Normal Postpartum Changes

Question 1

What is the term used to describe “the return of the uterus to a non-pregnant state”?

Answer 1

involution

Question 2

How can the uterus be described in terms of weight and location at the end of the 3rd stage of labor?

Answer 2

1ooo grams

midline and 2 cm below the umbilicus

Question 3

Where is the uterus and fundus located 12 hours after delivery of the newborn?

Answer 3

fundus is 1 cm above the umbilicus

Question 4

Twenty-four hours postpartum the uterus is the same size as it was at what point in the pregnancy?

Answer 4

20 weeks gestation

Question 5

In the first few days after delivery how does the uterus change in size in terms of progression?

Answer 5

decreases in size 1-2 cm every 24 hours

Question 6

How much does the uterus normally weigh on the 6th post-partum day?

Answer 6

500 grams and halfway between the umbilicus and symp. pubis

Question 7

What is the definition of subinvolution?

Answer 7

failure of uterus to return to non-pregnant state

Question 8

How much does the uterus weigh at 2 and 4 weeks postpartum?

Answer 8

300 grams at 2 weeks

100 grams at 4 weeks

Question 9

When does the uterus return to its non-pregnant location?

Answer 9

6 weeks

Question 10

What is the definition of autolysis?

Answer 10

a decrease in hormones that leads to a destruction of tissue

Question 11

How can the cervix be described after birth in terms of consistency and appearance?

Answer 11

soft, protruding into vagina, bruised, swollen, with or without lacerations…optimal environment for infections

Question 12

What changes occur in the cervix 12-18 hours after birth?

Answer 12

shortens and becomes firmer

Question 13

How can the cervix be described 2-3 days post-partum?

Answer 13

short, firm, regained form.
cervical os closes gradually
dilation: 2-3 cm

Question 14

How can the cervix be described 1 week postpartum?

Answer 14

dilation at 1 cm

Question 15

What is responsible for the decreased vaginal lubrication, thin vaginal mucosa, and absence of rugae in the postpartum woman?

Answer 15

deprivation of estrogen

Question 16

When do rugae return?

Answer 16

3 weeks, but never the same.

Question 17

How long do lacerations and incisions typically take to heal?

Answer 17

2-3 weeks to heal and 4-6 months to completely heal

Question 18

What clinical manifestations are associated with hemorrhoids during the post-partum period

Answer 18

-itching
-discomfort
-bright red bleeding
w/defecation

Question 19

Expulsion of the placenta leads to a decrease in what 2 hormones?

Answer 19

estrogen and progesterone

Question 20

The decrease of estrogen and progesterone postpartum cause what?

Answer 20

diuresis of extracellular fluid

Question 21

How long can hcG show up in maternal blood postpartum?

Answer 21

3-4 weeks

Question 22

Decrease in progesterone leads to an increase in what hormone?

Answer 22

prolactin

Question 23

What factors may affect prolactin levels?

Answer 23

frequency and duration of feeding

• use of supplementary feeding
• strength of suckling

Question 24

What is the function of oxytocin?

Answer 24

milk ejection and let down reflex

Question 25

What adjustments should be made for the postpartum woman with DMT1?

Answer 25

she will need less insulin. It will be more difficult to read glucose tolerance tests.

Question 26

When should the provider expect the thyroid to return to normal postpartum?

Answer 26

Pre-pregnancy levels in 4 weeks. Normal in 3 months. She has an increased risk of autoimmune thyroiditis

Question 27

How long does the basal metabolic rate remain elevated?

Answer 27

1-2 weeks, gradually returns to normal.

Question 28

What influence the return of abdominal muscle tone?

Answer 28

• previous tone
• exercise
• amount of fat

Question 29

When can the new mother expect her abdomen to normalize?

Answer 29

for 2 weeks it is relaxed, in 6 weeks it should return to pre-pregnancy state.

Question 30

What is the term used to describe “separation of abdominal wall muscles”?

Answer 30

diastasis recti abdominis

Question 31

How long does the renal system take to normalize? What are normal findings in a urine sample?

Answer 31

• 8 weeks
• In 6 weeks, decreased hypotonia and dilation and disappearance of proteinuria
• Lactosuria can occur in breastfeeding mothers

Question 32

When do mothers start losing fluid after birth?

Answer 32

12 hours

Question 33

What are normal findings regarding fluid volume changes in the post partum mother for the first few days?

Answer 33

-urine output 3000 ml/day with profuse diuresis and weight loss 5-6 pounds

Question 34

Urinary retention can cause bleeding and increase the postpartum mother’s risk for infection. When should the nurse expect this to resolve?

Answer 34

5-7 days

Question 35

What factors decrease the chances of a spontaneous BM after birth?

Answer 35

• opioids
• low peristalsis
• lacerations/soreness
• dehydration and lack of food

Question 36

When does colustrum “early milk” mature?

Answer 36

72-96 hours

Question 37

When can the breastfeeding mother expect engorgement to occur?

Answer 37

24-48 hours

Question 38

When can bottle-feeding mothers expect engorgement?

Answer 38

day 3-4

Question 39

When can bottle-feeding mothers expect lactation to cease?

Answer 39

a few days to 1 week

Question 40

What is the average blood loss for a vaginal birth?

Answer 40

300-500 ml

Question 41

What is the average blood loss for a cesarean birth?

Answer 41

500-1000 ml

Question 42

How is the new mother’s cardiac output effected in the first 2 postpartum weeks?

Answer 42

down 30%

Question 43

When can the nurse expect normal cardiac output for the new mom?

Answer 43

6-8 weeks

Question 44

What are normal findings in terms of vital signs in the postpartum woman?

Answer 44

• 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

Question 45

What are normal findings in terms of blood components in the postpartum woman?

Answer 45

• 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