Chapter 15: Postpartum Adaptations Flashcards
Puerperium
begins after birth of the placenta and lasts about 6 weeks
Post partum is the first year after birth.
Cervix
returns to pre-pregnant state by 6 weeks. It closes, but never appears the same. The cervical os closes by 2 weeks
The external os widens and never appears the same, more jagged.
Changes in Pulse and BP
Cardiac output and stroke volume decrease after birth (returns about 3 months after)
Reflected in bradycardia (40-60) for 2 wks (because blood to the placenta is now going back to heart)
Tachycardia about 100 and postpartum women re-warrants further investigation. It may indicate hypovolemia, dehydration, or hemorrhage. In most instances of postpartum hemorrhage, blood-pressure and cardiac output remain increased because of the compensatory increase in heart rate.
Blood-pressure remains about the same. A significant increase with a headache may indicate preeclampsia. Decrease may indicate infection or hemorrhage.
Uterus
Involution: changes that return uterus to its nonpregnant size and condition. It includes three processes.
- Contraction of muscle fibers to reduce those previously stretch during pregnancy
- Catabolism, which reduces enlarged, individual myometrial cells 3. Regeneration of the epithelium
Afterbirth it weighs 1000 g or 2.2 pounds. At one week it decreases by 50%. At six weeks it weighs approximately 50 g or 2 ounces. Afterbirth the uterus descends from the level of the umbilicus at a rate of 1cm or one fingerbreadth below the umbilicus. By the end of 10 days you should not be able to palpated because it is in the true pelvis.
Factors that help with uterine involution include complete expulsion of amniotic membrane and placenta, complication free labor and birth, breast-feeding, and early ambulation.
Factors that inhibit include a long difficult birth, incomplete expulsion of placenta, infection, over distention, full bladder, anesthesia, close childbirth spacing.
Lochia
Vaginal discharge afterbirth resulting from involution. The average amount is 240-270 mL or 8-9 ounces. Cesareab births have less because it is removed manually. It usually lasts for three weeks but possibly as long as six. Three stages.
Lochia rubra is a deep red mixture of mucus, tissue, and blood for the first 3 to 4 days.
Lochia serosa is pinkish brown and is from 3 to 10 days. Contains leukocytes, decidual tissue, red blood cells, and serous fluid.
Lochia alba is the final stage and is white or light brown consists of leukocyte, decidual tissue, reduced fluid content. It’s usually from 10 to 14 days but as long as 6 weeks.
Danger sign is the reappearance of bright red blood after it has stopped.
After pains
Uterine contractions that can be worse in multiparity and breast-feeding women. They are usually stronger during breast-feeding because of the release of oxytocin.
Vagina
Usually returns to normal size by 6 to 8 weeks but will always remain a bit larger. As ovarian function and estrogen production resume the mucosa thickens and rugate return in about three weeks. Many women have dryness and discomfort until regular menstruation returns.
Blood components
Red blood cell production ceases after birth causing a low hemoglobin and hematocrit during the first 24 hours. They slowly rise over the next two weeks. White blood cell count increases and remains elevated for 4 to 6 days. This can complicate diagnosis of infection. Clotting factors increase during pregnancy leading to increased risk for coagulation
Postpartum diuresis
Results from large amounts of IV fluids given during labor, the decreasing antidiuretic effective oxytocin as it declines, the building and retention of extra fluids during pregnancy, and decreasing production of aldosterone. These contribute to a rapid filling of the bladder that during the first 12 hours after birth and may continue the 1st week. Normal function is within a month
Glomerular filtration rate and renal plasma flow increase significantly during pregnancy and return after six weeks
A full bladder is dull to percussion. Will displace uterus up and t the right.
Musculoskeletal adaptations
As the levels of relaxin, estrogen, and progesterone decline, the joints returned back to their prepregnant state. Women may have fatigue, activity intolerance, and joint pain. Good body mechanics are essential. Joints are completely stable within 6 to 8 weeks. If rectus muscle tone is not regained through exercise, support may not be adequate during future pregnancies
Integumentary adaptations
The most common period for hair loss is within three months after birth when estrogen returns to normal. Striae gravidarum/stretch marks fade but do not disappear. Diaphoresis is common and helps reduce the amount of fluids retained during pregnancy.
Endocrine adaptations
Estrogen and progesterone drop quickly with delivery of the placenta. Decreased estrogen levels are associated with breast engorgement and diuresis. Is at its lowest level a week after birth. If not breast-feeding it increases by two weeks. It remains low if breast feeding. hCG and hPL are not detectable after a week.
Prolactin declines in 2 weeks if not breastfeeding.
Lactation
Prolactin estrogen and progesterone cause synthesis and secretion of colostrum. Afterbirth when estrogen and progesterone decrease, prolactin is able to cause the secretion of milk which occurs within 4 to 5 days. Oxytocin helps with ejection of milk.
Prolactin is released from the anterior pituitary gland to initiate milk production.
Oxytocin is released from the posterior pituitary gland to promote milk letdown.
Infants sucking stimulates prolactin and oxytocin.
Menstruation and ovulation
For non-lactating women, menstruation resumes as early as 7 to 9 weeks but usually about three months. The first cycle is not ovulatory.
For breast-feeding the time can vary from 3 to 18 months depending on whether there is supplementation with formula.
Ovulation may occur before menstruation. Breast-feeding is not a reliable method of contraception
Attachment
Formation of a relationship between a parent and his or her newborn through a process of physical and emotional interaction. Early contact is crucial.
