Puerperium

synonym

Peurperium

English: childbed

definition

As a puerperium (Peurperium) is the period after a birth in which the pregnancy (pregnancy) -oriented body returns to its original state.
In addition, milk production begins at the puerperium (Lactogenesis) and to the milk flow (lactation). The puerperium begins with the birth of the placenta and lasts about 6 to 8 weeks.

Length of bed

The period of the first six to eight weeks after birth designated. In addition, between a Early bed and one Late week bed can be differentiated, with the early morning bed denoting the first ten days after birth. From the eleventh day after the birth, the woman is in the late week bed. Depending on how quickly the birth wounds heal, the length of the puerperium can vary from woman to woman. However, it usually ends in six to eight weeks.

The real childbed

During the puerperium, patients who are referred to as those who have recently given birth experience some physiological, normal changes in their body and mind. During this time there may also be pain in the abdomen or abdominal pain in the puerperium. These are usually due to the change processes in the body, which are quite normal after delivery.

Regression of the uterus (uterine involution)

During the puerperium there is regression (involution) of the uterus (uterus) that occurred during the pregnancy (Pregnancy) increased in size and especially in muscle mass (hypertrophy of Myometrium).

At the end of pregnancy, the uterus weighs around 1000 g and reaches at its highest point (Fundus uteri) in the 40th week, two cross fingers below the costal arch.
Right after the birth comes the uterine fundus, usually referred to as fundus in practice, between the navel (Umbilicus) and symphysis. By contracting the muscles of the uterus (contractions of the myometrium) called Aftermath, the uterus regresses quite quickly. The fundus is usually at navel level 24 hours after a birth. Every day after the birth, the fundus comes down one cross finger.
After a week, the uterus has already shrunk by half. On the tenth day the fundus is at symphysis level and after about six weeks, i.e. at the end of the Puerperium, the uterus has returned to its original size. Your weight is then again around 80 g.

Regression of the cervix (portio uteri)

The cervix, which has dilated during childbirth, forms in the course of the Puerperium also back. On the 10th day after the birth, he is only a finger wide.

Onset of the weekly flow (Lochien)

Of the Weekly flow (Lochien) sets immediately after the birth (postpartum) and lasts about 4 - 6 weeks.
He provides one Wound healing the uterine lining (Endometrium), from which the placenta (placenta) and consists of a composition of blood, dead cells (Detritus), Lymph, inflammatory cells and inflammatory fluid (serous exudate).

Immediately after the birth and for the first week during the Puerperium is the weekly flow (Lochial secretion) bloody and appears as a red weekly river (Lochia rubra) designated. The wound flow can initially be around the 500 ml be. It becomes less and less during the puerperium. The proportion of blood in the weekly flow is also less, as the vessels of the uterine lining are pressed off by the after-labor (compressed) and the bleeding stops.

In the second week during the puerperium, the weekly flow looks brown (Lochia fusca), then turns yellow in the third week (Lochia flava) and is whitish or colorless from the fourth week (Lochia alba).

Note: weekly flow

The weekly flow during the Puerperium is always infectious because it is a perfect breeding ground for germs (e.g. Streptococci and Staphylococci) and the germs multiply well there.

Wound healing

The wound of the perineal incision made during delivery (Epistomy) or the perineal tear or vaginal tear that may have occurred heals in the Puerperium good.

Reformation of the pelvic floor muscles

The pelvic floor muscles that work during the pregnancy stretched, forms within six weeks of the birth back again.

Regression of edema of pregnancy

The fluid stored during pregnancy (Edema) regress within the puerperium. Depending on the water retention, the woman loses approx. 5 - 10 liters of fluid.

Change in hormonal balance

With the end of pregnancy and the beginning of the puerperium, the pregnancy and sex hormones in the body also change.

The Pregnancy hormones like the hormone produced by the child HCG (Humanes C.horion Gonadotropin) or that of the placenta (Placenta) formed hormone HPL (Humanes plazentares L.aktogen), which served to maintain pregnancy, are no longer formed and existing Hormones degraded, so that the level of these hormones in the blood is soon no longer detectable.
Also the concentration of the sex hormone progesterone in the blood, which was also formed in the second half of pregnancy by the placenta and served to maintain the pregnancy, decreases during the puerperium. The breakdown product of Progesterone Pregnadiol can be detected in the urine at most one week after delivery.

The decrease in the concentration of the sex hormone progesterone leads reflexively to increased production and release (secretion) of the hormone Prolactin. Prolactin is for that Milk production (Lactogenesis) responsible. As this hormone rises, milk production also begins. Also is the concentration of the hormone Oxytocin elevated. Oxytocin is for that Milk flow (Milk secretion) responsible.

Onset of menstrual bleeding (menstruation)

The Menstrual period generally starts in non-breastfeeding mothers after the end of the weekly flow, i.e. approx. 6 - 8 weeks after the birth.

At lactating Mothers start their first menstrual period between the 8th week and the 18th month after giving birth.

Change in psyche

With a lot of women who have recently given birth (about 70%) usually starts with the 2nd or 3rd day after the birth in the puerperium, a depressive mood or a short-term depression, referred to as materniy blues, post partum blues or "Howling Days", observed.
This bad mood lasts for a few hours or a few days and then disappears again.
The reason for this psychological change is, on the one hand, the rapid and severe drop in pregnancy hormones and the change in the body Puerperium and on the other hand the exertion of the birth itself, a possible sleep deprivation caused by the pregnancy as well as worries of the "new situation“And failing to live up to the role of mother.

Puerperal pain

During the puerperium, women can suffer from different pains. Pain in the puerperium is usually the direct result of childbirth. The entire pelvic and genital area of ​​the woman was stressed and can be painful as a result.

Breastfeeding pain is also not uncommon during the puerperium. Infections can also cause abdominal pain, headache, chest pain, fever, and other symptoms. Pain in the puerperium should therefore be used as a reason to see a doctor in order to rule out serious causes for the symptoms. If the pain is still caused by the birth, it will gradually subside over time and will be completely gone after a few days to weeks.

Read more on the topic: Pus from the nipple

Fever in the puerperium

If you have a fever in the puerperium, you should always have one infection be thought. In the puerperium, the Inflame uterusif the discharge (Weekly flow), which occurs naturally after birth, builds up in the uterus. By bacteria the lining may eventually become inflamed, causing fever and pain. The inflammation can also spread to the ovaries or even the peritoneum.

Also one Inflammation of the chest (Puerperal mastitis) by breastfeeding the child is possible and can lead to fever and a reddened and painful chest.

Read more about this under Inflammation of the chest

Of course, it can also be other infections that are not directly related to the birth. For example flu-like infections, Inflammation of the gastrointestinal or urogenital areas.

Fever during the puerperium should definitely be taken seriously and clarified by a doctor so that adequate therapy can be initiated in good time.

Read more about this under Postpartum fever

Fever with headache

Stepping in the puerperium Fever and headache different causes for the discomfort must be considered. Most often it is one Infection in the genital area, because the uterus through the still somewhat open cervix and the wound surface inside particularly susceptible to infections from rising germs is. Such an infection can always be accompanied by a fever and headache. Even an ordinary one a flu-like infection must be thought, as this is particularly common with fever and headache.

Also the Inflammation of the chest Breastfeeding the infant in the puerperium is common and often leads to Headache with fever and general fatigue.

At particularly severe headache with stiff neck and / or sensitivity to light should always be one Meningitis (meningitis) should be thought. If there is clinical evidence for this, a diagnostic puncture of the nerve water is carried out and this is examined for pathogens. There are fever and headache in the puerperium serious symptomsthat necessarily continue medically clarified and should be watched.

Fever while breastfeeding

Fever while breastfeeding may be associated with a breast infection (Puerperal mastitis) occur. When the baby is breastfeeding, tiny cracks in the nipple (Rhagades) through which germs can enter the chest and cause an infection there. This is usually expressed by a Redness, swelling, and warmth of the affected breast. Affected women often complain too Fever, headache, and swelling of the lymph nodes in the armpit area. If the breasts are normal, other infections for the occurrence of the fever must also be considered.

Fever and body aches

Fever and pain in the puerperium are always signs of a infection. Pain in the limbs is particularly common viral infections on, for example, in the case of flu-like infections or real flu (Influenza). But also other infections that typically occur during the puerperium, such as breast inflammation (mastitis) or the Inflammation of the lining of the womb (Endometritis) can with a General deterioration, fever and body aches accompanied. It is imperative that the women concerned be thoroughly examined and adequately treated so that complications can be avoided.

Abdominal pain in the puerperium

Abdominal pain in the puerperium are very often and often caused by the birth itself. During a vaginal delivery, the mother's muscles performed at their best and had to work very hard to get the child through the birth canal. In addition, the pelvis was stretched very much, the cervix was greatly expanded and the entire pelvis was very busy. Accordingly, it is not uncommon for women to still feel pain in their abdominal area during the puerperium. However, these will subside over time.

Also the Aftermath after the birth, which occur at irregular intervals for a few days and the Regression of the uterus serve can be responsible for abdominal pain during this period.

Are the Abdominal pain very severe and even increase in intensity, so must one infection be thought. The inflammation of the uterus itself is common in this context. The The uterus is particularly prone to inflammation during the puerperium, as the cervix is ​​still slightly open and germs can rise particularly easily and get into the uterus. The pathogens can easily settle there through the wound surfaces within the uterus and cause an infection. If there is an obstacle to the weekly flow, it also builds up in the uterus and creates an optimal environment for the growth of various pathogens. The Inflammation can reach the ovaries and the abdomen. Abdominal pain in the puerperium should therefore be taken seriously and continue medically clarified so that adequate therapy can be initiated.

Please also read our topic on this Abdominal pain in the puerperium

Postpartum depression

Postpartum depression is estimated to affect 10-20% of women who have given birth. It manifests itself through low moods, a feeling of inner emptiness, numbness, lack of energy, feelings of guilt, fluctuating feelings towards the child and many other symptoms. It is not uncommon for anxiety and panic attacks as well as concentration and sleep disorders to occur. In its lightest form, postpartum depression is also called "Baby bluesIt usually occurs within the first few weeks after the birth and subsides again after a few weeks. In contrast to baby blues, which only last a short time due to the slight progression, manifest postpartum depression lasts for several weeks. However, it varies in its intensity is very strong from woman to woman, that is, it can express itself through only slight listlessness and sadness as well as through the most severe depressive states up to suicidal thoughts and attempts.

For this reason, every woman with signs of postpartum depression should be examined and clarified. With pronounced forms, temporary drug treatment may be necessary. In addition, psychotherapeutic discussions are offered that are intended to help stabilize the woman concerned. Good social support and support from family and partners have a protective effect, as the woman then does not feel alone and less quickly overwhelmed with caring for her child. Severe postpartum depression is sometimes accompanied by a disturbed bond between mother and child, as the mother can have problems emotionally accepting and accepting her child as such. These problems in the mother-child bond are also often caused by the mother being very afraid of making mistakes and feeling guilty. Accordingly, the treatment of postpartum depression also aims at stabilizing the mother-child relationship. Overall, the prognosis for postpartum depression is good. Most women make a full recovery from their illness.

Please also read our topic on this Postpartum depression