The Puerperium

The puerperium starts after the birth of a baby and continues until 6 to 8 weeks postpartum. Several recent interventions in management have been shown to improve outcomes. Delayed cord clamping, the practice of waiting for a period of time after a baby is born before clamping and cutting the umbilical cord, can increase hemoglobin levels, improve iron stores, and increase birth weight in newborns. Rooming in, the practice of mothers and newborns staying together, improves infant sleep and breast-feeding without affecting maternal sleep. Immediately after birth, significant physiologic and anatomic changes occur. Thromboembolic events are more common in the postpartum state than during pregnancy, but the majority of women do not require specific thromboprophylaxis but should be encouraged to walk after birth. Women who have not been previously immunized for influenza; tetanus, diphtheria, pertussis (Tdap); and rubella should be offered these immunizations. Women with uncomplicated pregnancies may engage in exercise within days after delivery. Pelvic floor physical therapy performed during pregnancy and postpartum may assist in maintaining or regaining muscle tone of the pelvic floor and may prevent or treat urinary incontinence. Perinatal depression affects one in seven women. Baby blues, which include mood swings, anxiety, tearfulness, and insomnia, should resolve by 2 weeks after delivery. Patients should be screened for depression using a standardized, validated tool and appropriate treatment initiated. All women should undergo a comprehensive postpartum visit within 6 weeks of delivery.   This review contains 2 figures, 4 tables and 34 references Key words: delayed cord clamping, hemodynamic changes, perinatal depression, postpartum, puerperium, rooming in, skin-to-skin contact