OB TEST 2 CHAPTER 20

Question 1

• Puerperium (4th trimester of pregnancy)-

Answer 1

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.

Question 2

• Involution-

Answer 2

of the uterus to a return nonpregnant state after birth

o Begins immediately after expulsion of the placenta with contraction of the uterine muscle.

Question 3

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

Answer 3

• At the end of the third stage of labor

Question 4

• The fundus descends

Answer 4

1-2 cm every 24 hours.

Question 5

• The uterus should not be palpable abdominally after how long?

Answer 5

after 2 weeks and should have returned to its nonpregnant location by 6 weeks after birth.

Question 6

• Subinvolution-

Answer 6

failure of the uterus to return to a nonpregnant state.

o Most common cause: retained placental fragments and infections

Question 7

exogenous oxytocin (Pitocin) is usually administered IV or IM immediately after expulsion of the placenta.

Answer 7

• Because the uterus must remain firm and well contracted,

Question 8

• Afterpains (afterbirth pains)-

Answer 8

)- 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

Question 9

• Lochia

Answer 9

Lochia persists up to 4-8 weeks after birth (white milky discharge)

Question 10

• Lochia

Answer 10

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

Question 11

Cervix

Answer 11

o Within 2-3 days postpartum it has shortened, become firm, and regained its form.

Question 12

Does the external cervical os ever regains its pre-pregnancy appearance?

Answer 12

no! Duh! It no longer has a circular shape but appears as a jagged slit often described as a “fish mouth”

Question 13

• Vagina and Perineum

Answer 13

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.

Question 14

How do you improve or regain • Pelvic muscular support

Answer 14

o Kegel exercises

 Help to strengthen perineal muscles and encourage healing.

Question 15

• Placental Hormones

Answer 15

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.

Question 16

• Pituitary Hormones and Ovarian Function

Answer 16

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

Question 17

• Abdomen

Answer 17

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

Question 18

• Urine Components

Answer 18

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.

Question 19

• Postpartal Diuresis

Answer 19

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.

Question 20

• Urethra and Bladder

Answer 20

o Immediately after birth excessive bleeding can occur if the bladder become distended. (keep bladder flat)

Question 21

• Bowel Evacuation

Answer 21

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!!

Question 22

o Anal sphincter lacerations

Answer 22

are associated with an increased risk of postpartum anal incontinence.

Question 23

• Breastfeeding Mothers

Answer 23

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

Question 24

• Nonbreastfeeding Mothers

Answer 24

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

Question 25

• Cardiovascular System

Answer 25

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.

Question 26

o Cardiac Output

Answer 26

 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.

Question 27

o Vital Signs

Answer 27

 Heart rate and blood pressure return to nonpregnant levels within a few days. Respiratory function rapidly returns to nonpregnant levels after birth.

Question 28

• Blood Components

Answer 28

o Hematocrit and Hemoglobin
 Increase by the 7th day
o White blood cell count
 Increase is normal

Question 29

o Coagulation Factors

Answer 29

 Clotting factors and fibrinogen are normally increased during pregnancy and remain elevated in the immediate puerperium

Question 30

o Varicosities

Answer 30

 Varicosities of the legs and around the anus (hemorrhoids) are common during pregnancy.

Question 31

• Neurologic System

Answer 31

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

Question 32

o Postpartum headaches can be caused by

Answer 32

 Postpartum- onset preeclampsia
 Stress
 Leakage of cerebrospinal fluid into the extradural space during placement of the needle for epidural or spinal anesthesia

Question 33

o Adaptations of the mothers’ musculoskeletal system that occur during pregnancy

Answer 33

are reversed in the puerperium.

Question 34

o The joints are completely stabilized by

Answer 34

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.

Question 35

• Integumentary System

Answer 35

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.

Question 36

• Immune System

Answer 36

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

Question 37

AUTOLYSIS

Answer 37

self destruction of hypertrophied tissue in uterus