Ch 18: Maternal Physiologic Changes in the postpartum Flashcards
Uterus
Contractions (After birth)
Lochia rubra
Lochia serosa
Lochia alba
Cervix
Vagina and perineum
Reproductive system and associated structures
one of the first things to adapt to that postpartum body is the uterus
Involution process is the return of the uterus to a non-pregnant state following birth
Uterus
Progresses rapidly
Fundus descends 1 to 2 cm every 24 hours
2 weeks after childbirth the uterus is no longer palpable
two weeks after delivery it is nestled right where it should be
and is now no longer an abdominal organ it’s going to return to it’s not pregnant state
Returns to a nonpregnant state by 6 weeks
Involution process is the return of the uterus to a non-pregnant state following birth
post birth after birth contractions this is the chemical symbol for oxytocin
postpartum hemostasis is achieved by compression of the intramyometrial blood vessels as the uterine muscle contracts - what we’re trying to achieve is that hemostasis of those blood vessels hormone
oxytocin released from that pituitary gland strengthens and coordinates that - we want women to contract
the more babies they have the harder that uterus has got to work in trying to involute so some of these contractions women can report as being just as strong or stronger than labor contractions - actually want something stronger than Ibuprofen for these contractions
Postpartum hemostasis achieved by compression of intramyometrial blood vessels as uterine muscle contracts
Hormone oxytocin, released from pituitary gland, strengthens and coordinates uterine contractions
Contractions (After birth)
different from menstrual blood
This is the discharge that we have after delivery
is actual blood and decidual and trophoblastic debris so you have to kind of look at it as being more debris and not so much blood at the beginning there is a good mixture of blood and so that’s why it has that really purplish red appearance to it this is the kind of discharge you’re going to see in the hospital those first three days sometimes four
Blood and decidual and trophoblastic debris
Duration of 3 to 4 days
Lochia rubra
kind of a mix it’s kind of a pinkish orangish discharge and it consists of Old Blood - orange brown color and serum and white blood cells and just more debris that’s just the uterus cleaning itself out that’s going to take over right about day four and it’s going to persist for upwards of three or more weeks
Old blood, serum, leukocytes, and debris
Duration of 22 to 27 days
Lochia serosa
Leukocytes, decidua, epithelial cells, mucus, serum, and bacteria
Continues 2 to 6 weeks after birth
which is going to continue for about 2 to 6 weeks after birth
whitish yellowish color and it is mostly mucus serum bacteria white blood cells epithelial cells there’s no blood or Old Blood visible
Lochia alba
Is the next to start changing in postpartum
by the time you’re 12 hours postpartum the cervix has already started to progress towards that pre-pregnant state
may actually have a clot that will lodge because that dilation has started to regress soon after delivery
Soft immediately after birth
During the next 12 to 18 hours the cervix shortens, becomes firm, and regains prepregnant form
during the next 12 to 18 hours the cervix will shorten so it’s going to start to be less than it’s going to shorten and kind of thicken up it’s been up and it’s going to start to regain that non or that pre-pregnant form
Cervical os, dilated to 10 cm during labor, closes gradually
Cervix
Postpartum estrogen deprivation responsible for thinness of vaginal mucosa and absence of rugae
Vaginal rugae reappear within 3 weeks
Thickening of vaginal mucosa occurs with return of ovarian function
Dryness and coital discomfort, dyspareunia, may persist until return of ovarian function
Introitus is erythematous and edematous
Episiotomies heal within 2 to 3 weeks (May take longer)
Hemorrhoids (anal varicosities) are common and decrease within 6 weeks of childbirth
Pelvic muscular support
Vagina and perineum
estrogen deprivation that we see especially in a breastfeeding mom is responsible for the thinness of that vaginal mucosa and the absence of the Rouge the actual vaginal Vault that has all this little wrinkles and gets all stretched out during delivery
Postpartum estrogen deprivation responsible for thinness of vaginal mucosa and absence of rugae
women have kind of like a pseudomenopausal state and the few weeks after delivery because estrogen is so low not unlike menopause so women who are choosing to breastfeed will have a prolonged a deprivation of estrogen because we know that estrogen is going to inhibit that way that lactation feedback so estrogen is too high mom’s not going to make any milk so we need estrogen to be low unfortunately that low level of estrogen is also going to cause a lot of dryness and discomfort in the vagina painful intercourse
as ovulation returns so does the hydration of the vaginal mucosa and that reggae and troitus is going to be have erythema and be a little identities
Dryness and coital discomfort, dyspareunia, may persist until return of ovarian function
Have erythema and be a little indentous as that makes sense that their vaginal delivery there will be some trauma to the introitus
Introitus is erythematous and edematous
any lacerations or episiotomies usually heal within just a couple of weeks if they’re extensive care like a third or fourth degree but obviously can take much longer
Episiotomies heal within 2 to 3 weeks (May take longer)
hemorrhoids which are those anal varicosities are very common and pregnancy but typically decrease within those six weeks
Hemorrhoids (anal varicosities) are common and decrease within 6 weeks of childbirth
postpartum pelvic muscular support supportive tissues of pelvic floor that are torn or stretched during childbirth it really kind of depends on the trauma to the pelvic musculature as to how that’s going to heal it can require up to 6 months to regain full tone to the pelvic floor
Supportive tissues of pelvic floor torn or stretched during childbirth
Require up to 6 months to regain tone
Kegel exercises encourage healing
Pelvic muscular support
During first 2 weeks abdominal wall remains relaxed
Woman has still-pregnant appearance
Return to prepregnancy state takes 6 weeks
Depends on previous tone, proper exercise, and amount of adipose tissue
Abdomen
The abdomen so during this first couple of weeks the abdominal wall remains fairly relaxed it’s been stretched out and unless mama has been doing quite a few core exercises while she was pregnant and prior to she could very well still look very pregnant
During first 2 weeks abdominal wall remains relaxed