Chapters 13, 14, 16, 17, 18 Flashcards
afterpains (afterbirth pains)
Painful uterine cramps that occur intermittently for approximately 2 - 3 days after birth and that result from contractile efforts of the uterus to return to its normal involuted condition.
autolysis
the self-destruction of excess hypertrophied tissue
diastasis recti abdominis
separation of the two rectus muscles along the median line of the abdominal wall
involution
return of the uterus to a nonpregnant state after birth. Begins immediately after expulsion of the placenta.
lochia
vaginal discharge during the puerperium consisting of blood, tissue, and mucous
lochia alba
thin, yellowish to white, vaginal discharge that follows lochia serosa on approximately the tenth day after birth and may last from 2 to 6 weeks postpartum
lochia rubra
red, distinctly blood-tinged vaginal flow that follows birth and lasts 2 to 4 days
lochia serosa
serous, pinkish brown, watery vaginal discharge that follows lochia rubra until approximately the tenth day after birth.
pelvic relaxation
lengthening and weakening of the fascial supports of pelvic structures
puerperium
period between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state; fourth trimester of pregnancy
(typically 6 weeks, but time can vary)
subinvolution
failure of the uterus to reduce to its normal size and condition after pregnancy
At the end of the 3rd stage of labor, where should the uterus be located?
midline, approximately 2 cm below the level of the umbilicus.
12 hours after delivery the fundus can be palpated where?
the level of the umbilicus, possibly slightly above or below. After that fundus descends approximately 1 cm every day.
when should the uterus no longer be palpable abdominably?
2 week after birth
when should the uterus return to its pre-pregnancy state?
6 weeks after birth
What causes autolysis?
decrease in estrogen and progesterone after birth
lochial bleeding
Lochia usually trickles from the vaginal opening. The steady flow increases as the uterus contracts. A gush of lochia may result as the uterus is massaged. If the lochia is dark in color, it has been pooled in the relaxed vagina, and the amount soon lessens to a trickle of bright red lochia ( in the early puerperium)
non-lochial bleeding
if the bloody discharge spurts from the vagina, damage to a blood vessel may have occurred during birth. If so, some of the bleeding is not just normal lochial flow. If the amount of bleeding continues to be excessive and bright red, a vaginal or cervical tear may be the source.
Ovulation after birth
- can occur as soon as 27 days after birth in non-lactating women. With a mean time of 70 -75 days. menstruation typically resumes within 4-6 weeks.
- lactating women ovulation typically occurs at 6 months
postpartal diuresis
profuse diaphoresis often occurs, especially at night, for the first 2 or 3 days after childbirth.
Three postpartal physiologic changes protect the woman by increasing the circulating blood volume
- elimination of uteroplacental circulation reduces the size of the maternal vascular bed by 10-15%.
- loss of placental endocrine function removes the stimulus for vasodilation.
- mobilization of extravascular water stored during pregnancy occurs. In fact, by the 3rd postpartum day the plasma volume has been replenished as extravascular fluid returns to the intravascular space.
Transient anemia
after childbirth the total blood volume declines by approximately 16% from its predelivery value. Should return to normal within 8 weeks post partum
Normal WBC values afterbirth
it is not uncommon for values between 20,000 and 25,000
Temperature
Normal findings after Childbirth
Temp during first 24 hours may rise to 100.4F as a result of dehydrating effects of labor or a consequence of epidural anesthesia. After 24 hours the woman should be afebrile.
Pulse
Normal findings after Childbirth
Pulse returns to nonpregnant levels within a few days postpartum, although the rate of return varies among individual women
Respirations
Normal findings after Childbirth
Respirations should decrease to within the woman’s normal prepregnancy range by 6-8 weeks after birth.
Blood pressure
Normal findings after Childbirth
Blood pressure is altered slightly if at all. Orthostatic hypotension, as indicated by feeling of faintness, or dizziness immediately after standing up, can develop in the first 48 hours as a result of the splanchnic engorgement that may occur after birth.
Temperature
deviations from normal (and causes) after childbirth
a diagnosis of puerperal sepsis is suggested if a rise in maternal temperature to 100.4 is noted after the first 24 hours after childbirth and recurs or persists for 2 days. Other possible diagnoses are mastitis, endometritis, UTI, and other systemic infections
Pulse
deviations from normal (and causes) after childbirth
A rapid pulse rate or one that is increasing may indicate hypovolemia as a result of hemorrhage.
Respirations
deviations from normal (and causes) after childbirth
Hypoventilation (respiratory depression) may follow an unusually high subarachnoid (spinal) block or epidural narcotic after a cesarean birth
Blood pressure
deviations from normal (and causes) after childbirth
A low or decreasing blood pressure may reflect hypovolemia secondary to hemorrhage. However, it is a late sign, and other symptoms of hemorrhage usually alert the staff. An increased reading may result from excessive use of vasopressor or oxytocic medications. Because preeclampsia can persist into or occur first in the postpartum period, routine evaluation of blood pressure is needed. If a woman complains of headache, hypertension must be ruled out as a cause before analgesics are administered.
Varicosities after childbirth
Total or nearly total regression of varicosities is expected after childbirth
Lochia amounts
Scant (less than 2.5 cm) Light (less than 10 cm) Moderate (more than 10 cm) Heavy (one pad saturated within 2 hr) Excessive (one pad saturated within 15 minutes)
couplet care
one nurse, educated in both maternal and newborn care, functions as the primary nurse for both mother and neonate (also known as mother-baby care or single-room maternity care)
engorgement
Swelling of the breast tissue brought about by an increase in blood and lymph supplied to the breast, occurring as early milk (colostrum) transitions to mature milk, at approximately 72 - 96 hours after birth
uterine atony
relaxation of uterine muscles possibly leading to excessive postpartum bleeding and postpartum hemorrhage
warm line
a help line, or consultation service, for families to access, most often for support of newborn care and postpartum care after hospital discharge.
When are low risk complication mothers typically discharged?
24 - 36 hours after vaginal birth, often called early postpartum discharge, shortened hospital stay, or 1-day maternity stay.
What is the greatest risks associated with early discharge for the infant?
jaundice, feeding difficulties, infection, gastrointestinal obstruction, and unrecognized cardiac or respiratory problems.
Health protection Act of 1996
provided minimum standards for health plan coverage for mothers and their newborns. The plan required to allow the new mother and newborn to remain in the hospital for a minimum of 48 hours after a normal vaginal birth and for 96 hours after a cesarean birth.
Advantages of Early Postpartum Discharge
- Reinforces the concept of childbirth as a normal physiologic event.
- Allows shorter separation between mothers and other children.
- Extends a couple’s sense of control and participation beyond the birth itself.
- Capitalizes on the security of the home environment during the stressors of early parenting.
- Decreases unnecessary exposure to pathogens in the hospital environment
- allows beds on the maternity service to be used more effectively (greater turn around)
- Allows more time for mother, father, etc, to bond
- creates less disruption in the daily life of the family
- promotes active involvement of family and support person in assisting mother and newborn.
Disadvantages of early postpartum discharge
- complications (maternal or newborn) may go unrecognized)
- families may be or feel unprepared for the reality they face once the baby is at home.
- The mother is experiencing postpartum pain of discomfort
- the length of time for learning after the birth in the hospital setting is decreased.
- A vulnerability and crisis potential exists for both women and families.
minimum criteria for discharge of a healthy term newborn
- normal physical examination and clinical course
- vital signs WNL and stable for 12 hours prior to discharge
- Minimum of 2 successful feedings and able to coordinate sucking, swallowing, and breathing during feeding.
- urinated regularly and spontaneously stooled at least once
- risk of hyperbilirubinemia assessed and follow-up plans in place PRN.
- circumcision site without significant bleeding
- evaluated and monitored for sepsis
- maternal laboratory data reviewed
- infant blood type and coombs test results reviewed
- Hep B immunization administered
- Newborn hearing and PKU completed.
minimum criteria for discharge of the mother
- Knowledgeable, able, and competent to provide care
- risk factors assessed
- mother and family educated about safe environment
- plan in place for continuing medical care
- if discharged before 48 hr, follow-up within 72 hr by health care professional.
Lochia (days and which flow)
Day 1-3: rubra
Day 4-10: serosa
after day 10: Alba
The most common cause of excessive bleeding after birth is….
uterine atony
The two most important interventions for preventing excessive bleeding are…
- maintaining good uterine tone
- preventing bladder distention
