Assessment of condition and uterine involution
In the postpartum period, it is critically important to daily evaluate the state of the uterus based on three key parameters: uterine fundal height (UFH), consistency, and tenderness. Normally, the organ should be firm and painless. UFH measurement is performed using a tape measure over the pubic bone, with the patient's bladder strictly emptied.
- Day 1: UFH is 15–16 cm.
- Daily dynamics: the fundus descends by approximately 2 cm every day.
- By day 10: the uterus goes completely behind the pubic symphysis and is no longer palpable through the anterior abdominal wall.
For successful involution, regular bowel and bladder emptying is essential. Multiparous women often experience painful afterpains, for which analgesics and antispasmodics are prescribed.
Postpartum ultrasound monitoring
Ultrasound is used to most accurately assess the rate of involution and check the contents of the uterine cavity (presence of blood clots and remnants of decidual tissue).
- Days 1–3: echostructures are detected in small quantities and are localized mainly in the upper parts of the cavity.
- Days 5–7: the frequency of clot detection decreases; they shift to the lower parts, located in close proximity to the internal os.
Special attention is required for the ultrasound picture after a cesarean section. The reduction in uterine length in this case occurs much slower than after vaginal delivery. There is a pronounced thickening of the anterior wall in the lower uterine segment where the sutures are located. The sutures themselves are visualized as a zone of heterogeneous echodensity with punctate and linear signals having low sound transmission (the result of ultrasound reflection from ligatures).
Selection of postpartum contraception
Most women resume sexual activity 6–8 weeks after childbirth, making contraception highly relevant. Lactation is not an absolutely reliable method of protection, and strict requirements are imposed on contraceptives: they must be effective and safe for both mother and child.
- Lactational amenorrhea method: the anterior pituitary secretes prolactin, which blocks follicular maturation and ovulation. The condition for effectiveness is strictly regular breastfeeding (Pearl index is 2–3). However, ovulation occurs as early as the 4th week in 5% of postpartum women.
- Barrier contraception: condoms and spermicides are permitted immediately (Pearl index 4–20). Diaphragms and cervical caps are used no earlier than 6 weeks due to changes in the size of the cervix.
- Hormonal contraception: against the background of breastfeeding, progestin-only oral contraceptives are prescribed from the 6th week (they thicken cervical mucus and cause endometrial atrophy without affecting lactation). If there is no lactation, combined hormonal contraceptives may be used.
- Intrauterine contraception (IUD): according to WHO guidelines, the IUD is inserted either immediately after the delivery of the placenta (increased risk of expulsion) or 4 weeks later, including after a cesarean section.
- Surgical sterilization: tubal ligation is performed in the first 48 hours or delayed, up to 6 weeks.
Natural family planning methods (calendar, basal body temperature) are not used in the postpartum period, as amenorrhea does not provide clear criteria for calculations.
To quickly memorize the rate of uterine involution, use the "Minus Two" rule: every day the uterine fundal height decreases by exactly 2 centimeters until the organ is completely hidden behind the pubic symphysis by the 10th day.
Class and exam questions
When is hospital discharge normally performed after childbirth?
In an uncomplicated postpartum course, the woman and newborn are discharged on days 3–6. Further outpatient follow-up is carried out by the obstetrician-gynecologist and district pediatrician.
Why can the calendar method of contraception not be used after childbirth?
During lactational amenorrhea, there is no ovulation and no clear criteria for calculating safe days. For this reason, temperature and calendar methods are absolutely ineffective and are not used.
How does a cesarean section affect the ultrasound picture of the uterus?
After surgical delivery, the uterus contracts much more slowly. Ultrasound visualizes thickening of the anterior wall in the lower segment and heterogeneous echoes with low sound transmission from surgical sutures.
When can hormonal contraceptives be started during breastfeeding?
Progestin-only pills are appropriately prescribed from the 6th week postpartum. They are safe, do not affect lactation, thicken cervical mucus, and cause endometrial atrophy.
What else to study on this topic
- Changes in the genital organs in the postpartum period
- Changes in the mammary glands and physiology of lactation
- State of the central nervous system and cardiovascular system after childbirth
- Changes in the urinary system and digestive organs
- Dynamics of hormonal status in the postpartum period
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