnosis are as follows.
Vomiting
Diarrhea
Abdominal pain and tenderness
Tachycardia
Rash
FAQs on Puerperium: Definition, Stages & Care
1. What is the puerperium period in human biology?
The puerperium is the period following childbirth, typically lasting about six weeks, during which the mother's body, particularly the reproductive organs, returns to its pre-pregnant state. It is a time of significant physiological and psychological adjustment for the mother.
2. Are puerperium and postpartum the same thing?
Yes, the terms puerperium and postpartum period are used interchangeably. Both refer to the same timeframe after delivery—often called the "fourth trimester"—when the mother's body undergoes the process of returning to its non-pregnant condition.
3. What are the main stages of the puerperium?
The puerperium is generally divided into three stages to describe the recovery timeline:
- Immediate Puerperium: The first 24 hours after delivery, a critical time for monitoring potential complications like haemorrhage.
- Early Puerperium: From 24 hours up to the end of the first week. This stage involves the beginning of major physiological changes like uterine involution and lactation.
- Remote Puerperium: From the second week up to the sixth week, during which the reproductive organs fully return to their pre-pregnant state and hormonal levels stabilise.
4. What major physiological changes occur in a mother’s body during puerperium?
During puerperium, the mother’s body undergoes several significant changes. The most prominent change is the involution of the uterus, where it shrinks back to its normal size. Other changes include the healing of the placental site, the discharge of lochia (post-delivery vaginal discharge), the establishment of lactation, and the gradual return of the menstrual cycle. Hormonal levels, especially of oestrogen and progesterone, also drop significantly.
5. Why is the involution of the uterus a critical process during puerperium?
The involution of the uterus is critical for two main reasons. First, the contraction of the uterine muscles helps to compress blood vessels at the former placental site, which is essential for preventing postpartum haemorrhage (excessive bleeding). Second, it marks the return of the reproductive system to its non-pregnant state, allowing the body to heal and prepare for future menstrual cycles and potential pregnancies.
6. How do hormonal levels change during puerperium to support recovery and lactation?
After the delivery of the placenta, levels of oestrogen and progesterone drop sharply. This sudden decrease triggers the pituitary gland to release prolactin, the key hormone for milk production. The act of breastfeeding stimulates the release of oxytocin, which not only causes milk ejection (the "let-down" reflex) but also promotes uterine contractions, aiding in involution and reducing bleeding.
7. What is lochia and how do its changes signify the healing process?
Lochia is the vaginal discharge that occurs for several weeks after childbirth, consisting of blood, mucus, and uterine tissue. Its changing appearance is an important indicator of the healing process inside the uterus:
- Lochia rubra: A reddish discharge lasting for the first 3-4 days.
- Lochia serosa: A pinkish or brownish discharge that follows, lasting until about the 10th day.
- Lochia alba: A yellowish-white discharge that can last for another one to two weeks.
This progression shows that the uterine lining is healing properly.
8. What are some potential complications that can arise during the puerperium period?
While most recoveries are normal, several complications can occur during the puerperium. These include:
- Puerperal sepsis: An infection of the genital tract, often caused by poor hygiene.
- Postpartum haemorrhage (PPH): Excessive bleeding that can occur immediately or weeks after delivery.
- Thrombophlebitis: The formation of blood clots in the veins, particularly in the legs or pelvis.
- Postpartum depression: A mood disorder involving persistent feelings of sadness and loss of interest.
9. What is the "5-5-5 rule" often recommended for postpartum rest and recovery?
The "5-5-5 rule" is a simple guideline to encourage adequate rest during the early puerperium. It suggests a 15-day recovery plan structured as: five days in the bed (focusing only on self-care and bonding with the baby), followed by five days on the bed (light activities like reading while resting), and finally five days around the bed (gentle movement within the room). It emphasizes the importance of rest for physical healing and mental well-being.
