16 - Obs - The Puerperium - Physiological changes + General postnatal care

Question 1

Puerperium = The ? week period after deliv, body returns to ? state. Mostly ? care. Maternal morb and mort ass w preg is ? in this period. Many women ? to have probs after discharge, often go untrt/unrecognized.

Answer 1

6wk
prepregnant
midwife
highest
continue

Question 2

Genital Tract:
Placenta separates, ?
contracts, ? occludes placental ?. Uterine size decr over ?wks, 10d uterus no longer palp ?. ? (after pains) for 4d. ? os closed by 3d. ?
may be bloody for 4wks, yellow/? after. Menstruation delayed by ?, but by ? wks if not.

Answer 2

uterus
myometrium
vessels
6
abdominally
contractions
internal
lochia
white
lactation
6

Question 3

CV System:
Cardiac ? and ? vol decr to prepreg levels in 1wk. Loss of ? 6wks. BP back to normal ?
wks.

Urinary Tract:
Physiological ? of preg decr over 3m, GFR ?.

Answer 3

output
plasma
oedema
6

dilatation
decreases

Question 4

Blood:
U&E levels return to normal as normal ???. If no haemorrhage, ? and ? rise w haemoconcentration. WBC ?. Platelets and clotting factors ?, predisp to ???.

Answer 4

GFR
Hb and haematocrit
falls
rise
VTE

Question 5

General PN care
Mother and baby not ?, ?
important. Early ?
encouraged. Counselling and help w ? req. Uterine involution and ?, BP, HR and perineal ? checked ?. Fluid ?
checks to prevent ? if epidural. Analgesics for ? pain – also helped w ? ? ?. ??? checked pre discharge, ?
prescribed if apprt, w laxatives.

Answer 5

separated
privacy
mobilization
bfeeding
lochia
wounds
daily
balance
retention
perineal
pelvic floor exercises
FBC
iron

Question 6

General PN care
Discuss ?, esp if ?, allow to ask qns. Discharge dependent on ? ?, some 6h, others few days. ?? alerted if compx. Advice re ?.
Most women have ? Hx but not recorded. Psych referral for women w Hx, and postnatal plan inv ?? made. Vigilant observation for ?.

Answer 6

delivery
intervention
mothers wishes
GP
contraception
psych
GP
depression