Chapter 20

Question 1

Definition: The six-week period after childbirth; a time of rapid physiological changes within the woman’s body a sit returns to a prepregnant state.

Answer 1

Postpartum Period

Question 2

Define Involution

Answer 2

return of uterus to prepregnant state

Question 3

Definition: self-destruction of excess hypertrophied tissue

Answer 3

Autolysis

Tip - Hyperplasia tissue remains - accounts for slight increase in uterine size

Question 4

How fast does uterus descend?

Answer 4

1cm/ day

Question 5

By ____ weeks, uterus should not be palpable

Answer 5

Two weeks pp

Question 6

Subinvolution

Answer 6

Failure if the uterus to return to non-pregnant state Common cause includes retained placental fragments

Question 7

Contractions are caused by release of ____ from _______ gland. ] Ctx presses blood vessels to promote hemostasis

Answer 7

1 - Oxytocin 2 - Anterior Pituitary Tip - Breastfeeding immediately after birth inc. oxytocin release – reduce risk of postpartum hemorrhage.

Question 8

Lochia Rubia (Time Frame and Expected Findings)

Answer 8

Days 1-3 Dark Red consisting of mainly blood, decidual and trophoblastic debris Consists of small clots Moderate to scant amt Increased flow on standing or breastfeeding Fleshy odor

Question 9

Lochia Serosa (Time Frame and Expected Findings)

Answer 9

Days 4-10 Consists of old blood, serum, leucocytes, tissue debris Pink or brown color Scant amt Increased flow during physical activity

Question 10

Lochia Alba (Time Frame and Expected Findings)

Answer 10

Days 10-14 Consists of leukocytes, decidua, epithelial cells, mucus serum, bacteria Yellow to white in color Scant amt Fleshy odor

Question 11

Name some deviations from the normal lochia rubia

Answer 11

Large clots Heavy amt, saturates pad within 1 hour Excessively heavy amt, saturates pad in 15 min Placental fragments

Question 12

Name some deviations from the normal lochia seosa

Answer 12

Continuation of rubra stage after day 4 Heavy amt, saturates pad within 1 hour (sign of PPH) Foul odor (sign of infection)

Question 13

Name some deviations from the normal lochia alba

Answer 13

Bright red bleeding saturates pad within 1 hour (sign of late PPH) Foul odor (sign of infection)

Question 14

Cervix Characteristics before and after birth

Answer 14

• Nulliparous cervix is in shape of a donut - After birth -> appears red, edematous, bruised - External cervical os never regains pre-pregnancy appearance (appears as a jagged slit)

Question 15

Pelvic floor torn muscles are healed by ________ postpartum _____ exercises help strengthen perineal muscles and promote healing

Answer 15

6 weeks Kegal

Question 16

Postpartum _______ deprivation is responsible for thinness if vaginal mucosa, absence of rugae, and decreased amount of lubrication. Rugae reappear within ______ but never as promenint as the nulliparous woman.

Answer 16

Estrogen 3 weeks

Question 17

Drop in ____________ levels decrease blood glucose levels during pp period

Answer 17

human chorionic somatomammotropin (HCS) or human placental lactogen (hPL)

Question 18

PP Metabolic Changes (Insulin, Thyroid, BMR)

Answer 18

Insulin regime for diabetics has to be adjusted Thyroid levels decrease Basal metabolic rate returns to pre-pregnancy levels after 2 weeks post-birth

Question 19

PP Endocrine Changes (Hormone levels, When does menses return)

Answer 19

Levels of all hormones drop (estrogen, progesterone, prolactin, hCG) Menses return 7 – 9 weeks post-birth

Question 20

In nonlactating women _______ levels increase x 2 weeks; whereas, _______ levels drop x 3 weeks

Answer 20

Estrogen Prolactin

Question 21

GI muscle tone and motility _________ post-birth

Answer 21

Decrease

Question 22

Constipation can occur due to

Answer 22

Dehydration Decrease in GI motility Episiotomy and Perineal Lacerations

Question 23

Bladder Distention can occur due to

Answer 23

Anesthesia Urethral trauma or pelvic soreness Injury to external genitalia

Question 24

Definition: a yellowish fluid (first milk) should be present; milk comes in day 3 to 4 post-birth

Answer 24

Colostrum

Question 25

What is the amount of blood loss for vaginal delivery?

Answer 25

300-500ml - Vaginal 500-1000ml - C/S

Question 26

Clotting factors _______ after delivery of placenta; returns to normal 2 weeks postpartum

Answer 26

Decrease

Question 27

Decrease vascular resistance in the pelvis puts the PP woman at risk for

Answer 27

Orthostatic Hypotension

Question 28

What allows women to tolerate blood loss during birth

Answer 28

Pregnancy Induced Hypervolemia

Question 29

What are the expected V/S in regards to cardiovascular system?

Answer 29

• increase in b/p during first few days after birth. b/p return to prepregnant levels after a few weeks. BP >140/90 on 2 or more occasions at least 6 hours apart indicate preeclampsia - May have tachycardia d/t dehydration or late PPH - pulse rate, stroke vol, cardiac output (60-80% over prelabor value) increase during pregnancy; returns to prelabor values within a hour

Question 30

Hgb/Hct values drop or increase after birth WBC values drop or increase and why When do the values return to normal?

Answer 30

• Hgb/HCT or (H&H) – drop after birth (normal response): Returns to prepregnant levels at 6-8 wks pp - WBC – 20,000 to 25,000 mg/dl; increase due to stress of labor and birth. Returns to normal levels within 7 days

Question 31

Can ovulation occur before the end of the puerperium?

Answer 31

Yes