[Exam 2] Chapter 15 – Postpartum Adaptations Flashcards
When does the puerperium period begin?
After the delivery of the placenta and lasts 6 weeks.
Reproductive System Adaptations: What events occur after birth?
Shedding of the placenta and subsequent uterine involution involving tissue destruction and repair/remodeling
Reproductive System Adaptations - Uterine Involution: The return to its normal size involves what three processes?
Contraction of muscle fibers to reduce those previously stretched
Catabolism, which shrinks enlarged myometrial cells
Regeneration of uterine epithelium from lower layer of the decidua.
Reproductive System Adaptations - Uterine Involution: Size of uterus after 1 week and at end of 6 weeks?
Weights 1000 g before birth
500 g after 1 week
50 g at end of 6 weeks
Reproductive System Adaptations - Uterine Involution: How quickly does the uterus descent?
At a rate of 1 cm per day.
Reproductive System Adaptations - Uterine Involution: Subinvolution may occur if it does not return to its normal place. What is this?
Delayed or absent involution
Reproductive System Adaptations - Uterine Involution: What helps promote uterine involution?
Complete expulsion of amniotic membranes and placenta at birth, complication-free labor and birth process, breast-feeding- and early ambulation
Reproductive System Adaptations - Uterine Involution: What may inhibit involution
Prolonged labor and difficult birth, incomplete expulsion of amniotic membranes/placenta, uterine infection, and over-distention of uterine muscles.
Reproductive System Adaptations - Uterine Involution and Lochia: What is Lochia?
Discharge that occurs after birth and continues for 4-8 weeks.
Reproductive System Adaptations - Uterine Involution and Lochia: Why does this occur?
From involution. When superfiical layer of decidua basalis becomes necrotic and sloughs off
Reproductive System Adaptations - Uterine Involution and Lochia: How does this appear immediately after birth?
Bright red and contains mainly blood, decidual cells, and RBC and WBCs.
Reproductive System Adaptations - Uterine Involution and Lochia: Lochia passes through what three stages?
Lochia Rubra
Lochia Serosa
Lochia Alba
Reproductive System Adaptations - Uterine Involution and Lochia: What is Lochia Rubra?
Deep-red mixture of mucus, tissue debris, and blood that occurs for first 3-4 days after birth. As bleeding subsides, becomes paler
Reproductive System Adaptations - Uterine Involution and Lochia: What is Lochia Serosa?
2nd stage. Pinkish brown and is expelled 3-10 days postpartum.
Reproductive System Adaptations - Uterine Involution and Lochia: What is Lochia Alba?
Final Stage. Discharge is creamy white or light brown . Occurs 10-14 days but can last 3-6 weeks postpartum
Reproductive System Adaptations - Uterine Involution and Lochia: How should this smell?
Fleshy Smell. offensive odor indicates an infection
Reproductive System Adaptations - Uterine Involution and Afterpain: When is this most common?
In acute multiparous and breast-feeding woman. Due to stimulation during-breast-feeding with oxytocin released
Reproductive System Adaptations - Uterine Involution and Afterpain: Primiparous woman exerpience mild afterpains why?
Because their uterus is able to maintain an contracted state
Reproductive System Adaptations - Uterine Involution and Cervix: When changes occur here?
Internal cervical os returns to normal but external cervical os is no longer shaped like a circle, but looks like a fish mouth
Reproductive System Adaptations - Uterine Involution and Vagina: What happens as estrogen production resums?
Mucosa thickens and rugae return.
Reproductive System Adaptations - Uterine Involution and Vagina: How long for the vaginal epithelium to be restored?
By 6-8 weeks.
Reproductive System Adaptations - Uterine Involution and Perineum: How long for healing if laceration occured?
May take 4-6 months in absence of complications at site.
Reproductive System Adaptations - Uterine Involution and Perineum: What comfort measures can be given for perineal lacerations?
Ice packs, pouring warm water of area with peribottle. witch hzel pads, and sitz baths
Reproductive System Adaptations - Uterine Involution and Perineum: How long to restore muscle tone and why must this be done?
May take 6 months. Failure to restore this may lead to urinary incontinence later in life
Cardio System Adaptation: How long for CO and blood volume to return to normal?
Within 4 weeks.
Cardio System Adaptation - Pulse and BP: Decrease in CO is reflected how?
In bradycaria (40-60 bpm) for first 2 weeks
Cardio System Adaptation - Pulse and BP: What would it mean if woman had tachycardia after birth?
May indicate hypovolemia, dehydration, or hemorrhage.
Cardio System Adaptation - Pulse and BP: Should these decrease in postpartum period?
No.. CO and BP should not decrease
Cardio System Adaptation - Pulse and BP: Trend of BP after birth?
Falls in first 2 days, adn then increases 3-7 days after childbirth, adn returns to normal by 6 weeks
Cardio System Adaptation - coagulation: What changes here during pregnancy affect woman?
Coagulation, reduced fibrinolysis, and pooling adn stasis of blood in lower limb puts them at higher risk for blood clots.
Cardio System Adaptation - coagulation: When does this return to normal??
3 Weeks. Smoking, obesity, or immobility increase risk for this
Cardio System Adaptation - coagulation: Why is this elevated after birth?
Because it was stimulated at birth. Remains elevated for 2-3 weeks. This along with vessel damage during birht places woman at risk for thromboembolism
Cardio System Adaptation - Blood Cellular Components: What happens to Hgb and Hct?
Decrease slightly in first 24 hurs. During next 2 weeks, rise slowly.
Cardio System Adaptation - Blood Cellular Components: What happens to WBC?
Increases in labor and remains elevated for 4-6 days after birth, then falls to 6,000 - 10,000
Urinary System Adaptations: How do women do here after receiving anesthetic block or oxytocin?
Anesthetic inhibits neural functioning of bladder
Oxytocin has ADH effect.
At risk for incomplete emptying, bladder distention, and difficulty voiding
Urinary System Adaptations: Urination may be impeded by what?
Perineal laceration
Generalized swelling and bruising of perineum
Hematomas
Decreased bladder tone
Diminished sensation of bladder pressure
Urinary System Adaptations: Difficulty voiding can lead to what?
Urinary retention, bladder distention, and UTI infection
Urinary System Adaptations: Urinary retention can cause displacement of uterus from midline to where?
To the right and can inhibit the uterus from contracting properly
Urinary System Adaptations: Retention major cause of uterine atony, which is what?
Allows excessive bleeding.
Urinary System Adaptations: Why does postpartum diuresis occur?
As a result of large amount of IV fluid given, decreased ADH effect of oxytocin, and buildup/retention of extra fluids during pregnancy
GI System Adaptations: Why does this return to normal quickly?
Because gravid uterus no longer fills the abdominal cacity and causes pressure on abdominal organs
GI System Adaptations: Progesterone decliens, which usually cuases what?
Caused relaxation of smooth muscle during pregnancy and diminished bowel tone
GI System Adaptations: Decreased peristalsis occurs why?
Analgesics, surgery, diminished intra-abdominal pressure, and low-fiber diet, and insufficient fludi intake
Musculoskeletal System Adaptations: What changes occur during pregnancy?
Increased ligament laxity, weight gain, change in center of gracity, and carpal tunnel syndrome.
Musculoskeletal System Adaptations: What hormones decline after pregnancy which caused the joints to relax?
Relaxin, Estrogen, and Progesterone. Causes joints to return to prepregnant state