chapter 20 postpartum physiology

Question 1

The interval between birth and the return of the reproductive organs to their normal nonpregnant state is called the

Answer 1

postpartum period

Question 2

The postpartum period is also called

Answer 2

puerperium or fourth trimester

Question 3

The return of the uterus to a nonpregnant state after birth is called what

Answer 3

involution

Question 4

when does the involution process begin?

Answer 4

immediately after expulsion of the placenta with contraction of the uterine smooth muscle

Question 5

At the end of the third stage of labor, the uterus is in the _________ approximately ____ cm below the level of the umbilicus with the fundus resting on the ______ ______

Answer 5

-midline
-2
-sacral promontory

Question 6

How much does the uterus weigh at the end of the third stage of labor?

Answer 6

approximately 1000 g

Question 7

within 12 hours postpartum the fundus can rise to approximately what

Answer 7

1 cm above the umbilicus

Question 8

By 24 hours postpartum the uterus is about the same size as it was when?

Answer 8

20 weeks gestation

Question 9

the fundus decends ___ to ___ cm every 24 hours postpartum

Answer 9

1 to 2 cm

Question 10

by the _____ postpartum day the fundus is normally located halfway between the umbilicus and the symphysis pubis

Answer 10

sixth

Question 11

the uterus should not be palpable abdominally after ___ weeks and should have returned to its nonpregnant location by ____ weeks after birth

Answer 11

-two
-six

Question 12

The uterus weighs how many times its prepregnancy weight at full term

Answer 12

11 times

Question 13

the uterus weight involutes to approximately how much by 1 week after birth

Answer 13

500 grams

Question 14

the uterus weight involutes to approximately how much by 2 weeks after birth

Answer 14

300 grams

Question 15

by four weeks after birth the uterus weighs how much

Answer 15

100 grams

Question 16

what is responsible for stimulating the massive growth of the uterus during pregnancy

Answer 16

increased estrogen and progesterone

Question 17

an increase in the number of muscle cells

Answer 17

hyperplasia

Question 18

an enlargement of the existing cells

Answer 18

hypertrophy

Question 19

uterine growth results from both _______ and ______

Answer 19

hyperplasia and hypertrophy

Question 20

the self-destruction of excess hypertrophied tissue

Answer 20

autolysis

Question 21

afterbirth the decrease in progesterone and estrogen causes what

Answer 21

autolysis

Question 22

what causes the slight increase in uterine size following each pregnancy?

Answer 22

additional cells laid down during pregnancy that do not autolysis

Question 23

the failure of the uterus to return to a nonpregnant state due to ineffective uterine contractions

Answer 23

subinvolution

Question 24

what are the most common causes of subinvolution

Answer 24

-retained placenta
-infection

Question 25

postpartum hemostasis is achieved primarily by compression of _______ ______ _______ as the uterine muscle contracts rather than by _____ _____ and ______ ________

Answer 25

-intramyometrial blood vessels -platelet aggregation and clot formation

Question 26

this is released from the pituitary gland and strengthens and coordinates uterine contractions

Answer 26

oxytocin

Question 27

oxytocin promotes ________

Answer 27

hemostasis

Question 28

exogenous oxytocin is called

Answer 28

Pitocin

Question 29

why is pitocin given postpartum

Answer 29

because uterine contractions can become uncoordinated and decrease

Question 30

what can increase the release of oxytocin during the first few days postpartum

Answer 30

breastfeeding

Question 31

breast feeding postpartum releases oxytocin which promotes uterine contractions therefore decreases what

Answer 31

blood loss and risk for postpartum hemorrhage

Question 32

afterpains usually resolve in __ to __ days

Answer 32

3 to 7 days

Question 33

afterpains are more noticeable after births in which the uterus was _________

Answer 33

overdistended

Question 34

what two things usually intensify afterpains because both stimulate uterine contractions

Answer 34

-breastfeeding -exogenous oxytocin

Question 35

immediately after the placenta and membranes are expelled, ______ ______ and _______ reduce the placental site to an irregular nodular and elevated area averaging 4-5 cm in diameter

Answer 35

vascular constriction and thromboses

Question 36

______ growth of the endometrium causes sloughing of necrotic tissue and prevents the scar formation characteristics of normal wound healing

Answer 36

upward

Question 37

the unique healing of the endometrium allows what

Answer 37

resumption of usual cycle changes and implantation and placentation in future pregnancies

Question 38

endometrial regeneration begins within ____ days afterbirth and is completed by the _____ week

Answer 38

-3 days -third week

Question 39

Regeneration at the placental site is completed by the _____ week

Answer 39

sixth

Question 40

the characteristics of postbirth uterine discharge is known as what

Answer 40

lochia

Question 41

lochia correlates with what two things

Answer 41

-uterine involution -changes in the endometrium

Question 42

how long do most women typically experience lochia

Answer 42

4 - 6 weeks

Question 43

for the first two hours after birth how much lochia is to be expected?

Answer 43

that of a heavy menstural period

Question 44

if a woman receives an oxytocin medication the flow of lochia is often _____ until the effects of the medication wear off

Answer 44

scant

Question 45

the amount of lochia after a c-section is less due to what

Answer 45

the surgeon suctions the blood and fluids from the uterus or wipes the lining before closing the incision

Question 46

the flow of lochia usually increases with what

Answer 46

ambulation and breastfeeding

Question 47

a gush of blood when a woman stands is typical because why

Answer 47

blood pools in the vagina when lying down

Question 48

persistence of lochia rubra in the postpartum period suggests continued bleeding as a result of what

Answer 48

retained fragments of the placenta or membranes

Question 49

it is not uncommon for a woman to experience a sudden but brief increase in bleeding 7-14 days postpartum when what occurs

Answer 49

sloughing of eschar over the placental site occurs

Question 50

if bleeding from sloughing of eschar over the placental site lasts longer than 1-2 hours the woman should be evaluated for what

Answer 50

possible retained placental fragments

Question 51

what percentage of women still have normal lochia serosa discharge at their 6 week postpartum exam

Answer 51

10-15

Question 52

the continued flow of lochia serosa or alba by 3-4 weeks after birth can indicate what

Answer 52

endometritis

Question 53

what other symptoms occur with endometritis besides lochia serosa or alba?

Answer 53

-fever -pain -abdominal tenderness

Question 54

lochia should smell like normal menstrual flow, if odor is present it can indicate what

Answer 54

infection

Question 55

bright red lochia is called

Answer 55

rubra

Question 56

pinkish-brown lochia is called

Answer 56

serosa

Question 57

whitish yellow lochia is called

Answer 57

alba

Question 58

how long is lochia rubra to be expected after birth

Answer 58

1-3 days

Question 59

how long is lochia serosa to be expected after birth

Answer 59

4-10 days

Question 60

how long is lochia alba to be expected after birth

Answer 60

10-14 days but can last 3-6 weeks

Question 61

what are the contents of lochia rubra

Answer 61

-blood from placental site -trophoblastic tissue debris -vernix -lanugo -meconium

Question 62

what are the contents of lochia serosa

Answer 62

-blood -wound exudate -RBCs -WBCs -trophoblastic tissue debris -cervical mucus -microorganisms

Question 63

what are the contents of lochia alba

Answer 63

-WBCs -trophoblastic tissue debris

Question 64

two types of postpartum bleeding

Answer 64

lochial and nonlochial bleeding

Question 65

usually trickles from the vaginal opening and the steady flow is greater as the uterus contracts is what kind of bleeding

Answer 65

lochial bleeding

Question 66

bleeding from the source of a tear of the cervix or vagina

Answer 66

nonlochial bleeding

Question 67

the cervix is _____ immediately after birth

Answer 67

soft

Question 68

what changes occur to the cervix 12-18 hours after delivery

Answer 68

it shortens and becomes firmer

Question 69

how long after birth does the cervix shorten, become firm and regain its form?

Answer 69

2-3 days postpartum

Question 70

by day two or three postpartum the cervical dilation decreases to how many cm

Answer 70

2-3

Question 71

by 1 week postpartum the cervical dilation decreases to how many cm

Answer 71

1

Question 72

what happens to the external cervical os after delivery

Answer 72

it never returns to circular shape but looks like a slit often described as fish mouth

Question 73

________ delays the production of cervical and other estrogen-influenced mucus and affects mucosal characteristics

Answer 73

lactation

Question 74

page 419 ovaries section

Answer 74

-