Chapter 21- Maternal Postpartum Changes

Question 1

What is the postpartum period/fourth trimester?

Answer 1

Interval between birth and return of reproductive organs to their nonpregnant state; roughly 6-12 weeks post-birth

Question 2

What Maternal Physiological Changes occur?

Answer 2

• Weight drops from 11- 13 lbs from uterine contents and blood
• Pulse rate decreases and stabilizes
• Hemoglobin rises by 6 weeks postpartum
• Hemorrhoids may become prominent
• Respirations stabilize and ease of respirations occurs
• Hormones levels normalize by 4-5 weeks post partum
• Urinary retention and over distension may occur

Question 3

What is involution?

Answer 3

Return of uterus to nonpregnant state following birth
* Progresses rapidly
– Fundus descends 1 to 2 cm every 24 hours
– 2 weeks after childbirth
uterus lies in true pelvis

Question 4

What is subinvolution?

Answer 4

Failure of uterus to return to nonpregnant state
– Common causes are retained placental fragments and infection

Question 5

What is lochia?

Answer 5

Postbirth uterine discharge

Question 6

What is the difference between Lochia rubra, Lochia serosa, and Lochia alba?

Answer 6

• Lochia rubra: brighter red blood
• Lochia serosa: pinkish-brown discharge (old blood)
• Lochia alba: whitish-yellow discharge (leukocytes)

Question 7

What changes occur to the cervix right after birth?

Answer 7

– Soft immediately after birth
– Within 2 to 3 postpartum days, cervix is 2 to 3 cm, and by 1 week, it is about 1 cm.

Question 8

What is the Ectocervix? What changes occur after birth?

Answer 8

The portion of the cervix that protrudes into the vagina; appears bruised and has small lacerations—optimal conditions to develop infections.

Question 9

What changes occur to the Vagina and perineum?

Answer 9

– Estrogen deprivation: thinness of vaginal mucosa and absence of rugae.
– The vagina gradually decreases in size and regains tone but never completely returns to
prepregnancy state.
– Thickening of vaginal mucosa occurs with return of ovarian function.
– Dryness and coital discomfort (dyspareunia) may persist until return of ovarian function.
– Introitus is erythematous and edematous.
– Episiotomies heal within about 2 weeks.
– Hemorrhoids (anal varicosities) are common and decrease within 6 weeks of childbirth.

Question 10

What changes occur to the abdomen?

Answer 10

• During the first 2 weeks, the abdominal wall remains relaxed.
• The woman has a still-pregnant appearance.
• Return to prepregnancy state takes 6 weeks.
• Depends on previous tone, proper exercise, and amount of adipose tissue

Question 11

What hormone levels drop after pregnancy?

Answer 11

Decreases in human chorionic somatomammotropin (hCS), estrogens, cortisol, and placental enzyme insulinase reverse effects of pregnancy.
– Estrogen and progesterone levels drop markedly.

Question 12

What is the role of the placenta?

Answer 12

Hormone production