Or postpartum. What is the condition of the vagina and perineum after childbirth? What you need to know about postpartum discharge

Immediately after delivery, women begin the postpartum period, which is no less important than the birth itself. At this time, the woman in labor requires careful medical and self-control in order to prevent development and survive this period in normal terms.

How long is the normal postpartum period?

The postpartum period begins with the delivery of the placenta and average duration up to 8 weeks after delivery. During this time, the uterus should decrease to normal size, its structure is restored and the inner layer endometrium. During this period, the secretory function of the mammary glands begins - from the production of colostrum to full-fledged milk. The work of all organs and systems of a woman who was disrupted by pregnancy (especially the work of the kidneys) is restored. The normal postpartum period goes without complications, and its course depends on how the birth ended and how it is being conducted. postpartum period.

Early postpartum period, its course, possible complications

From the moment the placenta is born, the woman is under the supervision of a doctor for several hours: at this moment, the uterus begins to contract and decrease bloody issues from the birth canal. The earliest and dangerous complication at this moment - in the postpartum period, which most often occurs due to the remains of the placenta in the uterine cavity or the presence of injuries of the genital tract during childbirth.

After a few hours, the likelihood of bleeding decreases, but the postpartum period after caesarean section requires more careful monitoring, since bleeding in it occurs not only due to violations of uterine contraction, but due to the divergence of the sutures on the uterus.

In the next few days, the uterus contracts rapidly, and normal spotting and clots are replaced sanious secretions(lochia). If the contractions of the uterus are weak, and blood clots accumulate in its cavity, then microbial infection with the emergence of other severe complications - postpartum endometritis and postpartum sepsis.

Features of the postpartum period is that in addition to changes in the uterus, changes begin in the mammary glands. In the first days, thick colostrum appears in them. In case of violation of its outflow and poor pumping, lactostasis is possible with an increase in body temperature, pain and swelling of the chest, which disappear after pumping. But with the addition of an infection, another pathology of the postpartum period is possible - mastitis, in which appropriate medical treatment. Prevention of mastitis in the postpartum period is, first of all, the prevention of stagnation of milk in the breast during the postpartum period and personal hygiene with a mandatory daily shower, washing the breast warm water with soap up to 2 times a day.

At improper feeding many women may experience painful nipple cracks that require appropriate care. And another possible problem on the part of the mammary glands is hypogalactia (not enough milk is produced to feed the baby), the prevention of which can be good nutrition women and regular expression of milk.

Other complications in the postpartum period are postpartum depression, inflammatory diseases external genitalia, varicose veins hemorrhoids and thrombophlebitis of the veins of the legs and pelvis, neurological disorders from the sacral plexus.

How is the postpartum period after a caesarean section?

The physiology of childbirth and the postpartum period with cesarean section has its own characteristics: the placenta is completely removed, but more often there is postpartum endometritis due to a violation of the contractility of the uterus and stagnation of blood or lochia in its cavity. The postpartum period after caesarean section can be complicated by the effects of anesthesia, and infectious inflammation in the area of ​​the seam on the uterus or abdominal wall, peritonitis, intoxication syndrome due to impaired excretion stool in the postpartum period.

Late postpartum period, its course, possible complications

The duration of the early postpartum period from the moment the placenta passes to 8-12 days after birth, and from 2 to 8 weeks after them, the late postpartum period begins. During this period, the restoration of the uterine mucosa continues, milk is produced for the baby. Complications during this period will most often be a continuation of complications early period, although postpartum mastitis can occur at any time - due to violations of the rules of personal hygiene and improper attachment of the child.

Lasts for the first 4 hours after birth. At this time, the woman is being monitored by medical personnel. The midwife controls the discharge from the genital slit, uterine contractions, measures blood pressure, and assesses the general condition of the woman. If, during examination of the birth canal, damage to soft tissues (tears, cracks, etc.) is detected, then the doctor, depending on the clinical situation, sutures them under local or general anesthesia. Subsequently, the sutures require regular processing and careful care and are removed for 5-7 days. Before removing the stitches, it is not recommended to sit down, you need to feed the baby in a “lying” or half-sitting position.

In the late postpartum period

There is a gradual contraction of the uterus, a decrease in its size, which is accompanied by the release of the so-called lochia. The contractions of the uterus are especially noticeable at the time of sucking the baby's breast, because. stimulation of the nipple leads to an increase in the production of oxytocin. The uterus reaches its original size approximately by the end of the postpartum period, i.e. after 6-8 weeks.

In the first one to two weeks after birth, the bloody nature of lochia is noted, then they become gray-pink, and even later - yellow-gray. It's absolutely normal phenomenon. The suckers should not have an unpleasant odor, their discharge should not be accompanied by fever or pain.

If you are marked similar symptoms you need to see a doctor. The reason for seeking the help of an obstetrician-gynecologist should also be complete absence any secretions or their sharp decrease.

Considering that blood can serve as a breeding ground for many pathogenic bacteria, and your body is weakened after childbirth and very susceptible to infection, you should especially carefully adhere to some hygiene rules:

• monitor the cleanliness of hands, underwear and bed linen;
• your underwear should be clean and made from natural materials, preferably cotton. Try to change it regularly, especially the bra. To protect bed sheets and a mattress from blood contamination, lay a special oilcloth on the bed;
• take a hygienic shower at least 1 time per day (bath is contraindicated as long as there is discharge);
• at least 1 time in 4 hours (depending on the intensity of the discharge) change the sanitary napkin. Before changing the pad and after each bowel movement, the toilet of the external genitalia should be performed;
• Under no circumstances should sanitary tampons be used. Take off your underpants from time to time to allow free access to the crotch. Sanitary pads should not fit too tightly to the body, the skin of the perineum should "breathe".

Breast-feeding

An important event in the postpartum period is the establishment of lactation. To make this process go as smoothly as possible for you, carefully read our articles in the section. Here we will only say that in order for everything to be fine in the postpartum period with both you and the baby, it is important from the very beginning to do everything in accordance with the Basic Rules of Breastfeeding.

In the process of lactation, an increase in the size of the mammary glands occurs. Therefore, you should choose the right bra: it should be made of natural material, especially for nursing women, and match your new breast size. It should not be cramped, because. this can cause lactostasis or other breast problems.

Breastfeeding while breastfeeding includes:

• wash your hands thoroughly before breastfeeding;
• before offering the baby a breast, you can express the first few drops (optional);
• after breastfeeding, squeeze out a few drops of hindmilk and treat the nipple and areola with it;
• wait until the chest is dry. Arrange air baths for the breast more often, especially if, as a result of improper attachment of the child, problems appear in the form of abrasions or inflammation of the nipple;
• wash your chest with soap should be during a hygienic shower, but not too often, because. when washing with soap, the natural protective grease secreted by special glands on the areola is washed off.

Sometimes in the postpartum period, a woman may first find hemorrhoids in her. To help yourself, you should recover for the first 3-4 days with the help of special glycerin suppositories, wash yourself cold water, do not use toilet paper(better with cotton wool or wash). AT acute period cold compresses (ice cubes) work well. Then you can use tampons with sea buckthorn or olive oil, after consultation with a doctor - special anti-hemorrhoidal suppositories. Your diet should be balanced and rich in fiber to avoid constipation.

Visit to the antenatal clinic after childbirth

The first visit to the antenatal clinic after childbirth is best done 5-7 days after discharge from the hospital. Undoubtedly, your obstetrician-gynecologist, who has been observing you for all 9 months, will be very glad to see you. He will give you full information regarding the postpartum period and their recommendations. If you feel well and everything is proceeding as your doctor foresaw, then schedule a second visit to the consultation 1.5-2 months after the birth. During this visit, talk to your doctor about the methods of contraception that are right for you.

In most women menstrual function recovers approximately 6 months after the birth of the child. Sometimes it happens earlier. With exclusive breastfeeding, menstruation may be absent more than a year. it individual characteristics organism. After the restoration of menstruation, the chances of fertilization increase.

It is advisable to plan next pregnancy no sooner than 2 years after you stop breastfeeding your baby. This time is necessary for your body to rest and restore its reserves of vitamins, trace elements and other useful substances. Special attention trace to restore the level of calcium.

The fact is that during pregnancy, the fetus removes about 30 grams of calcium from the bones of the mother, and during the lactation period, 160-300 mg of this valuable mineral every day. As a result, after childbirth, there may be problems with teeth and nails, hair loss, loss of bone strength. A daily intake of 500 mg of elemental calcium is sufficient in combination with vitamin D, which helps better assimilation calcium in the body.

The early postpartum period begins from the moment the placenta is born and lasts 24 hours. This is an extremely important period of time during which important physiological adaptations occur. maternal organism to new conditions of existence, especially the first 2 hours after childbirth.

In the early postpartum period, there is a risk of bleeding due to impaired hemostasis in the vessels of the placenta site, impaired contractile activity uterus and traumatization of the soft birth canal.

The first 2 hours after birth, the puerperal remains in the delivery room. The obstetrician closely monitors general condition puerperas, her pulse, measures blood pressure, body temperature, constantly monitors the state of the uterus: determines its consistency, the height of the uterine fundus in relation to the pubis and navel, monitors the degree of blood loss,

Late postpartum - occurs 24 hours after birth and lasts 6 weeks.

Uterus

The most pronounced process of reverse development is observed in the uterus. Immediately after childbirth, the uterus contracts, acquires a spherical shape7, a dense texture. Its bottom is 15-16 cm above the pubis. The thickness of the walls of the uterus, the largest in the bottom area (4-5 cm), gradually decreases towards the neck, where the muscle thickness is only 0.5 cm. In the uterine cavity is a small amount of blood clots. The transverse size of the uterus is 12-13 cm, the length of the cavity from the external os to the bottom is 15-18 cm, the mass is about 1000 g. The cervix is ​​freely passable for the hand. Due to the rapid decrease in the volume of the uterus, the walls of the cavity are folded, and then gradually smooth out. Most pronounced changes the walls of the uterus are noted at the location of the placenta - in the placental site, which is a wound rough surface with blood clots in the vascular area. In other areas, parts of the decidua are determined, the remains of the glands, from which the endometrium is subsequently restored. Remained periodic contractile movements of the uterine muscles mainly in the bottom.

During the next week, due to the involution of the uterus, its mass decreases to 500 g, by the end of the 2nd week - up to 350 g, the 3rd - up to 200-250 g. By the end of the postpartum period, it weighs, as in a state outside of pregnancy, - 50-60 g.

The mass of the uterus in the postpartum period decreases due to the constant tonic contraction of muscle fibers, which leads to a decrease in blood supply and, as a result, to malnutrition and even atrophy individual fibers. Most of vessels are obliterated.

During the first 10 days after birth, the bottom of the uterus descends daily by approximately one transverse finger (1.5-2 cm) and on the 10th day is at the level of the womb.

The involution of the cervix has some features and is somewhat slower than the body. Changes begin with the internal os: within 10-12 hours after childbirth, the internal os begins to shrink, decreasing to 5-6 cm in diameter.

The external pharynx due to the thin muscular wall remains almost the same. The cervical canal in connection with this has a funnel-shaped shape. After a day, the channel narrows. By the 10th day, the internal os is practically closed. The formation of the external os is slower, so the cervix is ​​​​finally formed by the end of the 13th week of the postpartum period. The original form of the external pharynx is not restored due to the ongoing overstretching and tears in the lateral sections during childbirth. The uterine os has the appearance of a transverse slit, the cervix is ​​​​cylindrical, and not conical, as before childbirth.

Simultaneously with the contraction of the uterus, the uterine mucosa is restored due to the epithelium of the basal layer of the endometrium, wound surface in the area of ​​the parietal decidua ends by the end of the 10th day, with the exception of the placental site, the healing of which occurs by the end of the 3rd week. The remains of the decidua and blood clots under the action of proteolytic enzymes are melted in the postpartum period from the 4th to the 10th day.

In the deep layers of the inner surface of the uterus, mainly in the subepithelial layer, microscopy reveals a small cell infiltration that forms on the 2nd-4th day after birth in the form of a granulation shaft. This barrier protects against penetration of microorganisms into the wall; in the uterine cavity, they are destroyed due to the action of proteolytic enzymes of macrophages, biologically active substances and others. In the process of involution of the uterus, small cell infiltration gradually disappears.

The process of regeneration of the endometrium is accompanied by postpartum discharge from the uterus - lochia (from Greek lochia - childbirth). Lochia consist of impurities of blood, leukocytes, blood serum, remnants of the decidua. Therefore, the first 1-3 days after childbirth is bleeding(lochia rubra), on the 4-7th day the lochia become serous-sanitary, have a yellowish-brown color (lochia flava), on the 8-10th day - without blood, but with a large admixture of leukocytes - yellowish-white ( lochia alba), which are gradually (from the 3rd week) mixed with mucus from the cervical canal. Gradually, the number of lochia decreases, they acquire a mucous character (lochia serosa). At the 3-5th week, the discharge from the uterus stops and becomes the same as before pregnancy.

Total lochia in the first 8 days of the postpartum period reaches 500-1500 g; they have alkaline reaction, specific (rotten) smell. If for some reason there is a delay of lochia in the uterine cavity, then a lochiometer is formed. In the case of infection, an inflammatory process can develop - endometritis.

The fallopian tubes during pregnancy and childbirth are thickened and elongated due to increased blood supply and edema. In the postpartum period, hyperemia and edema gradually disappear. On the 10th day after birth, complete involution of the fallopian tubes occurs.

Regression ends in the ovaries in the postpartum period corpus luteum and the maturation of the follicles begins. As a result of the release of a large amount of prolactin in lactating women, menstruation is absent for several months or the entire time of breastfeeding. After the cessation of lactation, most often after 1.5-2 months, menstrual function resumes. In some women, ovulation and pregnancy are possible during the first months after childbirth, even while breastfeeding.

For most non-breastfeeding women, menstruation resumes at 6-8 weeks postpartum.

The vagina after childbirth is widely opened. Lower divisions its walls protrude into the gaping genital slit. The walls of the vagina are edematous, blue-purple in color. Cracks and abrasions are revealed on their surface. The lumen of the vagina in primiparas, as a rule, does not return to its original state, but remains wider; folds on the walls of the vagina are less pronounced. In the first weeks of the postpartum period, the volume of the vagina is reduced. Abrasions and tears heal by the 7-8th day of the postpartum period. From hymen papillae remain (carunculae myrtiformis). The genital slit closes, but not completely.

The ligamentous apparatus of the uterus is restored mainly by the end of the 3rd week after childbirth.

The muscles of the perineum, if they are not injured, begin to restore their function already in the first days and acquire their normal tone by the 10-12th day of the postpartum period, the muscles of the anterior abdominal wall gradually restore their tone by the 6th week of the postpartum period.

Milk glands

The function of the mammary glands after childbirth reaches its highest development. During pregnancy, under the influence of estrogens, milk ducts are formed, under the influence of progesterone, glandular tissue proliferation occurs, under the influence of prolactin, increased blood flow to the mammary glands and their engorgement, most pronounced on the 3rd-4th day of the postpartum period.

During the postpartum period, the following processes occur in the mammary glands:

• mammogenesis - development of the mammary gland;
• lactogenesis - initiation of milk secretion;
• galactopoiesis - maintenance of milk secretion;
• galactokinesis - removal of milk from the gland,

The secretion of milk occurs as a result of complex reflex and hormonal influences. Milk production is regulated nervous system and prolactin. Hormones have a stimulating effect thyroid gland and adrenal glands, as well as a reflex effect during the act of sucking,

Blood flow to the mammary gland increases significantly during pregnancy and later during lactation. There is a close correlation between the rate of blood flow and the rate of milk secretion. Milk accumulated in the alveoli cannot pass passively into the ducts. This requires contraction of the myoepithelial cells surrounding the ducts. They contract the alveoli and push the milk into the ductal system, which facilitates its release. Myoepithelial cells, like myometrial cells, have specific receptors for oxytocin.

Adequate milk production is an important factor successful lactation. Firstly, while alveolar milk is available to the child and, secondly, the removal of milk from the alveoli is necessary for the continuation of its secretion. That's why frequent feeding and emptying of the mammary gland improve milk production.

An increase in milk production is usually achieved by increasing the frequency of feeding, including feeding at night, and in the case of insufficient sucking activity in a newborn, feeding alternately from one to the other mammary gland. After the cessation of lactation, the mammary gland usually returns to its original size, although the glandular tissue does not completely regress.

Composition of breast milk

The secret of the mammary glands, released in the first 2-3 days after childbirth, is called colostrum, the secret released on the 3-4th day of lactation is transitional milk, which gradually turns into mature breast milk.

Colostrum (colostrum)

Its color depends on the carotenoids contained in colostrum. Relative density colostrum 1.034; dense substances make up 12.8%. The composition of colostrum includes colostrum bodies, leukocytes and milk globules. Colostrum is richer than mature breast milk proteins, fats and minerals, but poorer in carbohydrates. The energy value colostrum is very high: on the 1st day of lactation it is 150 kcal / 100 ml, on the 2nd - 110 kcal / 100 ml, on the 3rd - 80 kcal / 100 ml.

The amino acid composition of colostrum is intermediate between the amino acid composition of breast milk and blood plasma.

Colostrum also contains a large amount of oleic and linoleic acids, phospholipids, cholesterol, triglycerides, which are essential building blocks cell membranes, myelinated nerve fibers etc. In addition to glucose, carbohydrates include sucrose, maltose and lactose. On the 2nd day of lactation, the largest number beta-lactose, which stimulates the growth of bifidobacteria that prevent the reproduction of pathogenic microorganisms in the intestine. in colostrum in in large numbers also presented minerals, vitamins, enzymes, hormones and prostaglandins.

Breast milk is best view food for a child in the first year of life. The quantity and ratio of the main ingredients that make up women's milk provide optimal conditions for their digestion and absorption in the child's digestive tract. The difference between human milk and cow's milk (the most commonly used for feeding a baby in the absence of breast milk) is quite significant.

Human milk proteins are ideal, their biological value is 100%. Breast milk contains protein fractions identical to blood serum. Proteins of breast milk contain much more albumin, while cow's milk more caseinogen.

The mammary glands are also part of the immune system, specifically adapted to provide immune protection newborn from infections of the digestive and respiratory tracts.

The cardiovascular system

After delivery, the BCC decreases by 13.1%, the volume of circulating plasma (CV) - by 13%, the volume of circulating erythrocytes - by 13.6%.

The decrease in BCC in the early postpartum period is 2-2.5 times higher than the amount of blood loss and is due to the deposition of blood in the organs abdominal cavity with a decrease intra-abdominal pressure immediately after childbirth.

In the future, BCC and BCC increase due to the transition of extracellular fluid into the vascular bed.

Heart rate, stroke volume and cardiac output remain elevated immediately after delivery and in some cases higher for 30-60 minutes. During the first week of the postpartum period, the initial values ​​of these indicators are determined. Until the 4th day of the postpartum period, a transient increase in systolic and diastolic pressure by approximately 5% can be observed,

urinary system

Immediately after childbirth, hypotension of the bladder and a decrease in its capacity are observed. Bladder hypotension is exacerbated by prolonged labor and the use of epidural anesthesia. Hypotension of the bladder causes difficulty and violation of urination. The mother may not feel the urge to urinate or they become painful.

Digestive organs

Due to some smooth muscle atony digestive tract constipation may occur, which disappear with a balanced diet and active way of life Hemorrhoidal nodes that often appear after childbirth (if they are not infringed) are of little concern to puerperas.

Puerperium)

the period starting after childbirth and lasting 6-8 weeks; during this time, changes associated with pregnancy disappear in the woman’s body, the formation secretory function mammary glands. The first 8-12 days after childbirth, when there is especially active fixture the body of a woman to new conditions is called early P. p., the rest of it is called late P. p. A woman in the postpartum period is called a puerperal.

Changes in the mother's body. The most pronounced changes are observed in the genital organs, primarily in the uterus. Total number muscle cells of the uterus in P. p. is not sharply reduced, but they are significantly reduced in size. In parallel, there is a rapid connective tissue stroma of the uterus. Immediately after childbirth, a well-contracted has a mass of about 1000 G, its average dimensions are as follows: length 19 cm, width 12 cm, anteroposterior size 8 cm. In the future, these figures gradually decrease. A week later, the mass of the uterus is 500 G, by the end of the second week - 300 G, by the end of P. p. - less than 100 G. Accordingly, the size of the uterus also decreases: on the 2nd day after childbirth, its bottom is located at 12-15 cm above the upper edge of the pubic symphysis, on the 6th - by 8-10 cm, on the 8th - on 6-8 cm, on the 10th - on 4-6 cm(the height of the fundus of the uterus is determined with an empty bladder in the position of a woman lying on her back with straightened legs). The most accurate way to judge involution postpartum uterus allows dynamic echography.

In practical terms, along with changes in the size of the uterus, the dynamics of the number and nature of lochia (discharge from the postpartum uterus), due to the processes of cleansing and healing the wound surface of the uterus, is important. epithelial cover from the epithelium of the remnants of the glands provides epithelialization of the wound surface of the uterus by the 20th day after birth. The uterus is completely restored by the end of the 6th week, and in the area of ​​the placental site - on the 8th week. From the 1st to the 5th day P. p. plentiful, bloody; from the 6th to the 10th day - plentiful, sanious; from the 11th to the 15th day - moderate, yellowish color; from the 16th to the 20th day - scanty, light. Usually, discharge from the uterus stops at 5-6 weeks after birth. Prolonged spotting or their resumption is more often due to subinvolution (slowing down of reverse development) of the uterus, retention of placental remnants in the uterus, postpartum infection.

In connection with the termination of the function of the fetoplacental (Fetoplacental system) system and the resulting decrease in the level of estrogen and progesterone, significant changes in P. p. endocrine system. The secretion of prolactin by the anterior pituitary gland and other hormones of the lactogenic complex is enhanced. In ovaries in P. of the item maturation of follicles begins; in women who are not breastfeeding, and some lactating women at 6-8 weeks of the postpartum period resumes, which during the first 3-6 months, as a rule, is anovulatory.

Changes in hemodynamics are observed. The volume of circulating blood in P. p. first increases by 15-30%, then gradually decreases. This is due to the redistribution of blood due to the disappearance of uteroplacental circulation, contraction of the uterus and a decrease in its blood supply, changes water-salt metabolism excretion of a significant amount of fluid from the body. in P. rhythmic, complete, but its pronounced under the influence is noted external stimuli. normal, sometimes slightly reduced.

Kidney function in puerperas is normal, usually elevated. Also increased fluid secretion sweat glands. Characterized by morphological and functional changes in the bladder. Shortly after delivery, cystoscopy reveals hyperemia and swelling of the bladder mucosa, often submucosal hemorrhages. The capacity of the bladder in P. p. increases, to the intravesical fluid pressure it decreases. As a result of this, there may be (especially in the first days after childbirth) overdistension of the bladder, incomplete emptying of it, which contributes to the development of infection. atonic, there is a tendency to constipation.

Doing. In the first 2-3 h after childbirth, she is in the delivery room, then she is transported on a gurney to the postpartum department. It is necessary to monitor the general condition of the woman, her body temperature, pulse rate, the condition of the uterus and mammary glands, the nature of the discharge from the genital tract, as well as the function of the bladder and intestines.

Of great importance in P. p. is the observance of the rules of personal hygiene. Particular attention is paid to the care of the mammary glands (washing with warm water and soap before and after applying to the baby's breast). The first application of the child to the breast in the absence of contraindications is carried out after 2 h after childbirth, then the child is fed 6-7 times a day after 3-3 1 / 2 h with a 6-hour break (see Feeding children).

On the first day after childbirth, a woman is recommended bed rest, on the second day healthy women in good general condition, it is allowed to get up at 15-30 min 1-2 times. Sewn perineum I and II degree are not an obstacle to getting up early. However, you should avoid movements associated with spreading the legs (for example, you can not sit down). Lessons physical therapy should be started on the first day after birth. They include exercises aimed at establishing normal diaphragmatic breathing, muscle strengthening abdominals and diaphragm of the pelvis, increasing the tone of the body. Getting up early and help improve blood circulation and are effective tool prevention of thrombophlebitis, stimulate the reverse development of the uterus, the function of the bladder and intestines.

A healthy puerperal should include fresh fruits, berries, and other foods rich in vitamins. Spicy and indigestible dishes (fatty meat, beans, peas, etc.), canned food are not recommended. Categorically contraindicated alcoholic drinks. When breastfeeding, the nutrition of puerperas should meet the needs of the organisms of the mother and child for energy and nutrients(see Nutrition, pregnant women and nursing mothers). Excessive food and drink do not increase the secretion of milk and are an unnecessary burden on the body.

Deadline for release from maternity hospital determined depending on the condition of the puerperal and the newborn. At normal flow P. item discharge from the hospital can be made no earlier than 5 days after birth. After discharge, the puerperal and the newborn are under the supervision of doctors antenatal clinic and children's clinic, and countryside- midwives of the feldsher-obstetric station and the local pediatrician. Upon returning home, a woman must strictly observe the rules of personal hygiene in order to prevent postpartum diseases, especially Mastitis a. Recommended hygienic, washing the mammary glands with warm water and soap before and after applying the baby to the breast, washing the external genitalia with soap under running water, regular change of underwear. The resumption of sexual activity in the normal course of the postpartum period is permissible no earlier than after 6-8 weeks. after childbirth. Importance have a balanced diet and physical therapy.

Bibliography: Bodyazhina V.I. in women's consultation, p. 222, M., 1987; Persianinov L.S. and Demidov V.N. Features of the function of the circulatory system in pregnant women, women in childbirth and puerperas, M., 1977; Strizhakov A.N., Baev O.R. and Medvedev M.V. Modern approach to the assessment of the involution of the uterus after childbirth, Akush. and gynec., No. 6, p. 44, 1987, bibliogr.

1. Small medical encyclopedia. - M.: Medical Encyclopedia. 1991-96 2. First health care. - M.: Bolshaya Russian Encyclopedia. 1994 3. encyclopedic Dictionary medical terms. - M.: Soviet Encyclopedia. - 1982-1984.

See what the "Postpartum period" is in other dictionaries:

POSTPARTUM- POSTPARTUM PERIOD. Contents: T. Physiology .................... 53 3 II. Postpartum hemorrhage.........541 III. Pathology of P. n..................555 IV. Postpartum psychoses ........... 580 Postpartum period time from the moment of discharge ... ... Big Medical Encyclopedia

POSTPARTUM- begins after the birth of the child and the exit of the child's place with membranes (afterbirth); lasts 6 8 weeks. At this time, recovery processes are taking place in the woman’s body: the changes that occurred during ... ... Brief Encyclopedia household

The period from the expulsion of the placenta to the completion of the reverse development of changes in the reproductive system of a woman that arose in connection with pregnancy and childbirth; lasts 6 8 weeks. The most significant changes during this period occur in the uterus, ... ... Sexological Encyclopedia

6 8 weeks from the birth of the placenta, during which there is a reverse development of all changes in the body of a woman caused by pregnancy and childbirth ... Big Encyclopedic Dictionary

It starts from the moment the placenta is born (See Placenta) and lasts 6 8 weeks. In P. p. in the body of the puerperal, almost all changes in the systems and organs that have arisen during pregnancy and childbirth undergo reverse development (involution). Uterus… Great Soviet Encyclopedia

6 8 weeks from the birth of the placenta, during which there is a reverse development of all changes in the body of a woman caused by pregnancy and childbirth. * * * POSTPARTUM PERIOD POSTPARTUM PERIOD, 6 8 weeks from the birth of the placenta, in ... ... encyclopedic Dictionary

- (puerperium; synonym: puerperal period, puerperium) the period from the birth of the placenta to the completion of the reverse development of changes in the organs of the reproductive system of the mother that occurred during pregnancy and childbirth ... Big Medical Dictionary

postpartum period called the period from the moment of birth of the placenta (placenta and membranes) until the moment when the reverse development (involution) of those organs and systems that have undergone changes due to pregnancy ends. It lasts 6 to 8 weeks. A woman after childbirth is called a puerperal.

postpartum period according to the terms is divided into early and late postpartum period.

Early postpartum period lasts the first 2-4 hours after childbirth, during which the woman is in the delivery room under the supervision of a doctor and midwife. This is due to the fact that most often complications associated with a violation of uterine contraction, the remains of placental lobules in the uterus, are manifested by the occurrence of bleeding during these hours.

Immediately after birth, the uterus weighs about 1000 g, its height is at the level of the navel. During this period, the doctor examines the cervix in the mirrors and soft tissues of the birth canal. Inspection is mandatory for all puerperas. If injuries of the tissues of the birth canal are detected (ruptures of the cervix, vaginal walls, perineum), if necessary, sutures are placed under the local or general anesthesia. The type of anesthesia depends primarily on the size and location of the gaps. Subsequently, the seams must be kept dry, treated 2-3 times a day with alcohol and a solution of brilliant green. Normally, the stitches are removed for 5-7 days.

Throughout early postpartum period the doctor monitors the general condition of the puerperal, the nature of the pulse, blood pressure, the state of the uterus. From time to time he massages the uterus through the anterior abdominal wall to remove accumulated blood clots.

After 2 hours, if the woman's condition does not inspire concern, she is transported on a gurney to the postpartum ward.

late postpartum period

This is the time from the moment the woman is transferred to the postpartum department until the moment when the changes caused by pregnancy and childbirth disappear in the woman's body. It lasts 6 to 8 weeks.

During the first week, the mass of the uterus is halved, that is, it reaches 500 g. By the end of the second week, it weighs 350 g, by the end of the third - 250 g. By 6-8 weeks, the reverse development of the uterus stops. The uterus of a woman giving birth has a mass of about 75 g.

The involution of the uterus occurs due to the degeneration of muscle elements into fatty ones. The breakdown of muscle fibers is accompanied by cell death, but not all. Only a part of the fibers (50%) dies, while the other half forms new myometrial cells.

postpartum discharge from the genital tract (blood, mucus, melted organic elements) are called lochia. The total number of lochia reaches 500-1500 g in 6-8 weeks. They have a peculiar rotten smell.

In the first 2-3 days, the lochia has a bloody character, on the 4-5th day they take on a bloody-serous appearance. A week after the birth, the lochia have a grayish-white appearance, by the end of the third week of the postpartum period, the discharge almost stops.

The mammary glands begin to actively develop during pregnancy. In the postpartum period in the mammary glands, the formation of the necessary for feeding the newborn takes place. In the first 2-3 days, the mammary glands secrete colostrum, from 3-4 days - milk.

The value of colostrum in feeding a newborn is truly enormous. It prepares gastrointestinal tract baby to assimilate real milk. Colostrum differs from milk in a significantly lower content of fat and carbohydrates, it is richer in proteins and salts. The presence in it of a huge number of maternal immunoglobulins and biologically active substances determines the formation of primary immunity in the newborn. Therefore, early (already in the delivery room) attachment to the breast is so important.

Human milk contains 88% water, 1.13% protein, 7.28% sugar, 3.36% fat. Milk contains substances necessary to meet all the needs of a newborn.

The process of becoming lactation occurs as follows: from 3-4 days the mammary glands begin to secrete milk, which is accompanied by their engorgement, sometimes a slight single rise in temperature. With each subsequent day, the amount of milk increases. good lactation characterized by the release of up to 800-1000 ml of milk per day.

At excessive breast engorgement their elevated position is necessary, which can be provided with a good bra. In addition, you need to limit drinking; After each feeding, completely express the remaining milk; if the mammary glands are not emptying sufficiently, seek help from a midwife.

AT postpartum period may be observed two physiological rises in temperature . The first is noted within 12 hours after childbirth, it is due to the woman's overstrain during childbirth, as well as the entry into the blood after increased muscle work of lactic acid.

The second increase in temperature - 3-4 days after childbirth - is explained by the fact that it is by this time that microorganisms from the vagina penetrate into the uterus, in which the healing processes of the mucous membrane are far from completed. Defensive reaction against the introduction of microorganisms into tissues is expressed, in particular, by a short-term single increase in temperature to 37.5º.

AT postpartum period there may be dysfunction of the bladder (urinary retention), intestines (stool retention), slowing down the involution (regression) of the uterus.

At urinary retention they try to call it reflexively (create a sound reflex by opening a tap with water, pour warm water over the urethra), put a warm heating pad on the lower abdomen. If these measures do not help, they are assigned medications, if the above procedures fail, empty bladder using a catheter.

At no independent chair on the 3rd day after birth cleansing enema or give a laxative; diet is adjusted.

In the first 2 days after childbirth, food should be easily digestible and high-calorie (cottage cheese, sour cream, semolina, kissel, cookies). From the 3rd day after a bowel movement, a regular diet is prescribed with the addition of milk, fresh fruits and vegetables. Food should be rich in vitamins that the body of both the mother and the child needs. Must be avoided spicy dishes, canned food, sausages, fatty meat, alcohol.

Delayed uterine involution - this is the backlog of the uterus in reverse development. In this case, ice is prescribed on the lower abdomen, reducing funds.

Currently, in almost all maternity hospitals, births are taken by a team of medical workers, which necessarily includes a neonatologist and a pediatric nurse. Children's doctor(neonatologist) closely monitors the course of childbirth and begins to deal with the child as soon as his head is born.

To avoid mucus entering the upper respiratory tract a soft rubber sterile canister or electric suction is used to remove mucus from the nasal passages and mouth. A newborn is born slightly bluish, takes its first breath, lets out a cry, moves its arms and legs, and begins to quickly turn pink. And it is at this moment that he is laid on his mother's stomach so that she can see and touch her child. This is very useful not only for the child (this is how his first contact with the outside world takes place), but also for the moral state of the mother, when she sees the baby, she noticeably calms down, which favorably affects the further course of childbirth and the postpartum period. This is currently practiced in almost all maternity hospitals.

During this time, as a rule, the pulsation in the umbilical cord stops (first in the arteries, and then in the vein), before that it is not recommended to pinch it. As soon as the pulsation of the vessels of the umbilical cord stops, a clamp is applied to it at a distance of 10-15 cm from the umbilical ring, the second clamp is placed 2 cm outward from the first. The umbilical cord between the clamps is wiped with 95-degree alcohol and cut.

Immediately after birth, prevention of blenorrhea (damage to the child's eyes by gonococci), since the possibility of infection of the newborn when passing through birth canal mother. Currently, a 30% solution of sodium sulfacyl (albucid) is used for this purpose. The eyelids of a newborn are wiped with sterile cotton swabs(separately for each eye) from the outer corner to the inner. The lower eyelid of each eye is pulled back and applied to the everted eyelids, 1 drop of the solution. At the birth of a girl, the same solution in the amount of two drops is also instilled into the vulva. The newborn is washed with warm water, removing mucus, blood, meconium, carefully wiped with a warm sterile diaper, placed on a heated changing table and the umbilical cord is processed. The remainder of the umbilical cord is again treated with alcohol, a clamp is applied at a distance of 0.5 cm from the umbilical ring for 1-2 minutes, then the clamp is removed, and a special plastic clip is placed in its place and the remainder of the umbilical cord is tightly clamped. The tissue of the umbilical cord above the bracket is cut off, the blood is removed. The rest of the umbilical cord is treated with a 5% solution of potassium permanganate and a sterile gauze bandage is applied to it.

After finishing the treatment, the midwife with a swab moistened with sterile sunflower oil removes grease residues from the baby's skin, especially in places of natural folds ( inguinal folds, axillary pits). Then the newborn is weighed, its length (from the crown to the heels), the size of the head, and the circumference of the shoulder girdle are measured.

Bracelets are put on the arms of the newborn, which indicate the surname, name, patronymic of the mother, the date, hour and year of birth of the child, his gender, body weight and length, the birth history number of the mother, the number of the newborn. The child is wrapped in sterile warm diapers and a blanket.

In many maternity hospitals it is currently practiced to attach the baby to the mother's breast in the delivery room 15-20 minutes after birth, if there are no contraindications. And this is done not even because the child is hungry, but then so that the child's body receives the maternal microflora and many useful protective factors (maternal immunoglobulins) from colostrum. The first drops of breast milk have miraculous properties, they bring health to the child in the full sense of the word. At the same time, a neonatologist talks to the mother, he informs her about the baby’s condition (his assessment on the Apgar scale), about birthmarks on the body or face, and gives the first recommendations.

The condition of the child in the first minute and 5 minutes after birth is assessed by Apgar score. The newborn assessment system was proposed in 1953 by Virginia Apgar. Using this method, you can fairly objectively judge the condition of the child. Most newborns get a score of 7-8 in the first minute due to some blueness and decreased muscle tone. After 5 minutes, the score rises to 8-10 points.

Assessment in points of the condition of the newborn after birth according to the Apgar scale

A newborn baby is considered full-termif the period of its intrauterine development was a full 37 weeks, body weight is equal to or exceeds 2500 g, and height is 45 cm. The average weight of a full-term boy is 3400-3600 g, a full-term girl is 3200-3300 g. Average length body 49-52 cm.

full-term baby screaming loudly, he active movements well-defined muscle tone and sucking reflex. His skin is pink and elastic. The subcutaneous fat layer is well developed. The bones of the skull are elastic, the lateral fontanelles are closed, auricles elastic. The nails extend past the fingertips. In girls, the large labia close the small ones; in boys, the testicles are lowered into the scrotum.

For the next 2 hours after the birth, the child, together with his mother, is in the delivery room under the supervision of a doctor and a midwife, and then, if there are no contraindications for cohabitation, they are transferred to the postpartum ward.