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What is the puerperium?
This is the period following delivery. It lasts six weeks but this figure is really only for convenience and is not marked by any particular milestone. The puerperal period is a continuum with changes taking place, both physically and emotionally, following the period of pregnancy and eventual delivery.
What happens in the puerperium?
For the majority of women, this period passes relatively smoothly, with realization of their hopes and adjustments to motherhood as they had expected. For a very significant minority, things do not go according to expectations. Problems can range from the relatively minor to quite serious and complex ones, as we shall see below.
Pain after delivery
What causes perineal or vaginal pain after delivery?
For those women who achieve a successful vaginal delivery, be it spontaneous or with some instrumental assistance, an episiotomy may be applied to ease delivery. This is repaired immediately but, for the first day or two, the area may be quite sore.
Alternatively, in the course of delivery there could be a tear (which is also repaired immediately after delivery) and/or bruising in the vaginal and vulval areas. These could produce soreness, which tend to make sitting and walking rather uncomfortable. The healing is quite rapid and usually the pain is gone within about three or four days.
Are there any other sources of pain?
Haematoma (blood-clot) formation within the vaginal wall is another significant source of perineal or vaginal pain occurring shortly after delivery. The pain is usually progressive, starting only a few hours after delivery. If it remains undiagnosed for a lengthy period of time, it may lead to urine retention. Examination will readily reveal the swelling, usually in the vaginal canal.
If the injury leading to the haematoma formation is high in the genital tract, the haematoma may form in the pelvic cavity and an ultrasound is the readily available means of establishing the diagnosis.
What causes haematoma formation?
Usually it is the trauma of delivery that causes rupture of blood vessels underneath the vaginal skin. Accordingly, there is no surface evidence of the damage and that's why it may remain undetected for hours, even days.
Alternatively, a haematoma may result from an inappropriately repaired episiotomy or tear. Laceration to the cervix may also lead to a pelvic haematoma.
What is the treatment for a haematoma?
The clot has to be accessed and drained. The bleeding vessels are then secured with absorbable stitches. Most affected women are quite amazed at the instant and almost total relief obtained after such a seemingly simple procedure.
What happens if the haematoma is in the pelvis?
If this is not progressive - which is usually the case - the preferred approach is conservative management. Pain associated with a pelvic haematoma is usually adequately managed using ordinary pain-control medication. The haematoma will clear up with time. The only risk, albeit small, is that it could get infected, where a change of plan becomes necessary (see below).