Class 4: Body Systems Changes Throughout Perinatal Period Flashcards
describe vital signs throughout pregnancy (BP, HR, T, RR)
- normal BP in pregnancy = <140/90
- increased HR (15-20 bpm)
- temp should remain in N range
- no change or slight increase in RR
describe VS intrapartum (BP, HR, RR, T)
- both SBP and DBP can increase during contractions and return to baseline between
- r/o supine hypotension
- HR may increase in 1st and 2nd stage
- increased RR (d/t increase in physical exertion during labor & increased O2 consumption)
- temp may be slightly elevated
describe VS during postpartum (HR, BP, RR, T)
- HR and BP return to prepregnant lvls within few days
- BP could stay elevated longer w HTN
- return to prepregnancy RR
- temp may increase to 38* within first 24 hrs due to dehydrating effects of labour –> should be afebrile after 24 hrs
describe changes to cervix during pregnancy (3)
- hypertrophy
- hyperplasia
- increased vascularity
describe changes to uterus during pregnancy (5)
- increase in size
- decidua increases
- increased vascularity
- uterus elongates
- uterus rises out of pelvis into abdomen
describe the position of uterus during the first 12 weeks of pregnancy
- within pelvis
describe the position of uterus at 20 weeks of pregnancy
- uterine fundus around the umbilicus
describe the position of uterus from 36-40 weeks of pregnancy
- fundus at xiphoid process
describe changes in contractility during pregnancy
- 16+ weeks Braxton hicks contractions may be felt (painless, irregular, stop w walking or exercise)
describe changes to uteroplacental blood flow during pregnancy
- increases dramatically
- blood flow thru uteroplacental vascular system at 40 weeks is 450-650 mL/min
describe changes to uterine contractions during intrapartum period
- normally intensify and increase in freq throughout labor process
- strong, regular process
what contributes to the start of labor contractions (5)
increased:
- estrogen
- oxytocin
- prostaglandins
- decreased progesterone
- progressive uterine distension and pressure = increase irritability of muscle layer of the uterus
what changes to the cervix occur during the intrapartum period
- effaces (up to 100%) & dilates (from closed to 10cm, aka fully dilated) throughout the first stage of labour
describe changes to the cervix during the post-partum period (4)
- cervix is 2-3cm within 2-3 days postpartum
- by 1 week, 1cm
- bruising & small lacerations at the outer part of the cervix that opens into the vagina
- external os of the cervix never returns to its pre-pregnancy appearance, appear as jagged line/slit instead of circular
describe how ovarian function of lactating vs nonlactating varies during the postpartum period
- lactating and nonlactating persons differ in timing of first ovulation and menstruation d/t elevated prolactin lvls in lactating persons suppress ovulation
describe changes to ovarian function postpartum in nonlactating person (3)
- ovulation can occur as early as 27 days after birth
- mean time = 7-9 weeks postpartum
- 70% of non-lactating birthers menstruation within first 12 week after birth
describe changes to ovarian function postpartum in lactating person
- return of ovulation depends on breast/chest/pumping patterms
- mean time = 6 months after birth
define: lochia
- the name for the uterine discharhe that passes vaginally following birth
what 3 types of lochia occur postpartum
- lochia rubra
- lochia serosa
- lochia alba
describe the appearance of lochia rubra, what does it include (3)?
- bright red or dark bleeding
- includes blood and decidual/trophoblastic debris
- can include small clots
describe the onset, heaviness and duration of lochia rubra
- amount of a heavy menstrual period in first 2 hrs after birth
- may soak a pad every 2-3 hrs
- lasts 3-4 days
describe the appearance of lochia serosa, what does it include (4)?
- brownish or pinkish color
- includes old blood, serum, leukocytes, and debris
describe the heaviness and duration of lochia serosa
- flow = mild to moderate
- days 4-10 (can be longer, lasting up to 27 days, majority day 10)
describe the appearance of lochia alba, what does it include (6)?
- white in color
- includes leukocytes, decidua, epithelial cells, mucus, serum, and bacteria
describe the heaviness and duration of lochia alba
- light flow or spotting
- from day 10 up to 4-8 weeks post partum
describe uterine placement during the postpartum period
- should be midline on the abdomen
deflection of the uterus can indicate??
- a distended bladder
describe the size and consistency of the uterus during the postpartum period
- initially, uterus should feel about size of grapefruit, round
- fundus should feel firm
what does a soft/boggy postpartum indicate?
- uterine atony
what is uterine atony
- the most common cause of excessive bleeding in the postpartum period as it means the intra-myometrial blood vessels are not being adequately compressed by the uterine muscle contractions
what is subinvolution? what is this often related to?
- the failure of the uterus to return to the non pregnant state
- often related to retained placental fragments or infection
expulsion of the placenta leads to? specifically which ones? what happens specifically in non-lactating birthers?
- decreased placental-produced hormones
- estrogen and progesterone lvls drop markedly
- in non-lactating birthers, estrogen lvls begin to increase 2 weeks after birth
describe endomatreial regeneration postpartum
- completed by postpartum day 16, except at the placental site where it is completed at 6 weeks
describe changes to the vagina, vulva, and perineum during pregnancy (5)
- Chadwick sign
- leukorrhea
- increased thickness of mucosa
- increased vascularity and sensitivity
- relaxation of CT
describe changes the vagina, vulva, and perineum during the intrapartum period (2)
- stretching of the vagina and vaginal introitus occurs during birth
- perineal lacerations may occur during birth or epsiotomy may be performed
if forceps are used for birth, what can occur on the pelvic floor?
- hematomas
describe changes to the vagina during the postpartum period (7)
- thin and smooth immediately after birth
- rugae restored in 3rd week postpartum
- gradually decreases in size and regains tone, but may never return to pre-pregnancy state
- dryness (d/t increased estrogen) and coital discomfort may persist until return of ovarian function
- thin vaginal mucosa (d/t estrogen deprivation)
- then thickening of vaginal mucosa with return of ovarian function
- mucosa may remain atrophic in lactating person, at least until menses return
describe changes to the perineum during the postpartum period (2)
- episiotomies/laceration repairs –> site initially erythematous and edematous
- hemorrhoids (anal varicosites) can occur and decreased within 6 weeks of birth (should be soft and pink)
how are perineal lacerations classified?
- based on the tissue/structures involved
what is a 1st degree perineal laceration
- involves skin and structures superficial to the muscles
what is a 2nd degree perineal laceration
- extends thru the muscle
what is a 3rd degree perineal laceration
- extends thru the anal sphincter
what is a 4th degree perineal laceration
- involves the anterior rectal wall
describe the healing process of perineal lacerations
- intiial healing occurs within 2-3 weeks to the point that the perineum is barely distinguishable from that of a nulliparous person
- complete healing can take up to 6 months
describe changes to the breasts during pregnancy (8)
- heightened sensitivity from tingling to sharp pain
- areolae become more pigmented
- dilation of blood vessels in breasts visible
- colstrum may be present and potentially expressed @ 16 weeks or later
- lactations does not occur until after birth (d/t drop in estrogen)
- growth and development of mammary glands completed by mid pregnancy
- fullness, heaviness
- breasts more coarse/lobular w development of lacteriferous ducts
describe changes to the breast during the intrapartum period (6)
- no milk present
- colostrum usually present at birth (or prior)
- oxytocin stimulates the milk-ejection reflex –> stimulates milk letdown
- milk-ejection reflex can occur during labour = letdown of colostrum
- hormones decrease rapidly w birth = stim of prolactin production
- placing infant skin to skin stimulate feeding cues in infant
the 1st feeding (colostrum) should ideally occur how long after birth?
- in the first hour
what stimulates release of prolactin in the post-partum period (3)
- fall of progesterone after birth
- in response to infant feeding and emptying chest/breasts
- stimulates milk production and secretion
what stimulates the release of oxytocin during the postpartum period? what does oxytocin stimulate?
- infant sucking at nipple
- oxytocin stimulates the milk-ejection reflex (may feel tingling sensation as milk ejection occurs)
what is the nipple erection reflex
- when infant cries or sucks at chest/breast, helps to move milk thru the ducts to nipple pores
describe changes to breast during postpartum period
- for 1st 24 hrs after birth, breast tissue has no appreciable changes
- days 1-2 after birth breasts are soft
- nipple should have skin intact, no sores, no pain
what is an imp consideration for indivi w flat or inverted nipple?
- birther may need additional support to latch infant
describe milk production post-partum
- 72-96 hrs after birth, milk production begins
- milk production should stop approx 1 week after birth if no chest/breast feeding/pumping occurs
describe changes to the breast after milk production (6)
breasts become:
- tender
- full
- warm
- may feel lumps as milk ducts fill
- painfully full breasts may occur (engorgement)
- should soften w feedings
whats imp to note w breast milk?
- most substances ingested by the birther will pass to the infant thru breast/chest milk
describe changes to the CVS during pregnancy (7)
- increased CO (~1500mL or 40-50%)
- decreased PVR = decreased venous return
- varicose veins
- lower leg/feet edema (dependent edema)
- heart sounds change (systolic murmur, split S1/S2, audible S3)
- heart position moves up, rotated forward, and left
- increased clotting times
describe the impact of decreased PVR on BP
- decreased BP (DBP>SBP) in 1st and 2nd trimester
- by 3rd trimester usually increases by still within normal ranger
describe changes to the CVS during the intrapartum period (2)
- process of labour increases CO
- supine hypotension when ascending vena cava and descending aorta are compressed
describe changes to CVS during the postpartum period (3)
- blood volume returns to non-pregnancy lvls within a few days of birth d/t diruesis process
- CO returns to non-pregnancy lvls after 48 hrs
- diaphragm descends = normal cardiac axis restored, point of maximal impulse normalized
what is the average blood loss for a vaginal birth? c-section?
- vaginal = 300-500 mLs
- c-section = 500-1000 mLs
describe changes to the resp system during pregnancy (9)
- increased tidal function and minute ventilation
- some dyspnea w normal SpO2
- nasal congestion & nosebleeds
- increased BMR
- change in acid-base balance
- elevated diaphragm
- increased vascularity of mucus membranes
- ligaments of chest relax
- more O2 available to diffuse across placenta to fetus = allow for efficient exchange of CO2 from fetus to pregnant person
what changes in acid-base balance occur during pregnancy (4)
- decreased CO2
- increased O2
- decreased HCO3
- slightly increased blood pH
describe changes to the resp system during the intrapartum period
- increased RR rate due to increase in physical exertion during labour = increased O2 consumption
describe changes to resp system during the postpartum period
- resp function returns rapidly to pre-pregnancy lvls
- diaphragm descends
describe changes to the renal system during pregnancy (4)
- increased CO = increased renal flow to kidneys
- ureters and renal pevlsi relax & dilate which causes flow of urine to slow, urine retention
- increased UO & urinary freq
- increased risk of UTIs and pyelonephritis
how should a urine dip look during pregnancy (5)
should be clean with no:
- leukocytes
- glucose
- ketones
- blood
- protein
what is the best position to promote optimal renal flow
- side lying
describe changes to the renal system during the intrapartum period (2)
- trauma can occur to the urethra and bladder during birth process
- spontaneous voiding can be difficult
why might spontaneous voiding be difficult during the intrapartum period (4)
- tissue edema from pressure of fetus’ presenting part
- discomfort
- analgesia
- embarrassment (difficulty voiding of bedpan)
describe urine dipstick during intrapartum period
- proteinuria may occur due to increase in muscle activity (only time proteinuria may be considered normal)
describe changes to the renal system during the postpartum period
- diuresis occurs within 12 hrs to rid the body of excess fluid accumulated during pregnancy
- may have trauma/bruising to the urinary meatus from birth
what causes diruesis during postpartum period? (3)
due to decreased:
- estrogen
- removal of increased venous pressure in lower extremities
- loss of pregnancy induced increase in blood volume
what can be a significant contributor to postpartum uterine bleeding and why?
- a full/distended bladder
- bc it displaces the uterus
what is imp to note if client was catheterized during labour/birth
- increased risk of UTI in the postpartum period
describe pregnancy proteinuria and glycosuria during the postpartum period
- resolves within 6 weeks after birth
trauma to the bladder and urethra during birth and anesthesia (ie epidural) can affect what? what can this result in? what may be required due to this?
- the voiding reflex
- can result in urinary retention and bladder distension
- may require urinary catheterization if bladder is full/distended and unable to void
most birthers are able to void spontaneously how long after birth?
- within 8 hrs after birth
bladder tone is usually restored how long after birth?
- within 1st week after birth with adequate emptying
describe changes to the integ system during pregnancy (7)
- increased pigmentation on skin by week 16
- stretching of skin (striae gravidarum, palmar itching)
- increased hypertrophy and vascularity
- gums may bleed
- hair and nail changes (vary by person)
- increased perspiration
- acne may worsen
where is increased skin pigmentation seen in pregnant individuals (6)
- nipples
- erealoae
- axillae
- vulva
- melasma
- linea nigra
describe integ changes during the intrapartum period
- minute tears to the skin around the vaginal introitus can occur as a result of stretching during birth
describe integ changes during the postpartum period (2)
- striae, if present, fade from red to silver but are permanent
- increased pigmentation of areolae and linea nigra may not regress completely
describe changes to the hematologic system during pregnancy (5)
- increased blood volume (~50%)
- increased RBCs (~20-30%)
- dilution of RBCs
- increased clotting factors = increased risk fo DVTs or PEs
- normal hgb >110
describe changes to the immunologic system during pregnancy (5)
- spleen enlargment
- increased # of leukocytes but decreased function
- humoral immunity increases antibodies available to be transferred across placenta
- pregnant person more susceptible to viruses and other pathogens
- may have less symptoms from autoimmune disease
describe changes to hematologic system during intrapartum period
- WBC count may increase
describe changes to hematologic system during postpartum period (3)
- hgb and hct lvls depend on blood loss
- increased risk of thromboembolism
- varicosities (legs, anus, vulva) generally regress entirely following birth
what contributes to the increased risk of thromboembolism postpartum (4)
- immobility
- potential vessel damage
- increase in clotting factors
- increase in fibrinogen
hgb and hct lvls usually return to non-pregnancy lvls by??
- 8 week postpartum
describe changes to GI system during pregnancy (8)
- increased intra-abdominal pressure
- relaxed LES = reflux symptoms common
- delayed gastric emptying
- increased incidence of gallstones & cholecystitis
- decreased GI motility = r/o constipation
- increased incidence of gallbladder stasis
- hemorrhoids common
- NV in 1st trimester
describe changes to GI system during intrapartum period (4)
- GI motility and absorption of solid food decreases
- stomach emptying time slows
- NV common
- stool present in rectum may empty during pushing phase
describe changes to GI system during postpartum period (2)
- quite hungry following initial recovery from birth, fatigue, and anesthesia
- spontaneous bowel evacuation may not occur for 2-3 days after birth
bowel function should return to normal how long postpartum?
- within 1 week postpartum
describe nursing care r/t GI system changes postpartum (3)
- encourage fluid and fibre intake
- stool softeners generally provided postpartum
- auscultate for BS
describe changes to the MSK during pregnancy (7)
- increase weight
- change in posture
- pelvis tilts forward (shifts center of gravity)
- ligament and joint laxity
- ligaments and muscles of mid & low back strained
- abdominal wall muscles stretch
- feet may enlarge and/or become flatter
describe changes to MSK during intrapartum period (4)
- backache, joint ache related to fetal position
- labour process can cause muscle cramping (separate from uterine contractions)
- increased muscle activity during labor
- fascial stretching and trauma during birth = pelvis muscle relaxation
describe changes to MSK during postpartum period (4)
- supportive tissues of pelvic floor torn or stretched during birth
- abdominal wall is relaxed post-partum and regains muscular tone over several weeks
- joints stabilized by 6-8 weeks following birth
- may experience a permanent increase in shoe size
how long can it take for the supportive tissues of pelvic floor take to regain tone? what encourages healing?
- can take up to 6 months
- kegel exercises encourage healing
how long can it take for the abdominal wall to return to pre-pregnancy state
- up to 6 weeks
the time for the abdominal wall to return to pre-pregnancy state depends on?
- previous tone
- exercise
- exercise
- amount of adipose tissue
what may persist following birth r/t abdominal wall? what might it require?
- diastasis (separation) of the rectus abdominal muscle can persist
- may require surgery
what impact does estrogen have on the body system (3)
- increases vascularity
- increases tissue mass
- increases blood flow to areas
what impact does progesterone have on the body system? (2)
- stimulates growth of blood vessels
- causes smooth muscle relaxation
epidural insertion can potentially cause? what can this lead to?
- leakage of cerebrospinal fluid into the extradural space during placement of the needle
- which can result in post-dural puncture headache in post-partum period
