Ch. 18 Maternal physiologic changes Flashcards
Define involution
Return of the uterus to a nonpregnant state after birth (483)
By the end of the 3rd stage where is the uterus located
Midline 2cm below level of umbilicus (483)
Within 12hrs where is the uterus located
1cm above umbilicus (483)
When should the uterus be nonpalpable
After 2wk, and should return to its nonpregnant location by 6wks after birth (483)
Define subinvolution
Failure of the uterus to return to a nonpregnant state (483)
What is the most common cause of subinvolution
Retained placental fragments and infection (483)
Define hemostasis
Process which causes bleeding to stop, keep blood damaged blood vessels
How does breastfeeding help with decreasing blood loss and reduce risk for postpartum hemorrhage
It increases the release of oxytocin, which strengthens and coordinates uterine contractions, which compresses blood vessels and promote hemostasis
Define lochia
postbirth uterine discharge, initially bright red and may contain small clots
Persist (4-8) after birth (484)
What are the characteristics of lochia rubra
Bright red blood and Decidua and trophoblastic debris
What are the characteristics of lochia serosa
After 3-4days
Pink or brown
Discharge last b/w 22-27days
Define the characteristics of lochia alba
Yellow-white
Leukocytes, Decidua, epithelial cells, mucus, serum, bacteria
What can happen to the lochia if the mother is taking oxytocin
Flow of lochia is often scant until effects of the medication wear off
How can you differentiate b/w lochia bleeding and nonlochial bleeding
Lochia- trickles or gush w/message
nonlochial- bloody discharge spurts from vagina, excessive and bright red
T/F amount of lochia is usually less after a cesarean birth b/c the surgeon sanctions the blood and fluids from uterus
True (485)
How long does it take for the abdominal wall to return almost to its pre-pregnant state
6wk
Decreases in human chronic somatomammotropin, estrogen, cortisol, and placental enzyme insulinase reverse the diabetogenic effects of pregnancy which results in
Lower blood glucose levels in the immediate postpartum.
Mothers with type 1 will require less insulin for several days after birth
After birth which hormones decrease/increase
Decrease- estrogen, progesterone
Increase- prolactin
In nonlactating women ovulation occurs as early as
27days
mean 7-9wk
What is the mean time for ovulation after birth in lactating women
6months
What is responsible for the suppression of ovulation on lactating women
Persistence of elevated serum prolactin levels
About how long does it take for the dilation of the urethra and renal pelvis to return to their nonpregnant state
6wk
If dilation of the urethra persist for 3months or longer their is an increase risk for
UTI
When should the renal glycosuria induced by pregnancy disappear
1wk
What are some of the causes of bladder distention in the postpartum women
Decreased voiding due to decreased urge to void
Postpartal diuresis
What is the average blood loss for a vaginal birth
300-500ml
What is the average blood loss for a cesarean birth
500-1000ml
What happens to the mothers cardiac output after birth
Remain elevated over nonpregnant values for 12wk
What happens to the heart rate and blood pressure, respirations after birth
Return to nonpregnant levels within a few days
When does the colostrum transition into mature milk
About 72-96hrs after birth
t/f Following birth, the women’s 1st menstrual cycle will be heavier than normal and then return to pre-pregnant volume
True
What is the puerperium stage
4th trimester, 3-6wk
interval part between birth and the return of the reproductive organs to their nonpregnant state
Define autolysis
Self- destruction of excess hypertrophied tissue in the uterus
How long should it take until the uterus is nonpalpable
After 2wk postpartum
How long does it take for the uterus to return to its normal size
6wks
T/F Breastfeeding intensifies after birth pains
True because it stimulates contractions
Does lochia have an odor
It should smell like normal menstrual flow. If it is foul there may be an infection
How long should breast tenderness persist
24-48hrs after lactation
How should your explain the concept of the legal exercises
Pretend to stop the flow of urine midstream
During the first 10-12 days after birth, what its the common and acceptable WBC value
20,000-25,000
What is the most serious complication of bladder distention
Excessive urinary bleeding
What is the average weight loss immediate after birth
11-13lbs
Followed by return to prepregnancy weight in 2-3months
T/F afterpains are more noticeable in uterus that were overdistended
True
T/F afterpains are more painful in multifarious women
True
