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Chapter 11 The Puerperium
Cari Brown, MD
❍ Define the puerperium.
The period that extends from delivery of the placenta to 6 weeks postpartum.
❍ How many weeks does it take for the uterus to regain its nonpregnant size?
The uterus regains its nonpregnant size about 4 weeks after delivery.
❍ What is the process called by which the uterus shrinks to its nonpregnant size?
Involution.
❍ What is the term used to describe the arrest of the normal process of uterine involution?
Subinvolution. Subinvolution is recognized on exam by the presence of a uterus that is larger and softer than
normal for the particular postpartum time. It is usually associated with irregular or excessive uterine bleeding.
❍ What are the two most common causes of subinvolution?
Retained placental fragments and uterine infection.
❍ What is the typical size of the placenta, and what is the typical size of the implantation site following delivery
of the placenta?
The typical placenta has a diameter of 18 cm, and the placental implantation site is 9 cm in diameter after delivery
of the placenta.
❍ What is the definition of puerperal fever?
Temperature ≥100.4°F on any two of the first 10 postpartum days, exclusive of the first 24 hours.
❍ What are the risk factors for postpartum uterine infection?
Mode of delivery, prolonged rupture of membranes, multiple cervical exams, prolonged labor, internal fetal
monitoring, intra-amniotic infection, lower socioeconomic class, vaginal colonization with Group B streptococcus,
Chlamydia, Mycoplasma, Ureaplasma, and Gardnerella.