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Scientific Basis of Midwifery > Physiology of the Puerperium > Flashcards

Physiology of the Puerperium Flashcards

1
Q

Define puerperium

A

The time from immediately after the end of labour until the reproductive organs have returned to their pre-gravid condition, a period estimated to be around 6-8 weeks

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2
Q

Define the postnatal period

A

A period after labour during which the attendance of a midwife upon a woman and baby is required, being not less than 10 days and for suck longer period as the midwife considers necessary

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3
Q

What is involution of the uterus?

A

The return of the uterus into the pelvis through a process of:

  1. Contractions of the uterine muscle
  2. Autolysis
  3. Epithelial regeneration and proliferation
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4
Q

What is ischaemia?

A

After birth, the blood vessels of the uterus constrict and the blood circulation to the organs is reduced, causing tissue death

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5
Q

What occurs on expulsion of the placenta?

A

The muscle layers of the myometrium stimulate the action of ligatures that compress and occlude the large sinuses of the blood vessels to reduce blood loss

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6
Q

What is phagocytosis in relation to the puerperium?

A
  • The body needs to remove the extra fibrous and elastic tissue (collagen and elastin)
  • Macrophages and leucocytes engulf and ingest redundant tissue from autolysis and excrete it via the renal system
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7
Q

What is autolysis?

A

A process that uses proteolytic enzymes released from lysosomes to reduce the muscle size by removing redundant ischaemic muscle fibres

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8
Q

What is coagulation?

A
  • Blood clotting

- Done through platelet aggregation and the release of thromboplastin and fibrin

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9
Q

What is lochia?

A
  • The lining of the uterus being shed (decidua necroses)
  • Contains decidua, blood and serum
  • Woman may experience loss of lochia for up to 8 weeks
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10
Q

How long does it take for the new endometrial lining to develop?

A
  • Starts after 10 days
  • Complete after 6 weeks
  • Develops from the basal layer
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11
Q

What should be felt on palpation?

A
  • The fundus should be located centrally at same level/ slightly below umbilicus
  • Should feel firm
  • If uterus is not going down there may be something left inside or woman has full bladder
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12
Q

How much does the uterus weigh?

A
  • 60g pre-pregnancy

- 900-1000g at term

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13
Q

What are the 3 types of lochia?

A
  1. Lochia rubra (red)
  2. Lochia serosa (pink)
  3. Lochia alba (cream/white)
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14
Q

Describe lochia rubra

A
  • Contains fresh blood from placental site and decidua
  • This is discharged from the uterus up to 3-4 days
  • Shouldn’t be too heavy or contain too much blood
  • BF women may get bigger gush of blood due to uterus contracting faster
  • Less lochia for women who had CS
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15
Q

Describe lochia serosa

A
  • Contains less fresh blood as placental site starts to heal
  • Brownish/pink colour
  • Contains WBC, necrotic decidua and mucus
  • This is discharged up to 10-14 days
  • Characteristic sweetish odour
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16
Q

Describe lochia alba

A
  • Discharged up to 4-8 weeks

- Contains few RBC and is mostly serous fluid, WBC and mucus

17
Q

What happens on day 7 with reference to lochia?

A
  • Fibrin mesh that has formed over the placental site may be shed about day 7 as part of the healing process
  • Lochia may become heavier and fresh blood stained
18
Q

What is the average range of days that lochia is lost for?

A

24-36 days

19
Q

How does the cervix change in the puerperium?

A
  • After labour, the cervix has little tone but this rapidly increases during the first week and reduces in size
  • The cervix never returns to its pre-pregnant shape - sometimes referred to as a multiple os
20
Q

How does the vagina change in the puerperium?

A
  • The increased vascularity of the vagina decreases by day 3 after delivery and any oedema is quickly resolved
  • There is reduced tone after delivery but this quickly increases and the rugae of the vagina are evident after 3 weeks
21
Q

How do hormones change in the puerperium?

A
  • Oestrogen and progesterone levels decrease after placenta delivery
  • Prolactin levels increase
  • Oxytocin production
  • FSH and LH eventually produces and ovulation begins again
  • Hormonal changes affect woman’s wellbeing (baby blues)
22
Q

What is oxytocin production stimulated by?

A
  • Let down reflex (suckling)
  • Cuddling baby
  • This affects uterine contraction and involution
23
Q

How does the urinary tract change in the puerperium?

A
  • Marked diuresis in first 48 hrs after birth due to decreased oestrogen levels which reduces plasma vol. of blood to pre-pregnant levels
  • Possible water retention in first 48 hrs due to reduced progesterone which unbalances aldosterone levels
  • Dilation of urinary tract and kidneys occurs in pregnancy due to progesterone; this resolves within 21 days
24
Q

How does the cardiovascular system change in the puerperium?

A
  • Blood vol. reduces rapidly and will reach pre-pregnant volume by 6-9 weeks
  • Haemodilution effect decreased
  • Cardiac output increases initially and then reduces and maternal pulse drops
  • Coagulability remains high initially during puerperium so women are at risk of VTE
25
Q

Why does cardiac output increase initially?

A

Uterus is no longer compressing the vena cava and the uteroplacental blood flow returns to the venous system

26
Q

Why does coagulability remain high initially?

A

Prevents PPH

27
Q

How does the respiratory system change in the puerperium?

A
  • Full ventilation of the lungs can now occur as the gravid uterus is no longer compressing the lungs
  • Tidal volume and respiratory rate return to pre-pregnant rates within 1-3 weeks after delivery
28
Q

How does the musculoskeletal system change in the puerperium?

A
  • The effects of relaxin and progesterone and progesterone can take up to 12 weeks to reduce fully
  • Separated recti muscles, depending on severity, make take a few weeks to heal
  • 1cm = fine
  • 2cm = advise not to do abdominal exercise until this has reduced
  • 3cm = refer to physiotherapist
29
Q

How does the gastrointestinal system change in the puerperium?

A
  • Due to reduced progesterone levels, there will be improvement in gastric emptying and motility
  • Bowel movements return after 2-3 days
30
Q

What are the signs of infection in the mother?

A
  • Feeling unwell
  • Pale
  • Has a temperature
  • Tachycardia
  • Strong, unpleasant smell
31
Q

How may the uterus change if there is an infection?

A
  • Sub-involution = uterus feels wide and boggy, meaning its poorly contracted
  • Fundus may deviate to one size and not get smaller
  • Woman may experiences tenderness on palpation
  • Blood loss fresher and heavier and may be foul smelling
  • May pass clots
32
Q

What are the signs of wound infection?

A
  • Inflammation and tenderness around the wound
  • Slow healing or gaping at the skin edges
  • Pain felt deeper in the wound area
  • Clear/ purulent exudate (pus)
33
Q

What are the signs of breast infection?

A
  • May feel tight and swollen
  • One segment may be flushed or inflamed
  • One/both nipples may have cracked, broken or discoloured/ flaky skin

Scientific Basis of Midwifery (22 decks)

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