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
• Cardiovascular System
o Blood Volume
The average blood loss for a vaginal birth of a single fetus ranges from 300-500 mL.
The typical blood loos for women who have a c-section is 500-1000 mL.
o Cardiac Output
Cardiac output remains increased for at least the first 48 hours postpartum because of an increase in stroke volume.
This increased stroke volume is caused by the return of blood to the maternal systemic venous circulation, a result of rapid decrease in uterine blood flow and mobilization of extravascular fluid.
o Vital Signs
Heart rate and blood pressure return to nonpregnant levels within a few days. Respiratory function rapidly returns to nonpregnant levels after birth.
• Blood Components
o Hematocrit and Hemoglobin
Increase by the 7th day
o White blood cell count
Increase is normal
o Coagulation Factors
Clotting factors and fibrinogen are normally increased during pregnancy and remain elevated in the immediate puerperium
o Varicosities
Varicosities of the legs and around the anus (hemorrhoids) are common during pregnancy.
• Neurologic System
o Neurologic changes during the puerperium are those that result from a reversal of maternal adaptation to pregnancy and those resulting from trauma during labor and childbirth.
o Headache requires careful assessment.
Always investigate a headache
o Postpartum headaches can be caused by
Postpartum- onset preeclampsia
Stress
Leakage of cerebrospinal fluid into the extradural space during placement of the needle for epidural or spinal anesthesia
o Adaptations of the mothers’ musculoskeletal system that occur during pregnancy
are reversed in the puerperium.
o The joints are completely stabilized by
6-8 weeks after birth,
o Those in the parous woman’s feet do not.
o The new mother may notice a permanent increase in her shoe size.
• Integumentary System
o Chloasma (mask) of pregnancy usually disappears at the end of pregnancy.
o Vascular abnormalities such as spider angiomas (nevi), palmar erythema, and epulis generally regress in response to the rapid decline in estrogen levels after pregnancy.
o Hair growth slows during the postpartum period. Some women actually may experience hair loss because the amount of hair lost temporarily more than the amount regrown.
• Immune System
o No significant changes in the maternal immune system occur
o The mother’s need for a rebella, varicella, or tetnus-diphtheria-acellular pertussis vaccination or for prevention of Rh isoimmunization is determined
AUTOLYSIS
self destruction of hypertrophied tissue in uterus
