Initially, the contraction of the uterus is due to a substantial reduction in myometrial cell size it constricts the blood vessels and limits the bleeding. At this point, the uterus has an increased tone, feels firm, and weighs 1000 gms, and at the end of the first week, it weighs 500 gms, and by six weeks, it weighs approximately 50 gms. This rapid uterine contraction can lead to abdominal pain or cramps after childbirth. Immediately following the delivery, the uterus, and the placental site contracts rapidly to prevent further blood loss. Involution, a part of postpartum physiology, is the term given to the process of reproductive organs returning to their prepregnant state. The weight loss due to diuresis may continue up to 6 months after delivery. Further weight loss of 2 to 3 kg can be attributed to the brisk diuresis. There is a weight loss of 5 to 6 kg due to the expulsion of products of gestation and accompanying blood loss. The respiratory rate also begins to fall back to the pre-pregnancy level within 2 to 3 days. A rise of temperature beyond the third day or over the upper limit is usually a sign of infection. There could be a transient temperature rise (by 0.5C) on the third or fourth day due to breast engorgement. The temperature rise is attributable to the systemic absorption of metabolites accumulated due to muscle contractions. The temperature is slightly elevated up to 37.2C (99F) along with increased shivering, sweating, or diaphoresis in the first 24 hours and normalizes within 12 hours. Conversely, high blood pressure could be a sign of pain or pre-eclampsia. A significant decrease (> 20% below baseline) in blood pressure could be a sign of postpartum hemorrhage or septic shock. The blood pressure could be elevated due to pain or excitement but is generally in the normal range. The pulse rate may be elevated a few hours after childbirth due to excitement or pain and usually normalizes on the second day. There is generalized physical fatigue immediately after delivery.
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