A postpartum disorder or puerperal disorder is a

disease A disease is a particular abnormal condition that adversely affects the structure or function (biology), function of all or part of an organism and is not immediately due to any external injury. Diseases are often known to be medical condi ...

or condition which presents primarily during the days and weeks after

childbirth Childbirth, also known as labour, parturition and delivery, is the completion of pregnancy, where one or more Fetus, fetuses exits the Womb, internal environment of the mother via vaginal delivery or caesarean section and becomes a newborn to ...

called the

postpartum period The postpartum (or postnatal) period begins after childbirth and is typically considered to last for six to eight weeks. There are three distinct phases of the postnatal period; the acute phase, lasting for six to twelve hours after birth; the ...

. The postpartum period can be divided into three distinct stages: the initial or acute phase, 6–12 hours after childbirth; subacute postpartum period, which lasts two to six weeks, and the delayed postpartum period, which can last up to six months. In the subacute postpartum period, 87% to 94% of women report at least one health problem. Long term health problems (persisting after the delayed postpartum period) are reported by 31% of women. The

World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...

(WHO) describes the postpartum period as the most critical and yet the most neglected phase in the lives of mothers and babies; most

maternal A mother is the female parent of a child. A woman may be considered a mother by virtue of having given birth, by raising a child who may or may not be her biological offspring, or by supplying her ovum for fertilisation in the case of gestatio ...

and newborn deaths occur during the postpartum period.

Physical disorders

Diastasis recti

Diastasis recti Diastasis recti, or rectus abdominis diastasis, is an increased gap between the right and left rectus abdominis muscles. The increased distance between the muscles is created by the stretching of the linea alba, a connective collagen sheath c ...

is a gap between the two sides of the

rectus abdominis muscle The rectus abdominis muscle, () also known as the "abdominal muscle" or simply better known as the "abs", is a pair of segmented skeletal muscle on the ventral aspect of a person's abdomen. The paired muscle is separated at the midline by a ba ...

that can occur in the antenatal and postnatal periods. This condition has no associated morbidity or mortality. Treatment is physiotherapy.

Haemorrhage

Primary postpartum haemorrhage is blood loss following childbirth of more than 500ml (minor) or 1000ml (major). Secondary postpartum haemorrhage is abnormal or excessive bleeding after 24 hours and before 12 weeks postnatally.

Incontinence

Urinary incontinence Urinary incontinence (UI), also known as involuntary urination, is any uncontrolled leakage of urine. It is a common and distressing problem, which may have a significant effect on quality of life. Urinary incontinence is common in older women ...

and

fecal incontinence Fecal incontinence (FI), or in some forms, encopresis, is a lack of control over defecation, leading to involuntary loss of bowel contents—including flatus (gas), liquid stool elements and mucus, or solid feces. FI is a sign or a symptom ...

have been linked to all methods of childbirth, with the incidence of urinary incontinence at six months postpartum being 3–7% and fecal incontinence 1–3%.

Infection

Postpartum infections Postpartum infections, also known as childbed fever and puerperal fever, are any bacterial infections of the female reproductive tract following childbirth or miscarriage. Signs and symptoms usually include a fever greater than , chills, lower ...

, also known as childbed fever and puerperal fever, are any bacterial

infection An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

s of the female reproductive tract following

miscarriage Miscarriage, also known in medical terms as a spontaneous abortion, is an end to pregnancy resulting in the loss and expulsion of an embryo or fetus from the womb before it can fetal viability, survive independently. Miscarriage before 6 weeks ...

. Signs and symptoms usually include a fever greater than 38.0 °C (100.4 °F), chills, lower abdominal pain, and possibly bad-smelling

vaginal discharge Vaginal discharge is a mixture of liquid, cells, and bacteria that lubricate and protect the vagina. This mixture is constantly produced by the cells of the vagina and cervix, and it exits the body through the vaginal opening. The composition, ...

. It usually occurs after the first 24 hours and within the first ten days following delivery.

Mastitis

Puerperal mastitis is inflammation of the breast usually associated with

breastfeeding Breastfeeding, also known as nursing, is the process where breast milk is fed to a child. Infants may suck the milk directly from the breast, or milk may be extracted with a Breast pump, pump and then fed to the infant. The World Health Orga ...

. Symptoms typically include local pain and redness. There is often an associated fever and general soreness. Onset is typically fairly rapid and usually occurs within the first few months of delivery. Complications can include

abscess An abscess is a collection of pus that has built up within the tissue of the body, usually caused by bacterial infection. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pre ...

formation.

Obstetric fistula

Obstetric fistula Obstetric fistula is a medical condition in which a hole develops in the birth canal as a result of childbirth. This can be between the vagina and rectum, ureter, or bladder. It can result in incontinence of urine or feces. Complications may ...

is a medical condition in which a

hole A hole is an opening in or through a particular medium, usually a solid Body (physics), body. Holes occur through natural and artificial processes, and may be useful for various purposes, or may represent a problem needing to be addressed in m ...

develops in the

birth canal In mammals and other animals, the vagina (: vaginas or vaginae) is the elastic, muscular reproductive organ of the female genital tract. In humans, it extends from the vulval vestibule to the cervix (neck of the uterus). The vaginal int ...

as a result of childbirth, typically after a prolonged

obstructed labour Obstructed labour, also known as labour dystocia, is the baby not exiting the pelvis because it is physically blocked during childbirth although the uterus contracts normally. Complications for the baby include not getting enough oxygen which ...

and is preventable with timely access to

Cesarean section Caesarean section, also known as C-section, cesarean, or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen. It is often performed because vaginal delivery would ...

. The fistula can occur between the

vagina In mammals and other animals, the vagina (: vaginas or vaginae) is the elastic, muscular sex organ, reproductive organ of the female genital tract. In humans, it extends from the vulval vestibule to the cervix (neck of the uterus). The #Vag ...

and

rectum The rectum (: rectums or recta) is the final straight portion of the large intestine in humans and some other mammals, and the gut in others. Before expulsion through the anus or cloaca, the rectum stores the feces temporarily. The adult ...

ureter The ureters are tubes composed of smooth muscle that transport urine from the kidneys to the urinary bladder. In an adult human, the ureters typically measure 20 to 30 centimeters in length and about 3 to 4 millimeters in diameter. They are lin ...

, or

bladder The bladder () is a hollow organ in humans and other vertebrates that stores urine from the kidneys. In placental mammals, urine enters the bladder via the ureters and exits via the urethra during urination. In humans, the bladder is a distens ...

. It can result in incontinence of urine or feces.

Perineal tearing

Perineal tear A perineal tear is a laceration of the skin and other soft tissue structures which, in women, separate the vagina from the anus. Perineal tears mainly occur in women as a result of vaginal childbirth, which strains the perineum. It is the most com ...

ing is the spontaneous (unintended) tearing of the skin and other soft tissue structures which, in women, separate the vagina from the anus. Perineal tearing occurs in 85% of vaginal deliveries. At six months postpartum, 21% of women still report perineal pain and 11–49% report sexual problems or painful intercourse.

Peripartum cardiomyopathy

Peripartum cardiomyopathy Peripartum cardiomyopathy (PPCM) is a form of dilated cardiomyopathy that is defined as a deterioration in cardiac function presenting typically between the last month of pregnancy and up to six months postpartum. As with other forms of dilated ca ...

is decrease in heart function which occurs in the last month of pregnancy, or up to six months post-pregnancy. It increases the risk of

congestive heart failure Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome caused by an impairment in the heart's ability to fill with and pump blood. Although symptoms vary based on which side of the heart is affected, HF typically pr ...

, heart

arrhythmias Arrhythmias, also known as cardiac arrhythmias, are irregularities in the heartbeat, including when it is too fast or too slow. Essentially, this is anything but normal sinus rhythm. A resting heart rate that is too fast – above 100 beats ...

thromboembolism Thromboembolism is a condition in which a blood clot (thrombus) breaks off from its original site and travels through the bloodstream (as an embolus) to obstruct a blood vessel, causing tissue ischemia and organ damage. Thromboembolism can affe ...

, and

cardiac arrest Cardiac arrest (also known as sudden cardiac arrest CA is when the heart suddenly and unexpectedly stops beating. When the heart stops beating, blood cannot properly Circulatory system, circulate around the body and the blood flow to the ...

Postpartum thyroiditis

Postpartum thyroiditis Postpartum thyroiditis is a type of thyroiditis, inflammation of the thyroid, occurring in the first 12 months after pregnancy and typically involves hyperthyroidism followed by hypothyroidism which is most often temporary. Postpartum thyroiditi ...

is a phenomenon observed following pregnancy and may involve

hyperthyroidism Hyperthyroidism is a endocrine disease in which the thyroid gland produces excessive amounts of thyroid hormones. Thyrotoxicosis is a condition that occurs due to elevated levels of thyroid hormones of any cause and therefore includes hyperth ...

hypothyroidism Hypothyroidism is an endocrine disease in which the thyroid gland does not produce enough thyroid hormones. It can cause a number of symptoms, such as cold intolerance, poor ability to tolerate cold, fatigue, extreme fatigue, muscle aches, co ...

or the two sequentially. It affects about 5% of all women within a year after giving birth.

Pelvic organ prolapse

Pelvic organ prolapse Pelvic organ prolapse (POP) is characterized by descent of pelvic organs from their normal positions into the vagina. In women, the condition usually occurs when the pelvic floor collapses after gynecological cancer treatment, childbirth or hea ...

occurs when the uterus, bladder or rectum drop lower in the pelvis creating a bulge in the vagina. Approximately half of all women who have given birth experience some degree of pelvic organ prolapse, most frequently as they age and go through

menopause Menopause, also known as the climacteric, is the time when Menstruation, menstrual periods permanently stop, marking the end of the Human reproduction, reproductive stage for the female human. It typically occurs between the ages of 45 and 5 ...

Psychological disorders

Postpartum depression

Postpartum depression Postpartum depression (PPD), also called perinatal depression, is a mood disorder which may be experienced by pregnant or postpartum women. Symptoms include extreme sadness, low energy, anxiety, crying episodes, irritability, and extreme cha ...

is a moderate to severe depressive episode starting anytime during pregnancy or within the four weeks following delivery. It occurs in 4–20% of pregnancies, depending on its definition. Without treatment, postpartum depression can last for months or years. In addition to affecting the mother’s health, it can interfere with her ability to connect with and care for her baby and may cause the baby to have problems with sleeping, eating, and behavior as he or she grows. In 38% of the cases of postpartum depression, women are still depressed three years postpartum. In 0.2% of pregnancies, postpartum depression leads to psychosis. Research indicates that the location and method of postpartum care delivery may not significantly impact depression or anxiety symptoms. Whether care is provided at home, by telephone, or in a clinical setting, the outcomes for maternal mental health are similar. Additionally, integrated care models involving multiple providers have not shown to reduce postpartum depression rates in the first year after birth.

Postpartum psychosis

Postpartum psychosis Postpartum psychosis (PPP), also known as puerperal psychosis or peripartum psychosis, involves the abrupt onset of psychotic symptoms shortly following childbirth, typically within two weeks of delivery but less than 4 weeks postpartum. PPP is ...

is one of the many conditions that may occur following pregnancy or within the six week postpartum period. It is listed under ''mental and behavioral disorders associated with pregnancy, childbirth or the puerperium with psychotic symptoms'', and involves significant mental and behavioural features, including psychotic symptoms such as

delusion A delusion is a fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, hallucination, or some other m ...

s and

hallucinations A hallucination is a perception in the absence of an external stimulus that has the compelling sense of reality. They are distinguishable from several related phenomena, such as dreaming ( REM sleep), which does not involve wakefulness; pse ...

. Mood symptoms associated with depression or mania are also typically present.

Posttraumatic stress disorder (PTSD)

Research shows that symptoms of

Posttraumatic stress disorder Post-traumatic stress disorder (PTSD) is a mental disorder that develops from experiencing a Psychological trauma, traumatic event, such as sexual assault, domestic violence, child abuse, warfare and its associated traumas, natural disaster ...

are common following childbirth, with prevalence of 24–30.1% at six weeks, dropping to 13.6% at six months. PTSD is rarer; a review found that following normal childbirth (excluding stillbirth and some other complications) rates of PTSD ranged from 2.8–5.6% after six weeks, dropping to 1.5% at six months.

References

External links

{{Authority control Childbirth Pathology of pregnancy, childbirth and the puerperium Health issues in pregnancy