OG19.1 | Normal and Abnormal Puerperium — Summary & Reflection

KEY TAKEAWAYS

Key takeaways from this module:

1. Puerperium = 6 weeks (42 days) after delivery. Uterine involution descends 1 fingerbreadth/day, entering the pelvis by day 10–14 and non-palpable by 6 weeks.

1. Lochia progresses: rubra (days 1–4, red) → serosa (days 5–9, pinkish-brown) → alba (day 10+, white/yellow). Offensive odour at any stage = infection.

1. Puerperal pyrexia = ≥38°C on any 2 of the first 10 days (excl. day 1). Differential: '5 Ws' — Wind, Water, Wound, Walking (DVT), Womb/milk.

1. Puerperal sepsis: most dangerous complication. Common organisms: Group A streptococcus (most lethal — notifiable), E. coli, Staphylococcus. Treatment: Sepsis Six + broad-spectrum IV antibiotics ± ERPC for retained products.

1. Secondary PPH (24 h to 12 weeks): causes = RPOC + infection/subinvolution. Treat: resuscitate → ultrasound → ERPC if RPOC → antibiotics + uterotonics.

1. Psychological spectrum: Blues (days 3–5, self-limiting by day 10, 50–80%) → PPD (≥2 weeks, 10–15%, EPDS ≥13, SSRIs ± therapy) → Puerperal psychosis (days 2–14, 1–2/1000, EMERGENCY — immediate psychiatric admission, infanticide risk).

1. Contraception during puerperium: PPIUCD, LAM, POP, DMPA — discussed fully in the next SDL (og10-postpartum-contraception).

REFLECT

Kolb reflective prompt: Consider a postpartum woman you have seen on the ward or in the postnatal clinic. Was her lochia examined and documented? Was she asked about mood? If those assessments were not done, what prevented them — time, training, or cultural factors? Write 3–4 sentences on how you would structure a 5-minute postnatal check to cover both physical (involution, lochia, wound, blood pressure) and psychological (mood, sleep, infant bonding) domains efficiently. How would you sensitively screen for puerperal psychosis without alarming a woman who is well?