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OB > 1. Postpartum > Flashcards

1. Postpartum Flashcards

1
Q

Three divisions of the uterus

A

1) Corpus (Fundus)
2) Isthmus
3) Cervix (Neck)

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2
Q

What is the isthmus?

A

The lower uterine segment

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3
Q

Early 20th century word for postpartum

A

Puerperium

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4
Q

Two types of physiologic changes during the postpartum period

A

Retrogressive: Uterus
Progressive: Nipples

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5
Q

Duration of postpartum period

A

6 weeks or 42 days

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6
Q

The rapid return of the uterus to the non-pregnant state refers to what?

A

Uterine involution

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7
Q

What causes uterine involution?

A

Endogenous oxytocin released from the pituitary

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8
Q

Two main processes involved in uterine involution:

A

1) Contractions of the uterine smooth muscle fibers

2) Contractions continue reducing the size of the uterus

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9
Q

What is one result of the uterine contractions (of the smooth muscle fibers)?

A

o In time, thrombi form within the uterine wall and permanently seal the area.

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10
Q

Fundus location: Immediately post-partum

A

Halfway between the symphysus pubis and the umbulicus

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11
Q

Fundus location: 12 hours post partum

A

One finger ABOVE the umbilicus

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12
Q

How quickly does the fundus descend?

A
  • In the first 12 hours, it ascends a little

- After that, it will descend 1-2 fingerbredths every 2 hours

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13
Q

Where should the fundus be 24 hours postpartum?

A

At 24 hours, the fundus should be at umbilicus or one finger breadth (cm) below the umbilicus.

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14
Q

How much time does it take before the fundus is no longer palpable? What factor might speed this up.

A
  • After ten days

* Breastfeeding may speed it up

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15
Q

What is one factor that makes the first hour after birth so dangerous for a woman?

A

Uterine atony and the resulting risk of hemorrhage

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16
Q

What is uterine atony? Why is it dangerous?

A

o Uterus has no tone – not contracting

o Can lead to hemorrhage: One of the top reasons women die worldwide.

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17
Q

Prophylactic treatment for uterine atony. What is the dose and rate?

A

PITOCIN:

  • 1000cc with 20 units of pitocin x2
  • Rate: 100 - 125cc / hr
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18
Q

The failure or delay of hthe uterus to return to the non-pregnant state refers to __________.

A

Subinvolution

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19
Q

What causes subinvolution?

A

Infection or retained placental fragments

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20
Q

How long do uterine contractions continue?

A

Through the postpartum period

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21
Q

What causes the development of lochia?

A

Blood vessels clamp down, uterine lining sloughs out, maternal blood goes with it.

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22
Q

What pregnancy hormones are reduced immediately postpartum? (2)

A

Estrogen, Progesterone

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23
Q

Progesterone ceases until ______

A

First ovulation

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24
Q

When does endometrial regeneration occur?

A

Within six weeks after delivery

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25
Q

What comprises lochia?

A

Uterine discharge of blood, waste

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26
Q

What are the three types of lochia?

A

Lochia rubra
Lochia serosa
Lochia alba

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27
Q

What is lochia rubra?
• Days after birth
• Color
• Composition (4)

A
  • Days after birth: 1-3
  • Color: Bright red
  • Composition: Leukocytes, bacteria, white blood cells, fragments of lining
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28
Q

What is lochia serosa?
• Days after birth
• Color
• Composition

A
  • Days after birth: 3-10
  • Color: Pinkish brown
  • Composition: Leukocytes invade the area and help heal
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29
Q

What is lochia alba?
• Days after birth
• Color
• Composition

A
  • Days after birth: Day 10 or 11 to 3 weeks (can last up to 5 weeks)
  • Color Pale (Amount is decreased)
  • Composition: Cells, serum, leukocytes, bacteria
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30
Q

Bleeding: What is the first thing you do?

A

Massage the fundus

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31
Q

How does the fundus respond to massage?

A

If it’s soft, it will contract.

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32
Q

Any time you enter any patient’s room, you should assess what three things?

A
  • Pain
  • Bleeding
  • IV site
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33
Q

Define scant lochia

A

<2.5 cm (1 in ch) stain

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34
Q

Define light lochia

A

2.5 - 10 cm (1-4”) stain

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35
Q

Define moderate lochia

A

10-15cm (4 to 6”) stain

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36
Q

Define heavy lochia

A

Saturated in 1 hours time

37
Q

What causes pregnancy hormones to decrease?

A

Expulsion of placenta

38
Q

Five hormones that decrease with placental expulsion

A 
o	Human Placental Lactogen (hPL)
o	Human chorionic gonadotropin (hCG)
o	Estrogen
o	Progesterone
o	Cortisol
39
Q

Functions of Human placental lactogen (hPL) in pregnancy (2)

A
  • Promotes normal nutrition and growth of the fetus

* Promotes maternal breast development and lactation

40
Q

Function of human chorionic gonadotropin (hCG) in pregnancy (2)

A
  • Helps to maintain the corpus luteum and persist for the first 6-8 weeks of pregnancy
  • Helps to secrete progesterone and estrogen
41
Q

Function of Estrogen in pregnancy (3)

A
  • Breast enlargement
  • Growth of breast ducts
  • Enlargement of the external genitalia
42
Q

Function of progesterone in pregnancy (1)

A

• Promotes normal continuation of pregnancy

43
Q

Function of Cortisol in pregnancy (2)

A
  • Helps with metabolism of glucose, protein, fats

* Anti-inflammatory effect that is thought to prevent rejection of pregnancy.

44
Q

What is lactation?

A

The formation of breast milk

45
Q

What stimulates the growth of milk glands?

A

Estrogen level produced by the placenta

46
Q

What causes breasts to increase in size? (2)

A
  • Larger glands

* Accumulated fluid

47
Q

Changes in breasts postpartum

A

o First two days: Very little difference in a woman
o First 2-3 days: Colostrum
o 3-5 days: Breasts becomes full

48
Q

Role of suckling (2)

A

o Causes continued release of oxytocin and prolactin

o Production of milk depends on the suckling of the infant or the use of a breast pump.

49
Q

What happens to the vagina post-partum?

A

Rugae

50
Q

How can you advise a mother to tighten her vagina?

A

Kegels

51
Q

Changes to the cervix post-partum (timing)

A

o Contraction of cervix toward its pre-preganant state begins at once.
o By the end of the seventh day, external os opening narrows to the size of a pencil.

52
Q

Changes in the perineum postpartum (3)

A
  • Edema
  • Bruising
  • Hemorrhoids
53
Q

The cervix of someone who never had a baby is known as:

A

Nulliparous cervix

54
Q

The cervix of someone who has had a baby is known as:

A

Parous cervix

55
Q

How does a nulliparous cervix differ from a parous cervix?

A

The nulliparous cervix has a round os, the parous cervix has a slit os.

56
Q

For every 250 mL of blood loss (2 changes)

A

o Four point increase in hematocrit

o 1g decrease in hemoglobin

57
Q

How much blood loss at birth is considered normal for:

  • Vaginal birth
  • Caesarean birth
A
  • Vaginal birth: Up to 500 cc

* Caesarean birth: Up to 1000 cc

58
Q

What happens to maternal cardiac output postpartum? What is the risk?

A

Increase in maternal cardiac output

**RISK: HTN

59
Q

What causes increase to maternal cardiac output postpartum (4)?

A

o 1) Blood from the uteroplacental unit now returns to the maternal central.

o 2) Pressure on the blood vessels from gravid uterus is gone

o 3) Excess extracellular fluid returns

o 4) Also, blood vessels are constricting

60
Q

o During the postpartum period, the body rids itself of excess plasma volume that was needed during pregnancy by two main routes:

A

o Diuresis: 3,000 cc/day

o Diaphoresis: Especially at night (2nd night: wakes up soaked)

61
Q

Cardiac output postpartum (timing)

A

o Remains elevated for at least 48 hours postpartum

o Returns to pre-pregnancy levels within 2 weeks postpartum

62
Q

Post-partum changes: Blood levels

A
  • Hemoconcentration (due to volume loss, RBCs become more concentrated)
  • Elevated WBCs (Not a concern unless there’s a source of infection)
63
Q

Other postpartum changes (6)

A 
o	Increased appetite
o	Delayed bowel evacuation
o	Urinary retention
o	Stabilization of joints
o	Reverse of hyperpigmentation
o	Percieved Hair Loss
64
Q

When should you worry about postpartum urinary retention?

A

Cath if mom doesn’t pee for 6-8 hours after labor

65
Q

What makes a postpartum woman’s hips hurt?

A

Relaxin ⇒ Makes hips pliable. Sometimes painful.

66
Q

What are “normal” causes of fever postpartum?

A

Related to dehydration and exhaustion

67
Q

8 Components of postpartum nursing assessment

A 
o	Vital signs
o	Breasts and nipples
o	Abdomen
o	Uterus / fundus
o	Bladder
o	Perineum: Intact?  Episiotomy?
o	Lochia
o	Lower extremities
68
Q

If the fundus is to the _____, it is likely because _______.

A

If the fundus is to the right, it is likely because she has a full bladder.

69
Q

Fundal assessment: Possible abnormal findings

A
  • Fundal height greater than expected

* Fundus not firm (“boggy”)

70
Q

Woman’s position for a perineal assessment

A

Side-lying position, bent knee

71
Q

Three things to check for during a perineal assessment

A
  • Edema
  • Bruising
  • Well-approximated wound margins form an episiotomy / laceration tear
72
Q

What is an episiotomy?

A

A surgical incision of the perineum to prevent tearing and help to release pressure on the fetal head at birth

73
Q

What is a laceration?

A
  • When the woman tears on her own

* A jagged cut or tear that may involve only the skin layer or may penetrate deep subcutaneous tissues or tendons

74
Q

How long does it take lacerations / repairs to heal?

A

2-3 weeks postpartum

75
Q

A laceration affecting the _______ may cause a woman to have difficulty urinating after birth

A

Periurethral

76
Q

Tears in the _____ may be a source of significant bleeding after birth

A

The Cervix

77
Q

What does a 1st degree perineal tear involve?

A

Superficial vaginal mucosa or perineal skin

78
Q

What does a second degree perineal tear involve?

A

Deeper tissues, may include muscles of perineum

79
Q

What does a third degree perineal tear involve?

A

Anal sphincter

80
Q

What does a third degree perineal tear involve?

A

Anal sphincter into rectal mucosa

81
Q

Perineal care: Six items

A

o Mesh underwear
o Should change pad each time she goes to the bathroom
o Tucks: Hemorrhoid cream: Keep it in the fridge; put it in the fold of incision or hemorrhoid.
o Peripad (ice)
o Peripodal
o Sitz bath: Great for hemorrhoids or an episiotomy. “The poor man’s bidet.”

82
Q

Plan of care / interventions (7)

A

o Prevention of infection
o Prevention of excess bleeding
o Promote comfort, rest, ambulation, exercise
o Promote nutrition
o Promotion of normal bowel and bladder functions
o Breast feeding promotion or lactation suppression
o Health promotion / protection of future pregnancy

83
Q

Nutrition needs: Pregnancy v. Postpartum

A
  • 500 additional calories per day to breastfeed

* 300 additional calories a day for pregnancy

84
Q

Five components of postpartum psychological assessment

A 
o	Impact of birth experience
o	Maternal self image / sexuality
o	Family structure and functioning
o	Impact of cultural diversity
o	Adaptation to parenthood / parent
85
Q

3 stages of maternal postpartum adjustment

A
  • 1st phase: Dependent: “Taking it in”
  • 2nd phase: Dependent-independent: “Taking hold”
  • 3rd phase: Interdependent: “Letting Go”
86
Q

3 stages of paternal postpartum adjustment

A
  • Stage 1: Expectations
  • Stage 2: Reality
  • Stage 3: Transition to mastery
87
Q

Postpartum blues
• Prevalence
• Timing
• Symptoms

A
  • Approximately 50-80% prevalence
  • Peaks by within the first week and usually resolves by the second week
  • Symptoms are usually unrelated to events. Emotionally labile, Transient
88
Q

Postpartum depression prevalence

A

15-20% of women

89
Q

Signs and symptoms of postpartum depression (6)

A
  • Worsening of sleep disturbances
  • Appetite change
  • Worsening depression and irritability
  • Withdrawal and social isolation
  • Lacks compensatory measures
  • Interaction with baby is burdensome and demanding

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