Chapter 20 Flashcards
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.
Postpartum Period
Define Involution
return of uterus to prepregnant state
Definition: self-destruction of excess hypertrophied tissue
Autolysis
Tip - Hyperplasia tissue remains - accounts for slight increase in uterine size
How fast does uterus descend?
1cm/ day
By ____ weeks, uterus should not be palpable
Two weeks pp
Subinvolution
Failure if the uterus to return to non-pregnant state Common cause includes retained placental fragments
Contractions are caused by release of ____ from _______ gland. ] Ctx presses blood vessels to promote hemostasis
1 - Oxytocin 2 - Anterior Pituitary Tip - Breastfeeding immediately after birth inc. oxytocin release – reduce risk of postpartum hemorrhage.
Lochia Rubia (Time Frame and Expected Findings)
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
Lochia Serosa (Time Frame and Expected Findings)
Days 4-10 Consists of old blood, serum, leucocytes, tissue debris Pink or brown color Scant amt Increased flow during physical activity
Lochia Alba (Time Frame and Expected Findings)
Days 10-14 Consists of leukocytes, decidua, epithelial cells, mucus serum, bacteria Yellow to white in color Scant amt Fleshy odor
Name some deviations from the normal lochia rubia
Large clots Heavy amt, saturates pad within 1 hour Excessively heavy amt, saturates pad in 15 min Placental fragments
Name some deviations from the normal lochia seosa
Continuation of rubra stage after day 4 Heavy amt, saturates pad within 1 hour (sign of PPH) Foul odor (sign of infection)
Name some deviations from the normal lochia alba
Bright red bleeding saturates pad within 1 hour (sign of late PPH) Foul odor (sign of infection)
Cervix Characteristics before and after birth
- 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)
Pelvic floor torn muscles are healed by ________ postpartum _____ exercises help strengthen perineal muscles and promote healing
6 weeks Kegal
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.
Estrogen 3 weeks
Drop in ____________ levels decrease blood glucose levels during pp period
human chorionic somatomammotropin (HCS) or human placental lactogen (hPL)
PP Metabolic Changes (Insulin, Thyroid, BMR)
Insulin regime for diabetics has to be adjusted Thyroid levels decrease Basal metabolic rate returns to pre-pregnancy levels after 2 weeks post-birth
PP Endocrine Changes (Hormone levels, When does menses return)
Levels of all hormones drop (estrogen, progesterone, prolactin, hCG) Menses return 7 – 9 weeks post-birth
In nonlactating women _______ levels increase x 2 weeks; whereas, _______ levels drop x 3 weeks
Estrogen Prolactin
GI muscle tone and motility _________ post-birth
Decrease
Constipation can occur due to
Dehydration Decrease in GI motility Episiotomy and Perineal Lacerations
Bladder Distention can occur due to
Anesthesia Urethral trauma or pelvic soreness Injury to external genitalia
Definition: a yellowish fluid (first milk) should be present; milk comes in day 3 to 4 post-birth
Colostrum
What is the amount of blood loss for vaginal delivery?
300-500ml - Vaginal 500-1000ml - C/S
Clotting factors _______ after delivery of placenta; returns to normal 2 weeks postpartum
Decrease
Decrease vascular resistance in the pelvis puts the PP woman at risk for
Orthostatic Hypotension
What allows women to tolerate blood loss during birth
Pregnancy Induced Hypervolemia
What are the expected V/S in regards to cardiovascular system?
- 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
Hgb/Hct values drop or increase after birth WBC values drop or increase and why When do the values return to normal?
- 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
Can ovulation occur before the end of the puerperium?
Yes
