Normal postpartum changes
- Uterus: Involution begins immediately after delivery. At umbilicus by 24 hrs, halfway to symphysis pubis by 1 wk, non-palpable by 2 wks, normal size by 6 wks.
- Lochia: Postpartum uterine discharge (erythrocytes → leukocytes)
- Lochia rubra: Red/bloody, first few days.
- Lochia serosa: Pink/brownish, lasts ~2 wks.
- Lochia alba: Yellow/white, lasts up to 6-8 wks.
Mnemonic
红四军将士白干三周
- Cardiovascular: ↑ CO immediately post-delivery, then normalizes over 2 wks. Transient bradycardia common. Diuresis of excess fluid.
- Hematologic: Hypercoagulable state persists for ~6-8 wks (↑ risk of DVT/PE). Leukocytosis is common.
- Endocrine: Abrupt ↓ in estrogen, progesterone, hCG. Prolactin levels ↑ with breastfeeding, suppressing ovulation. Non-lactating women may ovulate as early as 4-6 wks postpartum.
- Routine Care: Pain control (NSAIDs), perineal care (sitz baths), bowel regimen (stool softeners), monitor for bleeding/infection. Contraception discussion.