OB TEST 2 CHAPTER 20 Flashcards
• Puerperium (4th trimester of pregnancy)-
The postpartum period is the interval between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state.
o Considered to last 6 weeks.
• Involution-
of the uterus to a return nonpregnant state after birth
o Begins immediately after expulsion of the placenta with contraction of the uterine muscle.
the uterus is in the midline (approx. 2 cm below WHEN DOES the level of the umbilicus) with the fundus resting on the sacral promontory
• At the end of the third stage of labor
• The fundus descends
1-2 cm every 24 hours.
• The uterus should not be palpable abdominally after how long?
after 2 weeks and should have returned to its nonpregnant location by 6 weeks after birth.
• Subinvolution-
failure of the uterus to return to a nonpregnant state.
o Most common cause: retained placental fragments and infections
exogenous oxytocin (Pitocin) is usually administered IV or IM immediately after expulsion of the placenta.
• Because the uterus must remain firm and well contracted,
• Afterpains (afterbirth pains)-
)- uncomfortable cramping
o periodic relaxation and vigorous contractions are more common in subsequent pregnancies
o more noticeable after births in which the uterus was overdistended (large baby, multifetal gestation)
o Breastfeeding and exogenous oxytocin medication usually intensify these afterpains, b/c both stimulate uterine contractions.
Give pain meds
• Lochia
Lochia persists up to 4-8 weeks after birth (white milky discharge)
• Lochia
o The amount of lochia is less after cesarean births because the surgeon suctions the blood and fluids from the uterus or wipes the uterine lining before closing the incision
Cervix
o Within 2-3 days postpartum it has shortened, become firm, and regained its form.
Does the external cervical os ever regains its pre-pregnancy appearance?
no! Duh! It no longer has a circular shape but appears as a jagged slit often described as a “fish mouth”
• Vagina and Perineum
o The greatly distended smooth-walled vagina gradually decreases in size and regains tone.
o The introitus is usually barely distinguishable from that of a nulliparous woman if lacerations and an episiotomy have been carefully repaired, hematomas are prevents or treated early, and the woman observes good hygiene during the first 2 weeks after birth.
How do you improve or regain • Pelvic muscular support
o Kegel exercises
Help to strengthen perineal muscles and encourage healing.
• Placental Hormones
o For several days after birth, mothers with type 1 diabetes will likely require much less insulin than they did at the end of pregnancy.
o Estrogen and progesterone levels decrease markedly after expulsion of the placenta and reach their lowest levels 1 week after childbirth.
o Decreased estrogen levels are associated with breast engorgement and with the diuresis of excess extracellular fluid accumulated during pregnancy.
• Pituitary Hormones and Ovarian Function
o Prolactin levels in blood rise progressively throughout pregnancy and remain elevated in women who breastfeed.
o Ovulation occurs as early as 27 days after birth in nonlactating women, with a average time of approx.. 70-73 days.
o Menstruations usually resumes by 4-6 weeks postpartum after childbirth.
o Contraceptive options should be discussed early in the puerperium
• Abdomen
o Approx.. 6 weeks are required for the abdominal wall to approximate its prepreganacy state.
o Some striae (stretch marks) may persist
o The return of muscle tone depends on previous tone, proper exercise, and the amount of adipose tissue present.
o With or without overdistension because of a large fetus or multiple fetuses, the abdominal wall muscles separate (disatasis recti abdominis)
Surgical correction is rarely necessary
• Use abdominal binder
• Urine Components
o The renal glycosuria induced by pregnancy disappears by 1 week postpartum
o This breakdown of excess protein in the uterine muscle cells also contributes to pregnancy- associates proteinuria.
• Postpartal Diuresis
o Within 12 weeks of birth, women begin to lose excess tissue fluid accumulated during pregnancy
o Fluid loss through perspiration and increased urinary output accounts for a weight loss of approx. 2.25 kg during the early puerperium.
• Urethra and Bladder
o Immediately after birth excessive bleeding can occur if the bladder become distended. (keep bladder flat)
• Bowel Evacuation
o A spontaneous bowel evacuation may not occur for 2-3 days after childbirth. (no later than 3 days is normal)
Increase fiber food, then take stool softener
NO LAXATIVES!!
o Anal sphincter lacerations
are associated with an increased risk of postpartum anal incontinence.
• Breastfeeding Mothers
o Colostrum or early milk, a clear yellow fluid may be expressed from the breasts.
o Colostrum transitions to mature milk by about 72-96 hours after birth
• Nonbreastfeeding Mothers
o On the 3rd-or 4th postpartum day, engorgement may occur
o Engorgement resolves spontaneously, and discomfort usually decreases within 24-36 hours. A breast binder or well-fitted, supportive bra, ice packs, and fresh cabbage leaves
o Nipple stimulation is avoided
