gynecology and obstetrics
Postpartum Care
Clinical parameters
Within the first 24 hours, the woman’s pulse rate begins to drop, and her temperature may be slightly elevated. Vaginal discharge is grossly bloody (lochia rubra) for 3 to 4 days, then becomes pale brown (lochia serosa), and after the next 10 to 12 days, it changes to yellowish white (lochia alba). About 1 to 2 weeks after delivery, eschar from the placental site sloughs off and bleeding occurs; bleeding is usually self-limited. Total blood loss is about 250 mL; external pads may be used to absorb it. Tampons may be used only if the woman's practitioner approves their use. They are not used if they might inhibit healing of perineal or vaginal lacerations. Women should be told to contact their practitioner if they are concerned about heavy bleeding. Prolonged bleeding ( Postpartum Hemorrhage ) may be a sign of infection or retained placenta and should be investigated. The uterus involutes progressively; after 5 to 7 days, it is firm and no longer tender, extending midway between the symphysis and umbilicus. By 2 weeks, it is no longer palpable abdominally and typically by 4 to 6 weeks returns to a prepregancy size. Contractions of the involuting uterus, if painful (afterpains), may require analgesics. 