Normal Postpartum Changes
Parameter | First 24 hours | First 3–4 days | 5 days–2 weeks | After 2 weeks | After 4 weeks |
|---|---|---|---|---|---|
Clinical | |||||
Heart rate | Starts decreasing | Decreased to baseline | Baseline | Baseline | Baseline |
Temperature | Slightly elevated | Usually baseline | Baseline | Baseline | Baseline |
Vaginal discharge | Bloody (lochia rubra) | Bloody (lochia rubra) | Pale brown (lochia serosa)* | Pale brown to yellowish white (lochia alba) | Yellowish white to normal |
Urine volume | Increased | Increased | Decreasing to baseline | Baseline | Baseline |
Uterus | Begins involution | Continues involution | Firm, no longer tender Located about midway between the symphysis and umbilicus | Not palpable in the abdomen | Prepregnancy size |
Mood | Postpartum blues (baby blues) possible | Postpartum blues (baby blues) possible | Normal by 7 to 14 days | Baseline | Baseline |
Breasts (if not breastfeeding) | Slightly enlarged | Engorged | Decreasing | Baseline | Baseline |
Ovulation (if not breastfeeding) | Unlikely | Unlikely | Unlikely | Unlikely but possible | Possible; contraception required if appropriate |
Laboratory | |||||
WBC count | Up to 20,000–30,000/mcL | Decreasing | Decreasing to baseline | Baseline | Baseline |
Plasma fibrinogen and ESR | Elevated | Elevated | Decreasing to normal after 7 days | Baseline | Baseline |
* Placental site sloughing may result in blood loss of about 250 mL at 7–14 days. | |||||
ESR = erythrocyte sedimentation rate; WBC = white blood cell count. | |||||