This is the stage from the end of the third stage, and most of the patient organs have resumed the prepregnant state.

Duration of the puerperium:

It usually starts when the placenta has been delivered for six weeks or 42 days. Some of the organs may go back to the pregnant state in weeks or even in a month


the puerperium

  • The patient recovers from the labor, hence leaving her tired
  • Psychological experience: this helps the woman to realize that she is responsible for another human
  • With the aid of a medical practitioner-patient will be able to dice the appropriate contraceptive to use



1.General condition; Women experience shivering without a change in body temperature. The pulse rate is generally low, normal, or sometimes fast but should be above 100 bets per minute. The blood pressure usually varied but should be limited to less than140/90. The women have an immediate weight decrease of about 8 kg after conception but the further weight loss presented due to involutions of the uterus


There is increased skin pigmentation of the face, the wall of the abdomen, and vulva; however, the areolae tend to remain darker than before; there is also marked sweating

3 Gastrointestinal tract

– Thirst

– Constipation as a result of decreased tone of the bowel during pregnancy. Constipation is painful 

when a patient has hemorrhoids or when having an episiotomy

– Enemas admiration routinely is not of help to the patient. It causes constipation during the pauperism stage

Urinary tract

-Decreased tone of the bladder in pregnancy and edema during delivery cause urine retention. Dysuria may lead to unable to pass urine, and this leads to urine retention. Full bladder interferes with uterine contractions

-Diuresis happen on the 3rd day of puerperium; for a patient with edema, it may start immediately- after delivery

-Pelvic floor exercises are also called knyp exercises. Muscles that is mainly used is the one that suddenly stops urine during voiding

NB// The normal bladder function is likely to be temporarily impaired when the patient takes epidural analgesia


-Hemoglobin concertation stabilized at day 4 of the puerperium. However, platelets count increases and became stickier from the 4th and 10th 

day after delivery. Some of these changes, including clotting, may cause thromboembolism in the puerperium


There are marked changes that occur n the breast changes with the production of breast milk

Genital tract


has feature that disappears after delivery such as swollen and congestion. An episiotomy heals easily

Vigina is large after delivery, smooth m walled, edematous, and congested. During the third week, it rapidly shrinks and rugae return.

Cervix: First vaginal delivery, the nullipara external os becomes slit-like .for the first few days after delivery, the cervix remains partially open, 1 to 2 finger fitting, By the 7th day, the cervical os closed

Uterus: Involution is the most common change. The size of the uterus at delivery is about 20 weeks. By the end of the first week, the uterus becomes 12 weeks in length. The fundus should not be palpable at 14 weeks above the symphysis pubis. During the 6th week, 

it should reduce to its usual extent of a norma multiparous uterus. The multiparous is uterus is slightly larger than the nulliparous one. The size reduction leads to contraction and retraction of the uterine muscle. The normal involuting uterus should be firm and non-tender


decidua tissue dies due to ischemia, and she has lochia. Later on, lochia becomes straw-colored. Normal lochia has a typical non-offensive smell.


These three stages that are involved in the management

  1. Management of the 1st hour after delivery of the placenta
  2. The direction of the rest of the puerperium
  3. Control of postpartum visit during the 6th week