6.2a Postpartum Physiological Changes Flashcards
1
Q
Postpartum Physiology
A
- 6-8 weeks for organs to return to normal function.
- Post partum shivers usually start within 30 minutes and last from 2 minutes to an hour
- Uterus contracts immediately after delivery and then the muscles shrink.
- Within 24 hours after delivery uterus shrinks down and fundus should be at the umbilicus
- After 1 week the fundus should be felt halfway between umbilicus and symphysis pubis
- After 6-8 weeks the fundus should be normal
- Breast feeding causes quicker reduction in size of uterus due to oxytocin
- ## Oxytocin’s primary purpose is to contract ducts of breasts to help release milk.
2
Q
Postpartum Physiology
A
- Decidua Basalis has 2 layers, superficial layer sheds and deeper layer regenerates a new endometrium
- Lochia Rubra (red) is the shedding of the decidua superficial layer. (2-3 days)
- Lochia Serosa (watery) - 2-3 weeks
- Lochia Alba (Yellow/White)
3
Q
Post Partum Physiology
A
Cervix Contracts
- After a week cervix will be less than 1 cm dilated. It will never return back to the same shape as before birth. Looks like a large horizontal split
4
Q
Post Partum Physiology
A
- Safe to resume sex 3-4 weeks postpartum
- Ovulation returns 6-8 weeks in women who don’t breastfeed.
- Ovulation doesn’t return for up to 6 months for women who do breastfeed
- Prolactin inhibits sex hormones and ovulation
5
Q
Uterus
A
Involution - Return to nonpregnant state after birth. Begins with contractions after expulsion of fetus
- After birth - fundus 2cm below umbilicus
- 12 hours - fundus rises 1cm above umbilicus
- 24 hours - Uterus same size as 20 weeks of gestation
- Fundus descents 1-2 cm every 24 hours
- Day 6 fundus is halfway between umbilicus and symphysis pubis
- 2 weeks fundus is not palpable
- 6 weeks fundus is returned to normal
6
Q
Uterus
A
- Estrogen and progesterone stimulate the growth of uterus during pregnancy
- After birth, decrease in hormones causes autolysis (self destruction of tissue)
Subinvolution - Failure of uterus to return to pre-pregnant stage due to ineffective uterine contractions.
- Commonly caused by placental fragments and infection
7
Q
Lochia Bleeding
A
- Trickles from vaginal opening
- Greater flow when uterus contracts
- Gush appears following massage
8
Q
Cervix
A
- Soft immediately after birth
- After birth it protrudes into vagina, appears bruised, edematous, and may have lacerations (bad for infection)
- 2-3 days cervix shortens and regains its form
- Never goes back to original shape. Becomes a “fish mouth”
9
Q
Ovaries
A
- Ovulation returns in as early as 27 days (average 7-9 weeks) in non-lactating patients
- Ovulation returns in 6 months for patients who breastfeed
- Prolactin suppresses ovulation
- Because of uncertainty of when ovulation will return, contraceptive education in post-partum is necessary
10
Q
Vagina/Perineum
A
- Estrogen deprivation causes vagina mucosa to be thin and absence of rugae (ridges)
- Rugae re-appears in 3 weeks but never as prominent
- Estrogen deficiency causes decrease vaginal lubrication
- Breastfeeding mothers experience vaginal dryness
Dyspareunia - Localized vaginal dryness and discomfort
- Lasts until menstruation resumes
- Water soluble lubricant during sex is recommended
11
Q
Episiotomy/Lacerations
A
- Initial healing in 2-3 weeks
- 4-6 months to fully repair
12
Q
Hemorrhoids
A
- Anal varicosities which are common
- Develop during pregnancy
SYMPTOMS - Itching/Discomfort
- Bright red bleeding with defecation
- Decrease in size after 6 weeks of birth
13
Q
Kegel Exercises
A
- Help strengthen perineal muscles and encourage healing after birth
14
Q
Painful Cramps in Uterus
A
- After pains
- Breastfeeding causes release of oxytocin which cause contractions leading to after pains
- Happens first few days of postpartum
15
Q
Uterus
A
- Fundus becomes not palpable within 2 weeks of childbirth
16
Q
Lochia
A
- Should only last up to 6 weeks
17
Q
Protruding Abdomen
A
- Can cause women to look pregnant still after birth
- Should return to normal after 6 weeks
- Encourage exercise and sensible weight loss to return tone
18
Q
Frequent Urination After Birth
A
- Diuresis (extra urine) and diaphoresis are normal ways for body to rid fluid retained during pregnancy.
19
Q
Large Breasts After Pregnancy
A
- Due to lactation
- Occurs with drop in estrogen/progesterone after expulsion of placenta
- Because milk is not removed, the process will stop and the milk gets reabsorbed into circulatory system.
INTERVENTIONS - Wear snug bra
- Avoid warmth on breasts
- Icepack/analgesics can be used for pain
20
Q
Prolactin
A
- Inhibits estrogen and vaginal lubrication
- Breastfeeding may lead to dry vagina
- Use of water-based lubricants during sex is recommended
21
Q
VS After Birth Temperature
A
- First 2 hours temp can rise to 100.4 due to dehydration
- Patient should return to normal after 24 hours
- Sepsis watch is placed if temperature remains 100.4+ after 24 hours or persists for 2 days
22
Q
VS After Birth Pulse
A
- Remains elevated for first hour after birth
- Bradycardia is common
- Increasing HR can be due to hypovolemia or hemorrhage
- Returns to normal after 48 hours
23
Q
Blood Pressure
A
- Increases over the first few days after birth (5%)
- Returns to normal after a few weeks to months
- Orthostatic hypotension can develop in first 48 hours
- Low blood pressure can indicate hypovolemia and hemorrhage
- Elevated BP over 140/90 on 2 occasions can indicate gestational hypertension or preeclampsia
24
Q
Respirations
A
- Normal, stays normal right after birth
25
Q
After-Pains
A
Most common in
- Multiparity
- Macrosomia
- Multifetal Pregnancy
- Breastfeeding
- Administration of oxytocin
26
Q
Colostrum
A
- Early milk (clear yellow fluid)
- Mature milk occurs 72-96 hours after birth (lactogenesis 2)
- Engorgement (hard, uncomfortable, elevated temperature) breasts are temporary and last 24-48 hours
27
Q
Non-Breastfeeding Mothers
A
- Prolactin levels drop rapidly
- Engorgement occurs on 3-4 days
- Lactation ceases in a few days to a week
