46. Physiologic puerperium Flashcards
what is the puerperium?
the period following delivery of the baby and placenta to 6 weeks postpartum.
what occurs to uterus and cervix in puerperium?
the uterus rapidly decreases in weight from 1000 grams at delivery to 100-200 grams 3 weeks postpartum.
The cervix loses its elasticity and regains its pre-pregnancy firmness
what type of vaginal discharge is seen postpartum?
Shedding of serous exudate, RBCs, WBCs, decidua, epithelial cells, and bacteria (lochia rubra, serosa and alba)
what is lochia rubra?
for a few days after delivery, vaginal discharge appears red.
what is lochia serosa?
from the 4th day postpartum to approx. 2-3 weeks postpartum, vaginal discharge appears pale yellow.
what is lochia alba?
up to a few weeks postpartum, vaginal discharge appears white.
potential pathologies seen with postpartum vaginal discharge
- Endometritis → infection of the endometrial lining; associated with foul-smelling lochia.
- Subinvolution → uterine fails to return to its normal size; potentially presents as prolonged lochia, abnormal uterine bleeding, pelvic pain.
what vaginal and pelvic muscle physiological changes are seen in puerperium?
Fascial stretching and trauma during childbirth result in pelvic muscle relaxation, which may not return to the pregravid state.
*important to perform pelvic floor muscle training (kegel exercises)
Potential subsequent pathologies of pelvic muscle during puerperium?
- Pelvic organ prolapse.
- Urinary incontinence.
what occurs to the peripheral vascular resistance in pueperium?
Marked increase because of the removal of the low-pressure uteroplacental circulatory shunt.
what occurs to the cardiac output and plasma volume in puerperium?
gradually return to normal values during the first
2 weeks postpartum.
As a result of the loss of plasma volume and the diuresis of extracellular fluid, a marked weight loss occurs in the first week.
Peripartum dilated cardiomyopathy occur due to
ventricular dilatation and decreased contractility
that develops in < 0.1% of pregnancies during the last month of pregnancy to 5 months postpartum.
peripartum dilated cardiomyopathy risk is associated with?
increased maternal age and multiparity.
what are the psychological changes in puerperium?
- Postpartum blues (‘baby blues’).
- MDD with peripartum onset (postpartum depression).
- Postpartum psychosis.
In women who do not nurse, menstrual flow usually returns by?
6-8 weeks, although variable
what occurs to the maternal insulin requirements during puerperium?
decrease significantly because of the removal of the placenta, which produces many insulin antagonists. Insulin requirements may go below prepregnant levels during the puerperium, particularly in breastfeeding women
when should women with gestational D.M undergo a 75-g OGTT postpartum?
4-12 weeks postpartum
First gynecological F/U postpartum is recommended at?
6 weeks postpartum
what should a woman that is Rh negative receive postpartum?
an IM injection of Rhogam within 72 h’ postpartum
Rhogam contains antibodies to the Rh-D antigen such that any Rh-positive fetal cells that mix with maternal blood during the time of delivery will be removed from the circulation, before sensitizing the mother’s immune system.
what vaccinations should be given postpartum?
- MMR and Varicella (contraindicated during pregnancy)
2.Tdap
how can we monitor the postpartum mood?
with the PHQ-9 questionnaire or the Edinburgh postnatal depression scale.
Discharge instruction and clinician discussion
- Perineal care
- Wound care in case of cesarean delivery or episiotomy sutures
- Breastfeeding and breast care
- Normal vaginal discharge (lochia) vs. abnormal vaginal discharge (delayed PPH)
- Postpartum contraception
- Postpartum blues and potential problems in the transition to home settings
