Normal Postpartum Changes Flashcards
What is the term used to describe “the return of the uterus to a non-pregnant state”?
involution
How can the uterus be described in terms of weight and location at the end of the 3rd stage of labor?
1ooo grams
midline and 2 cm below the umbilicus
Where is the uterus and fundus located 12 hours after delivery of the newborn?
fundus is 1 cm above the umbilicus
Twenty-four hours postpartum the uterus is the same size as it was at what point in the pregnancy?
20 weeks gestation
In the first few days after delivery how does the uterus change in size in terms of progression?
decreases in size 1-2 cm every 24 hours
How much does the uterus normally weigh on the 6th post-partum day?
500 grams and halfway between the umbilicus and symp. pubis
What is the definition of subinvolution?
failure of uterus to return to non-pregnant state
How much does the uterus weigh at 2 and 4 weeks postpartum?
300 grams at 2 weeks
100 grams at 4 weeks
When does the uterus return to its non-pregnant location?
6 weeks
What is the definition of autolysis?
a decrease in hormones that leads to a destruction of tissue
How can the cervix be described after birth in terms of consistency and appearance?
soft, protruding into vagina, bruised, swollen, with or without lacerations…optimal environment for infections
What changes occur in the cervix 12-18 hours after birth?
shortens and becomes firmer
How can the cervix be described 2-3 days post-partum?
short, firm, regained form.
cervical os closes gradually
dilation: 2-3 cm
How can the cervix be described 1 week postpartum?
dilation at 1 cm
What is responsible for the decreased vaginal lubrication, thin vaginal mucosa, and absence of rugae in the postpartum woman?
deprivation of estrogen
When do rugae return?
3 weeks, but never the same.
How long do lacerations and incisions typically take to heal?
2-3 weeks to heal and 4-6 months to completely heal
What clinical manifestations are associated with hemorrhoids during the post-partum period
-itching
-discomfort
-bright red bleeding
w/defecation
Expulsion of the placenta leads to a decrease in what 2 hormones?
estrogen and progesterone
The decrease of estrogen and progesterone postpartum cause what?
diuresis of extracellular fluid
How long can hcG show up in maternal blood postpartum?
3-4 weeks
Decrease in progesterone leads to an increase in what hormone?
prolactin
What factors may affect prolactin levels?
frequency and duration of feeding
- use of supplementary feeding
- strength of suckling
What is the function of oxytocin?
milk ejection and let down reflex
What adjustments should be made for the postpartum woman with DMT1?
she will need less insulin. It will be more difficult to read glucose tolerance tests.
When should the provider expect the thyroid to return to normal postpartum?
Pre-pregnancy levels in 4 weeks. Normal in 3 months. She has an increased risk of autoimmune thyroiditis
How long does the basal metabolic rate remain elevated?
1-2 weeks, gradually returns to normal.
What influence the return of abdominal muscle tone?
- previous tone
- exercise
- amount of fat
When can the new mother expect her abdomen to normalize?
for 2 weeks it is relaxed, in 6 weeks it should return to pre-pregnancy state.
What is the term used to describe “separation of abdominal wall muscles”?
diastasis recti abdominis
How long does the renal system take to normalize? What are normal findings in a urine sample?
- 8 weeks
- In 6 weeks, decreased hypotonia and dilation and disappearance of proteinuria
- Lactosuria can occur in breastfeeding mothers
When do mothers start losing fluid after birth?
12 hours
What are normal findings regarding fluid volume changes in the post partum mother for the first few days?
-urine output 3000 ml/day with profuse diuresis and weight loss 5-6 pounds
Urinary retention can cause bleeding and increase the postpartum mother’s risk for infection. When should the nurse expect this to resolve?
5-7 days
What factors decrease the chances of a spontaneous BM after birth?
- opioids
- low peristalsis
- lacerations/soreness
- dehydration and lack of food
When does colustrum “early milk” mature?
72-96 hours
When can the breastfeeding mother expect engorgement to occur?
24-48 hours
When can bottle-feeding mothers expect engorgement?
day 3-4
When can bottle-feeding mothers expect lactation to cease?
a few days to 1 week
What is the average blood loss for a vaginal birth?
300-500 ml
What is the average blood loss for a cesarean birth?
500-1000 ml
How is the new mother’s cardiac output effected in the first 2 postpartum weeks?
down 30%
When can the nurse expect normal cardiac output for the new mom?
6-8 weeks
What are normal findings in terms of vital signs in the postpartum woman?
- increased HR for 1st hour
- decreased HR 40-50 bpm is common
- increased BP for a few days
- low grade fever for 24 hours (not above 100.4)
- shivering for the first few minutes
What are normal findings in terms of blood components in the postpartum woman?
- moderately decreased HCT for 3-4 days
- WBC above 30,000 which can obscure the diagnosis of an acute infection
- clotting factors and fibrinogen remain high
- may find fibrin split products in blood
