ch. 20 postpartum physiology

Question 1

reproductive system and associated structures: postpartum period

Answer 1

postpartum period: interval between birth and return of the reproductive organs to their non-pregnant state
- referred to as puerperium, or “fourth trimester of pregnancy)

Question 2

reproductive system and associated structures: uterus

Answer 2

(a) involution process
- autolysis: cells body no longer needs
- subinvolution: goes back to size, behind pelvic bone
(b) contractions:
- afterpains: allows for involution
(c) placental site: where lochia comes from

Question 3

reproductive system and associated structures: lochia

Answer 3

postbirth uterine discharge
- bleeding postpartum
- 2 weeks
(a) types:
- (p1) rubra: bright red (2-3 days)
- (p2) serosa: pinkish brown
- (p3) alba: whiteish yellow

Question 4

reproductive system and associated structures: cervix

Answer 4

spongy, bruised, lacerated (repaired)

Question 5

reproductive system and associated structures: ovaries

Answer 5

normal period resumes 12 weeks (3 months)
- resumption of ovulation and menses
- lactating vs. non-lactating women
- lactating/breastfed -> no menses BUT Q3 feeds for effectiveness

Question 6

reproductive system and associated structures: vagina/perineum

Answer 6

• episiotomy and laceration assessments (lateral, up/down)
• hemorrhoids (can occur in 3rd trimester, lateral position for assessment, infection/hematoma assessment

Question 7

reproductive system and associated structures: pelvic muscular support

Answer 7

• kegel exercises (strengthen vaginal muscles, 200/day) (tight/release vaginal muscles)
• pelvic relaxation (pelvic tilt, restrengthen)

Question 8

reproductive system and associated structures: breast

Answer 8

1) breastfeeding mothers:
(a) colostrum: early mulk (2nd trimester, “liquid gold”, very healthy for bones, protein/amino acids)
(b) transitions to mature milk in 72-96 hours
(c) lactogenesis II: aka “milk coming in”
(d) engorgement: breasts become rock hard, very firm
- comfort measures: supportive bras, pads in bra, cold packs, cabbage leaves

2) non-breastfeeding mothers:
- engorgement resolves in 24-48 hours after milk comes in (not comfortable with lactating but feel okay pumping)
- lactation ceases within a few days to 1 week (avoid warm water/stimulation on breast)

Question 9

cardiovascular system

Answer 9

1) blood volume:
- vaginal birth (300-500cc loss)
- cesarean section (800-1000cc loss)
- heart works extra hard

2) cardiac output increases:
- during labor & immediate pp, then returns to normal

3) vital signs:
- may see increase in temp (38) in first 24 hours, THEN normal
- d/t birth process, lactogenesis

4) varcosities:
- regress rapidly after birth
- spider nevi varicose veins
- heart compensates for extra blood volume

5) blood compenents:
- hemotocrit/hemoglobin
- WBC: can rise to 30,000, return to normal in 1-2 wks
- coagulation factors: clotting factors/fibrinogen rise during pregnancy & immediate pp
- increase risks for DVT & PE for up to 12 weeks

TIP:
- risk for 3 months
- protects women from bleeding out (watch DVT)

Question 10

respiratory system

Answer 10

1) immediate decrease in intraabdominal pressure at birth

2) decreased pressure on the diaphragm

3) reduced pulmonary blood flow

4) chest wall compliance

5) the decline in progesterone that occurs with loss of the placenta causes PaCO2 levels to rise

Question 11

endocrine system

Answer 11

1) placental hormones:
- estrogen/progesterone levels decrease

2) pituitary hormones/ovarian function
- prolactin: remains elevated in women who breastfeed
- nonbreastfeeding: prolactin levels decrease after birth and reach the nonpregnant range by the third postpartum week

3) metabolic changes

Question 12

urinary system

Answer 12

1) renal function:
- renal glycosuria disappears by 1 week postpartum

2) fluid loss (2L):
- postpartal diuresis of extracellular fluid (menopausal)

3) urethrea/bladder
- immediately after birth
- excessive bleeding can occur if bladder becomes distended
- stress incontinence

Question 13

GI system

Answer 13

1) bowel evacuation
- 2-3 days post birth
- anal sphincter lacerations (3/4th degree) are associated with postpartum incontinence
- if anal incontinence lasts beyond postpartum period, f/u needed to determine the specific cause and appropriate treatment (rectal fistula)

Question 14

integumentary system

Answer 14

1) melasma (mask of pregnancy) disappears

2) hyperpigmentation of the aerolar and linea nigra may NOT regress completely

3) striae gravidarum (stretch marks)
- silver white: light complex
- dark: darker complection

4) angiomatas (vascular spiders) disappears

5) hair loss often reported during the first 3 months postpartum (decreased estrogen + thinning hair

Question 15

muskuloskeletal system

Answer 15

1) adaptation of system are reversed

2) the return of muscle tone depends on previous tone, proper exercise, and amount of adipose tissue present

3) diastasis recti abdominis: abdominal wall muscle separates

4) joints are stabilized 6-8 weeks after birth

Question 16

neurological system

Answer 16

1) changes result from reversal of maternal adaptations to pregnnacy and from trauma dring labor and childbirth

2) pregnancy induced neurologic discomforts abate after birth

3) headaches are common in the first postpartum week

Question 17

immune system

Answer 17

1) gradually returns to its prepregnnat state - exact timeline unclear

2) rebound of the immune system can trigger “flare ups” of autoimmmune conditions