Class 7: Post Partum Body System Changes Table Flashcards
what changes occur to the HR, BP, and RR during the postpartum period
- HR and BP return to prepregnancy lvls within a few days
- return to prepregnancy RR
what changes to T occur during the postpartum period
- temp may increase to 38*C within 1st 24 hours due to dehydrating effects of labor
- should be afebrile after 24h
describe contractions of the uterus in the postpartum period (2)
- release of oxytocin from pituitary gland strengthens/coordinates muscle contractions in postpartum period
- continued muscle contractions of uterus support achievement of hemostasis by compression of intra-myometrial blood vessels
the relase of oxytocin postpartum is supported by
- breastfeeding
the continued uterus contractions in postpartum are experienced as…
- afterpains / cramps
define: involution
- the return of the uterus to a nonpregnant state after birth
during pregnancy, the uterus enlarges due to hyperplasia and hypertrophy. what occurs after birth?
- autolysis destroys the hypertrophied cells
- the uterus remains slightly larger in size after each pregnancy due to the additional cells from the process of hyperplasia
describe changes to uterus size postpartum
- rapidly reduces in size after birth
the fundus usually descends ___cm q24h postpartum
- 1-2 cm every 24 hrs
two weeks after birth, where does the uterus lie?
- lies in true pelvis below symphysis
at the end of the 3rd stage of labor, where is the uterus located? how much does it weight?
- fundus 2cm below umbilicus
- 1000 g
at 12hrs after birth, where is the uterus located?
- may rise to 1cm above umbilicus
at 24 hrs after birth, where is the uterus located?
- uterus is about the same size that it was at 20 weeks gestation
after 2 weeks, where is the uterus located? how much does it weigh?
- uterus is no longer abdominally palpable
- 350g
by 6 weeks postpartum the uterus weighs approx?
- 60-80 g
describe uterine placement postpartum
- should be midline on abdomen
deflection of the uterus can indicate?
- a distended bladder
describe the size and consistency of the uterus postpartum (3)
- ~size of a grapefruit
- round
- firm
what is uterine atony?
- loss of tone in the uterine musculature
what indicates uterine atony?
- large uterus
- soft/boggy uterus
uterine atony is the most common cause of? how?
- 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
- the failure of the uterus to return to the prepregnant state
subinvolution is often related to.. (2)
- retained placental fragments
- infection
the unique healing process of the endometrium prevents?
- normal scar formation
endometrial regeneration is compelte by? expect where and when is this compelted?
- complete by postpartum day 16
- except at placental site where it is completed at 6 weeks
expulsion of the placenta leads to? particularly which ones?
- leads to decrease of placental-produced hormones
- estrogen and progesterone lvls drop markedly
in non-lactating birthers, estrogen lvls begin to increase when??
- 2 weeks after birth
define: lochia
- the name for the uterine discharge that passes vaginally following birth
describe lochia rubra, what can it include?
- bright red or dark bleeding
- can include small clots, blood, decidual & trophoblastic debris
describe the heaviness and duration of lochia rubra
- heaviness: amt of a heavy menstrual period in first 2 hrs after birth, may soak a pad q2-3 h
- duration: 3-4 days
describe the color of lochia serosa, what does it include?
- color: brownish or pinkish color
- includes: old blood, serum, leukocytes, and debris
what is the duration of lochia serosa, heaviness?
- heaviness: mild to moderatr
- duration: days 4-10 (can last up to 27 days, majority day 10)
describe the color of lochia alba, what does it include?
- white in color
- includes: leukocytes, decidua, epithelial cells, mucus, serum, bacteria
what is the heaviness of lochia alba? duration?
- heaviness: light flow or spotting
- duration: day 10 until 4-8 weeks postpartum
how large is the cervix within 2-3 days postpartum? 1 week?
- 2-3 days: 2-3 cm
- 1 week: ~1cm
describe the appearance of the cervix postpartum?
- outer part of the cervix that opens into the vagina (ectocervix) appears bruised and has small lacerations
- external os of cervix never returns to its pre-pregnancy appearance = jagged line/slit instead of circular
the small lacerations of the cervix postpartum causes what?
- optimal conditions for development of infection
describe the differences in ovarian function in lactating vs nonlactating persons? why does this occur?
- differ in timing of ovulation and menstruation
- bc elevated prolactin lvls in lactating persons suppress ovulation
describe menstruation of non-lactating birthers
- 70% menstruate within the first 12 weeks after birth
- ovulation can occur as early as 27 days after birth, mean time = 7-9 weeks postpartum
describe menstruation of lactating birthers
- return of ovulation depends on breast/chest/pumping patterns
- mean time = 6 months after birth
describe the consistency of the vagina immediately after birth, why?
- vagina is thin and smooth immediately after birth
- due to edema, increased vascularity
describe the consistency of the vagina in 3rd week postpartu,m
- rugae restored
describe the size and tone of the vagina postpartum (3)
- decreases in size
- regains tone
- may never return to prepregnancy state
what impact does decreased estrogen postpartum have on the vagina (3)? how long does this last?
- dry
- coital discomfort
- thin vaginal mucosa
- until return of ovarian function
describe mucosa of the vagina postpartum in the lactating person
- may remain atrophic until menses returns
perineal lacerations are classified based on?
- tissues/structures involved
how many degrees of perineal lacerations are there?
4
describe 1st degree of perineal laceration
- involves skin and structures superficial to muscles
describe 2nd degree of perineal laceration
- extends thru muscle
describe 3rd degree of perineal laceration
- extends thru anal sphincter
describe 4th degree perineal laceration
- involves anterior rectal wall
describe the site of episiotomies/lacerations repairs initially?
- site initially erythematous and edematous
describe the healing of episiotomies/lacerations repairs postpartum
- initial healing occurs within 2-3 weeks to the point that the perinum is barely distinguishable from that of a nulliparous person
- complete healing can take up to 6 months
what can occur and be decreased within the postpartum period r/t to the perineum? what can they look like?
- hemorrhoids can occur and decreased within 6 weeks after birth
- should be pink and soft
what stimulates prolactin release after birth? what else stimulates its release?
- fall of progesterone
- also produced in response to infant feeding and emptying chest/breasts
what role does prolactin play postpartum?
- stimulates milk production and secretion
what stimulates oxytocin release postpartum? what effect does this have?
- infant sucking at nipple stimulates oxytocin production
- stimulates the milk-ejection reflex
what is the nipple erection reflex
-when infant cries or sucks at breast, helps to move thru the ducts to nipple pores
what might the person feel as milk ejection occurs?
- tingling sensation
birthers w flat or inverted nipples may need?
- additional support to latch infant
describe changes to the breasts during the 1st 24 hrs postpartum
- no appreciable changes
what is present at birth r/t breasts? at what point does milk production begin?
- colstrum present at birth
- 72-96 hrs after birth milk production begins
describe the firmness of breasts in days 1-2 after birth?
- soft
describe the breasts after milk production (6)
- firm
- tender
- warm
- lumps as milk ducts fill
- painfully full breasts may occur (engorgement)
- breasts should soften w feedings
describe the nipples postpartum (3)
- should have skin intact
- no sores to area
- not painful
milk production will stop approx _____ after birth if no breast feeding/pumping
- 1 week
what is imp to note w breast feeding
- most substances ingested by the birther will pass to the infant thru chest milk
what is the average blood loss for a vaginal birth? c-section?
- vaginal: 300-500 mL
- c-section: 500-1000 mL
describe blood volume postpartum
- returns to nonpregnancy lvls within a few days after birth due to diuresis
describe cardiac output postpartum
- returns to nonpregnant state after 48 hrs
describe position of the heart postpartum
- diaphragm descends = normal cardiac axis is restored
- point of meximal impulse normalized
describe BP postpartum w HTN?
- could stay elevated longer
describe resp function postpartum
- rapidly returns to prepregnancy lvls following birth
- diaphragm descneds
pregnancy proteinuria and glycosuria resolves within…
- 6 weeks after birth
what occurs postpartum r/t GU system? why?
- diuresis occurs within 12 hrs
- to rid the body of excess fluid accumulated during pregnancy
why does diuresis occur postpartum? (3)
- decreased estrogen
- removal of increased venous pressure in lower extremities
- loss of pregnancy induced increase in blood volume
after birth, trauma can occur to?
- urinary meatus
- bladder
- urethra
what impact can trauma to the GU system have d/t birth and anesthesia? what might this require?
- affect voiding reflex = urinary retention and bladder distension
- may require urinary catheter if bladder distended/full and unable to void
most birthers are able to void spontaneously within?
- 8 hrs
a full/distended bladder can be a signif contributor to? how?
- postpartum uterine bleeding as it displaces uterus (up and to right)
postpartum, bladder tone is usually restored within?
- first week after birth w adequate emptying
if client was cathetrized during L&D, what is there an increased risk for?
- UTI in postpartum period
describe changes to integ system postpartum
- striae, if present, fade from red to silver but permanent
- increased pigmentation of areolae and linea nigra may not regress completely
describe hbg & hct postpartum
- lvls depend on blood loss
- usually return to non-pregnancy lvls by 8 weeks postpartum
why is there an increased risk of thromboembolism postpartum?
due to:
- immobility
- potential vessel damage
- increase in clotting factors and fibrinogen in pregnancy and immediate postpartum (esp w c-section)
describe changes to varicosities postpartum
- varicosities of the legs/anus/vulva generally regress entirely following birth
describe hunger postpartum, why?
- likely to be quite hungry following initial recovery
- from birth, general fatigue, anesthesia
spontaneous bowel evacuation may not occur for how long after birth? why?
- may not occur for 2-3 days
- due to: decreased muscle tone, decrease in food/fluids during birth, anticipated discomfort to perineum
describe interventions for bowel movements postpartum (2)
- encourage fibre and fluid intake
- stool softeners generally provided postpartum
bowel function should return to normal how long postpartum?
- 1 week postpartum
what is a specific intervention r/t GI system with a c-section
- should auscultate for bowel sounds
supportive tissues of pelvic floor may be ____ after birth
- may be torn or stretched
how long can it take for the tissue of the pelvic floor to regain tone? what can encourage healing?
- can take up to 6 months to regain tone
- kegel exercises encourage healing
describe the abdominal wall postpartum
- relaxed postpartum
how long does it take for the abdominal wall to regain muscular tone
- regains tone over several weeks –> can take up to 6 weeks to return to prepregnancy state
return to prepregnancy state of abdominal wall depends on? (3)
- previous tone
- exercise
- amt of adipose tissue
what may persist r/t MSk system following birth? what might this require?
- diastasis (seperation) of the rectus abdominis muscle can persist
- may require surgery
how long does it take for the joints to stabilize following birth? this may cause?
- 6-8 weeks
- a permanent increase in shoe size
