Changes in the Blood

■ Leukocytosis occurs during and after labor up to 30,000/^L

■ There is a relative lymphopenia.

■ There is an absolute eosinopenia.

■ During the first few postpartum days, the hemoglobin and hematocrit fluctuate moderately from levels just prior to labor.

By 1 week postpartum, the blood volume has returned to the patient's nonpregnant range.

Cardiac Output

■ The cardiac output remains elevated for > 48 hours postpartum.

■ By 2 weeks postpartum, these changes have returned to nonpregnant levels.

Colostrum is a deep yellow-colored liquid secreted by the breasts that contains minerals, protein, fat, antibodies, complement, macrophages, lymphocytes, lysozymes, lactoferrin, and lactoperoxidase.

Women with extensive pituitary necrosis (Sheehan syndrome) cannot lactate due to the absence of prolactin.

Puerperal fever seldom persists for > 4 to 16 hrs. Other causes of fever (e.g., mastitis, endometritis, UTI, thrombophlebitis) must be excluded.

Milk letdown may be provoked by the cry of the infant or inhibited by stress or fright.

Elevation of plasma fibrinogen and the erythrocyte sedimentation rate remain for > 1 week postpartum.

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