Assessment - Postpartum: Nursing

The postpartum period, also known as the puerperium, or “the fourth stage of labor”, starts after delivery of the fetus and the placenta, and it extends through the first six weeks after birth. During this period, the body gradually returns to its pre-pregnancy state. There are several complications that can arise during the postpartum period, and early diagnosis is essential for appropriate management of these conditions.

Okay, let’s start with some physiology. So, after delivery, the uterus tends to regress back to its normal size and resume its pre-pregnancy position by the sixth week, a process known as involution. There are also some physiological changes that occur during pregnancy that begin to change back to pre-pregnancy levels in the postpartum period. For example, during pregnancy there is increased blood plasma volume in relation to red blood cell mass. As a consequence, maternal hemoglobin and hematocrit are usually relatively low during pregnancy, since the same amount of red blood cells are circulating in a higher volume of blood. After delivery, through increased diuresis or urine production, and increased diaphoresis or sweat production, blood volume returns to normal in about 6 to 12 weeks, and hemoglobin, and hematocrit levels normalize within 4 to 6 weeks. Likewise, during pregnancy, plasma fibrinogen and other pro-coagulant factors increase, and they stay elevated until 4 to 6 weeks following delivery.

Now, there are some complications that can happen during the postpartum period, the main one being postpartum hemorrhage, meaning excessive blood loss following delivery. Other common complications include injuries to the genital tract, such as hematomas and lacerations. Hematomas are localized collections of blood that commonly affect the vulva, vagina, and perineum. They can cause significant pain and discomfort, and large hematomas can cause hemodynamic instability and even hypovolemic shock.