OB Class 3 Flashcards
where is the fundus within 12hrs of delivery
it rises to about the level of the umbilicus
where is the fundus immediately after delivery
midway between the symphysis pubis and umbilicus
:it is about the size of a large grapefruit
what is the result of subinvolution
postpartum hemorrhage
what are risks for increased afterpains
- being a multipara
- :multiple stretching of muscle fibers leads to loss of muscle tone that causes alternate contraction and relaxation of the uterus
what increases afterpains
multifetal pregnancy
large infant
hydramnios
retained blood clots are present
what are interventions for afterpains
help keep the uterus contracted to provide relief
:decreases rapidly after 48hrs
lochia rubra normal characteristics
days 1-3
bloody, small clots, fleshy earthy odor
red or red/brown
Lochia serosa normal characteristics
days 1-4
decreased amount
serosanguineous
pink or brown tinged
how long does it take for vagina to complete involution and gain approximately the same size and contour it had before pregnancy
6-10weeks
what are possible causes of postpartum dyspareunia (discomfort during sex) in lactating women
ovarian function and estrogen production isnt well established during lactation leading to vaginal dryness and discomfort during sex
what normal changes in coagulation occur during the postpartum period
plasma fibrinogen increases
: takes 4-6 weeks before the hemostasis returns to normal prepregnant levels
what puts women at increased risk of urinary distention and emptying issues postpartum
urethra, bladder, and tissue around urinary meatus become edematous
how does the displaced uterus cause uterine atony and increased bleeding
the displacement results in decreased uterine muscle contraction (uterine atony) leading to excessive bleeding
why are protein and acetone often present in the urine during the first few days postpartum
:acetone suggest dehydration
:mild proteinuria is the result of catabolic processes involved in uterine involution
what changes occur to the skin and hair during the postpartum period
:pigmentation begins to recede
:stretch marks gradually fad to silvery lines
:hair loss begins 4-20weeks after delivery and is regrown in 4-6months
what s/s may indicate developing or worsening preeclampsia
headache proteinuria blurred vision photophobia abdominal pain
discuss menses
ovulation may occur before menses
frequent breastfeeding is likely to delay menses
how much weight is lost during childbirth
approximately 12lbs lost during childbirth
when should RhoGAM be administered
:mother is Rh (-) and baby is Rh (+)
:mother isnt sensitized
**give w/in 72hrs after childbirth
Vitals after vaginal birth
BP: 140/90 and below
PR: 40-50
result of large amoung ot blood that returns to central circulation
Temp: 100.4 and below
Fundus: attached or near level of umbilicus
Intervention with less than 12-14 RR and less than 95%O2 sat
notify anesthesiologist elevate head of bed admin oxygen admin narcan (lasts 30min) ****narcan reduces level of pain relief
pt teaching: how to suppress lactation
:manage discomfort by applying ice
:wear a well fitting bra or sports bra 24hrs a day until breast become soft
:refrain from stimulating breasts
:dont allow warm water to fall directly on breasts during showers
criteria for discharge
:no complications and assessments are normal
:mother has received instructions on self care and deviations from normal to report
:mother has received instructions on postpartum activity
newborn’s calorie intake for breast feeding
39-45 Kcal/lb each day
