General Physiological changes during puerperium

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

3. 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.

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

5. 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.

6. 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 .

7. 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.

8. 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

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

10. 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

11. 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.

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