A puerperium ( Peurperium ) refers to the period after a birth, in which the body oriented on the pregnancy (gravidity) returns to its original state.
In addition, the puerperium begins lactation and lactation . The puerperium begins with the birth of the mother's cake (placenta) and lasts about 6 - 8 weeks.
The puerperium is the period of the first six to eight weeks after birth. In addition, a distinction can be made between an early-week bed and a late-week bed, whereby the early-week bed refers to the first ten days after the birth. From the eleventh day after birth, the woman is in the late-week bed. Depending on how quickly the birth bones heal, the duration of the puerperium may vary from woman to woman. However, it usually ends after six to eight weeks.
During the puerperium, patients referred to as weaners experience some physiological, normal changes in the body and psyche. During this time it can also come to abdominal pain or abdominal pain in the puerperium. However, these are usually due to the processes of change in the body that are normal after delivery.
During the puerperium, there is a reversion ( involution ) of the uterus ( uterus ), which increases during pregnancy ( pregnancy ) and especially increased in muscle mass ( hypertrophy of the myometrium ).
The uterus weighs about 1000 g at the end of the pregnancy and reaches its highest point ( fundus uteri ) in the 40th week, two transverse fingers below the costal arch.
Immediately after birth, the fundus uteri, usually referred to in practice only as a fundus, lies between the belly button ( umbilicus ) and the symphysis. By contracting the uterine muscles (contractions of the myometrium), the so-called Nachwehen, it comes to a fairly rapid regression of the uterus. As a rule, the fundus is already at the navel level 24 hours after birth. Every day after birth, the fundus comes one transverse finger lower.
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, ie at the end of the puerperal, the uterus has returned to its original size. Your weight is then back to the 80 g.
The uterus, which has widened during birth, also forms during the puerperium. He is only finger-wide on the 10th day after birth.
The weekly flow ( Lochien ) begins immediately after birth ( postpartum ) and lasts about 4 - 6 weeks.
It is a wound healing of the endometrium from which the placenta has dissolved and consists of a composition of blood, dead cells ( detritus ), lymph, inflammatory cells and inflammatory fluid ( serous exudate ) that changes during the puerperium.
Immediately after delivery and during the first week of the puerperium, the weekly flow ( Lochial secretion ) is bloody and is referred to as the red weekly flow ( Lochia rubra ). The wound flow can be around 500 ml at the beginning. He is always lower during the puerperium. Also, the proportion of blood in the week flow is less, because the vessels of the endometrium are pulled ( compressed ) by the aftermath and the bleeding comes to a halt.
In the second week during the puerperium, the weekflow looks brown ( Lochia fusca ), becomes yellow ( Lochia flava ) in the third week, and is whitish or colorless from the fourth week ( Lochia alba ).
The weekly flow during the puerperium is always infectious, as it provides a perfect breeding ground for germs (including streptococci and staphylococci ) and multiply the germs there well.
The wound of the episiotomy ( epistaxis ), which may have been set during delivery, or of any resulting rupture or vaginal rupture, heals well in the puerperium.
The pelvic floor muscles, which were stretched during pregnancy, regress within six weeks after birth.
The stored during pregnancy fluid (edema) form back within the puerperium. Depending on the water retention, the woman loses about 5 - 10 liters of fluid.
With the end of the pregnancy and the beginning of the phase of the puerperium, the pregnancy and sex hormones in the body change.
Pregnancy hormones, such as the human-produced hormone HCG (human chorionic gonadotropin) or the placental hormone HPL (human placental lactogen), which were used to maintain pregnancy, are no longer produced and existing hormones are broken down, so that the the level of these hormones in the blood soon becomes undetectable.
Also, the concentration of the sex hormone progesterone in the blood, which was also formed in the second half of pregnancy from the mother cake and the maintenance of pregnancy, decreases during the childbirth. The degradation product of the 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 responsible for milk production ( lactogenesis ). As a result, the rise of this hormone also starts milk production. Also, the concentration of the hormone oxytocin is increased. Oxytocin is responsible for the milk flow ( milk secretion ).
The menstrual period generally begins in non-breastfeeding mothers after the end of the week's flow, ie about 6 - 8 weeks after birth.
For breastfeeding mothers, the first menstrual period sets in between the 8th week and the 18th month after birth.
For many mothers ( about 70% ), depressive moodiness or short-term depression, referred to as materniy blues, postpartum blues or "howling days", is usually observed starting on the 2nd or 3rd day after birth in the puerperium.
This detuning lasts for a few hours or a few days and then disappears.
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 in the puerperium and on the other hand, the effort of childbirth itself, any pregnancy-induced sleep deprivation as well as the " new situation " and the Role of the mother can not do justice.
In the puerperium women can suffer from different pains. Mostly, puerperal pain is the direct result of childbirth. The entire pelvic and genital area of the woman has been stressed and may hurt as a result.
Breastfeeding pain is not uncommon during the puerperal. In addition, infections can cause abdominal pain, headaches, chest pain, fever and other symptoms. Pain in the puerperium should therefore be taken as a reason for a visit to the doctor, to exclude serious causes of the complaint. If the pain is still due to the birth, then they will gradually subside with time and be completely subsided after a few days to weeks.
If a fever occurs during the puerperium, it must always be thought of an infection. In the puerperium, the uterus in particular can become inflamed when the discharge ( weekly flow ), which naturally occurs after birth, accumulates in the uterus. Bacteria can eventually inflame the mucous membrane and cause fever and pain. The inflammation can also spread to the ovaries or even the peritoneum.
An inflammation of the breast ( mastitis puerperalis ) by breastfeeding the child is possible and can lead to fever and a reddened and painful chest.
Of course, it can also be other infections that are not directly related to childbirth. For example, flu infections, inflammation in the gastrointestinal or urogenital area.
Fever in the puerperium should definitely be taken seriously and medically clarified, so that in due time an adequate therapy can be initiated.
If fever and headache occur during the puerperium, different causes for the complaints must be considered. Most commonly it is an infection in the genital area, as the uterus is particularly susceptible to infection by ascending germs due to the still open cervix and the wound surface inside. Such an infection can always be associated with fever and headache. Also, a common flu infection must be considered, as this is often associated with fever and headache.
Also, the inflammation of the breast by nursing the infant in the puerperium is common and often leads to headache with fever and general fatigue.
For particularly severe headaches with neck stiffness and / or photosensitivity, meningitis ( meningitis ) should always be considered. If there is clinical evidence, a diagnostic nerve puncture is performed and the virus is examined for pathogens. Fever and headache in the puerperium are serious symptoms that should definitely be further clarified and observed by a doctor.
Breastfeeding fever may occur during breast inflammation ( mastitis puerperalis ). Breastfeeding can cause baby tears to cause the smallest tears in the nipple ( rhagades ), which can cause germs to enter the breast and cause an infection there. This usually manifests itself by a redness, swelling and overheating of the affected breast. Not infrequently affected women also complain of fever, headaches and swelling of the lymph nodes in the armpit area. If the breasts are unremarkable, then other infections for the occurrence of the fever must be considered.
Fever and pain in the puerperium are always signs of infection. Body aches are particularly common in viral infections, such as influenza infections or influenza . However, other infections that typically occur in the puerperium, such as breast inflammation ( mastitis ) or inflammation of the endometrium (uterine lining) may be accompanied by worsening of the general condition, fever and body aches. It is important to thoroughly examine and adequately treat the affected women so that complications can be avoided.
Abdominal pain in the puerperium is very common and often conditioned by the surviving childbirth. In 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 greatly expanded and the entire pelvis very much used. Therefore, it is not uncommon for women to often experience abdominal pain in the postpartum period. These, however, settle over time.
Postpartum after-care, which may be irregular for a few days and may help to restore the uterus, may be responsible for abdominal pain over this period.
Are the abdominal pain very strong and even increase in intensity, so must be thought of an infection. Often in this context is the inflammation of the uterus itself. The uterus is particularly susceptible to inflammation in the puerperium, as the cervix is still slightly open, allowing germs to rise very easily and reach the uterus. Due to the wound surfaces within the uterus, the pathogens can easily settle there and cause an infection. If there is an outflow obstruction of the weekly flow, it accumulates in the uterus and forms an optimal environment for the growth of various pathogens. The inflammation can ascend into the ovaries and also into the abdomen. Therefore, abdominal pain in the puerperium should be taken seriously and further clarified by a doctor, so that an adequate therapy can be initiated.
Postpartum depression is estimated to occur in 10-20% of women who have given birth to a child. It expresses itself through low moods, a sense of inner emptiness, numbness, lack of energy, feelings of guilt, fluctuating feelings towards the child and many other symptoms. Not infrequently anxiety and panic attacks as well as concentration and sleep disorders occur. In the lightest form, the postpartum depression is also referred to as " baby blues ". It usually occurs within the first few weeks after birth and dies after a few weeks. In contrast to the baby blues, which lasts only briefly due to the slight course, manifests a manifest postpartum depression over several weeks. However, her intensity varies greatly from woman to woman, that is, she can express herself through only slight listlessness and grief, as well as from the most severe depressive states to suicidal thoughts and attempts.
For this reason, every woman with signs of postpartum depression should be examined and clarified. For severe forms, a temporary medical treatment may be necessary. In addition, psychotherapeutic discussions are offered to help stabilize the affected woman. Protective effect a good social support and support by family and partner, since the woman then feels alone and less quickly with the care of her child. Severe postpartum depression is sometimes associated with a broken bond between mother and child because the mother may have problems emotionally accepting and accepting her child as such. These problems in the mother-child bond are also often due to the fact that the mother is very afraid of making mistakes and feeling guilty. Accordingly, treatment of postpartum depression also aims to stabilize the mother-child relationship. Overall, the prognosis of the postpartum depression is good. Most women recover completely from their condition.