Class 7: Post Partum Body System Changes Table Flashcards
(97 cards)
1
Q
what changes occur to the HR, BP, and RR during the postpartum period
A
- HR and BP return to prepregnancy lvls within a few days
- return to prepregnancy RR
2
Q
what changes to T occur during the postpartum period
A
- temp may increase to 38*C within 1st 24 hours due to dehydrating effects of labor
- should be afebrile after 24h
3
Q
describe contractions of the uterus in the postpartum period (2)
A
- 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
4
Q
the relase of oxytocin postpartum is supported by
A
- breastfeeding
5
Q
the continued uterus contractions in postpartum are experienced as…
A
- afterpains / cramps
6
Q
define: involution
A
- the return of the uterus to a nonpregnant state after birth
7
Q
during pregnancy, the uterus enlarges due to hyperplasia and hypertrophy. what occurs after birth?
A
- 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
8
Q
describe changes to uterus size postpartum
A
- rapidly reduces in size after birth
9
Q
the fundus usually descends ___cm q24h postpartum
A
- 1-2 cm every 24 hrs
10
Q
at the end of the 3rd stage of labor, where is the uterus located? how much does it weight?
A
- fundus at or 1-2cm below umbilicus
- 1000 g
11
Q
at 12hrs after birth, where is the uterus located?
A
- may rise to 1cm above umbilicus
12
Q
at 24 hrs after birth, what is the size of the uterus
A
- uterus is about the same size that it was at 20 weeks gestation
13
Q
after 2 weeks, where is the uterus located? how much does it weigh?
A
- uterus is no longer abdominally palpable
- lies in true pelvis, below symphysis
- 350g
14
Q
by 6 weeks postpartum the uterus weighs approx?
A
- 60-80 g
15
Q
describe uterine placement postpartum
A
- should be midline on abdomen
16
Q
deflection of the uterus can indicate?
A
- a distended bladder
17
Q
describe the size and consistency of the uterus postpartum (3)
A
- ~size of a grapefruit
- round
- firm
18
Q
what is uterine atony?
A
- loss of tone in the uterine musculature
19
Q
what indicates uterine atony?
A
- large uterus
- soft/boggy uterus
20
Q
uterine atony is the most common cause of? how?
A
- excessive bleeding in the postpartum period as it means the intra-myometrial blood vessels are not being adequately compressed by the uterine muscle contractions
21
Q
what is subinvolution
A
- the failure of the uterus to return to the prepregnant state
22
Q
subinvolution is often related to.. (2)
A
- retained placental fragments
- infection
23
Q
the unique healing process of the endometrium prevents?
A
- normal scar formation
24
Q
endometrial regeneration is compelte by? except where and when is this compelted?
A
- complete by postpartum day 16
- except at placental site where it is completed at 6 weeks
25
expulsion of the placenta leads to? particularly which ones?
- leads to decrease of placental-produced hormones
- estrogen and progesterone lvls drop markedly
26
in non-lactating birthers, estrogen lvls begin to increase when??
- 2 weeks after birth
27
define: lochia
- the name for the uterine discharge that passes vaginally following birth
28
describe lochia rubra, what can it include?
- bright red or dark bleeding
- can include small clots, blood, decidual & trophoblastic debris
29
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
30
describe the color of lochia serosa, what does it include?
- color: brownish or pinkish color
- includes: old blood, serum, leukocytes, and debris
31
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)
32
describe the color of lochia alba, what does it include?
- white in color
- includes: leukocytes, decidua, epithelial cells, mucus, serum, bacteria
33
what is the heaviness of lochia alba? duration?
- heaviness: light flow or spotting
- duration: day 10 until 4-8 weeks postpartum
34
how large is the cervix within 2-3 days postpartum? 1 week?
- 2-3 days: 2-3 cm
- 1 week: ~1cm
35
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
36
the small lacerations of the cervix postpartum causes what?
- optimal conditions for development of infection
37
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
38
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
39
describe menstruation of lactating birthers
- return of ovulation depends on breast/chest/pumping patterns
- mean time = 6 months after birth
40
describe the consistency of the vagina immediately after birth, why?
- vagina is thin and smooth immediately after birth
- due to edema, increased vascularity
41
describe the consistency of the vagina in 3rd week postpartu,m
- rugae restored
42
describe the size and tone of the vagina postpartum (3)
- decreases in size
- regains tone
- may never return to prepregnancy state
43
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
44
describe mucosa of the vagina postpartum in the lactating person
- may remain atrophic until menses returns
45
perineal lacerations are classified based on?
- tissues/structures involved
46
how many degrees of perineal lacerations are there?
4
47
describe 1st degree of perineal laceration
- involves skin and structures superficial to muscles
48
describe 2nd degree of perineal laceration
- extends thru muscle
49
describe 3rd degree of perineal laceration
- extends thru anal sphincter
50
describe 4th degree perineal laceration
- involves anterior rectal wall
51
describe the site of episiotomies/lacerations repairs initially?
- site initially erythematous and edematous
52
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
53
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
54
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
55
what role does prolactin play postpartum?
- stimulates milk production and secretion
56
what stimulates oxytocin release postpartum? what effect does this have?
- infant sucking at nipple stimulates oxytocin production
- stimulates the milk-ejection reflex
57
what is the nipple erection reflex
-when infant cries or sucks at breast, helps to move thru the ducts to nipple pores
58
what might the person feel as milk ejection occurs?
- tingling sensation
59
birthers w flat or inverted nipples may need?
- additional support to latch infant
60
describe changes to the breasts during the 1st 24 hrs postpartum
- no appreciable changes
61
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
62
describe the firmness of breasts in days 1-2 after birth?
- soft
63
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
64
describe the nipples postpartum (3)
- should have skin intact
- no sores to area
- not painful
65
milk production will stop approx _____ after birth if no breast feeding/pumping
- 1 week
66
what is imp to note w breast feeding
- most substances ingested by the birther will pass to the infant thru chest milk
67
what is the average blood loss for a vaginal birth? c-section?
- vaginal: 300-500 mL
- c-section: 500-1000 mL
68
describe blood volume postpartum
- returns to nonpregnancy lvls within a few days after birth due to diuresis
69
describe cardiac output postpartum
- returns to nonpregnant state after 48 hrs
70
describe position of the heart postpartum
- diaphragm descends = normal cardiac axis is restored
- point of meximal impulse normalized
71
describe BP postpartum w HTN?
- could stay elevated longer
72
describe resp function postpartum
- rapidly returns to prepregnancy lvls following birth
- diaphragm descneds
73
pregnancy proteinuria and glycosuria resolves within...
- 6 weeks after birth
74
what occurs postpartum r/t GU system? why?
- diuresis occurs within 12 hrs
- to rid the body of excess fluid accumulated during pregnancy
75
why does diuresis occur postpartum? (3)
- decreased estrogen
- removal of increased venous pressure in lower extremities
- loss of pregnancy induced increase in blood volume
76
after birth, trauma can occur to?
- urinary meatus
- bladder
- urethra
77
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
78
most birthers are able to void spontaneously within?
- 8 hrs
79
a full/distended bladder can be a signif contributor to? how?
- postpartum uterine bleeding as it displaces uterus (up and to right)
80
postpartum, bladder tone is usually restored within?
- first week after birth w adequate emptying
81
if client was cathetrized during L&D, what is there an increased risk for?
- UTI in postpartum period
82
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
83
describe hbg & hct postpartum
- lvls depend on blood loss
- usually return to non-pregnancy lvls by 8 weeks postpartum
84
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)
85
describe changes to varicosities postpartum
- varicosities of the legs/anus/vulva generally regress entirely following birth
86
describe hunger postpartum, why?
- likely to be quite hungry following initial recovery
- from birth, general fatigue, anesthesia
87
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
88
describe interventions for bowel movements postpartum (2)
- encourage fibre and fluid intake
- stool softeners generally provided postpartum
89
bowel function should return to normal how long postpartum?
- 1 week postpartum
90
what is a specific intervention r/t GI system with a c-section
- should auscultate for bowel sounds
91
supportive tissues of pelvic floor may be ____ after birth
- may be torn or stretched
92
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
93
describe the abdominal wall postpartum
- relaxed postpartum
94
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
95
return to prepregnancy state of abdominal wall depends on? (3)
- previous tone
- exercise
- amt of adipose tissue
96
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
97
how long does it take for the joints to stabilize following birth? this may cause?
- 6-8 weeks
- a permanent increase in shoe size
