Post partum Flashcards
What is sub involution?
Uterus is not returning to pre pregnancy size within 14 days.
What is involution?
Uterus returning to pre pregnancy size within 14 days.
What is normal rate of uterus shrinking postpartum?
1 cm/daily (one finger breadth daily)
Descent is documented in relation to umbilicus. If U-1 means fundus at 1 cm below umbilicus
What is lochia?
Discharge postpartum
What is lochia rubra?
First 3 days -dark red or brown red
Educate:—-If soaking more than one pad an hour-that is a problem–
What is lochia serosa?
Day 4-10
Red, pink, brown tinged
What is lochia alba?
Day 11-21
Light color
What is average blood loss for vaginal and C-Section births?
vag-500 cc
CS-1000 cc
What urine changes occur postpartum days 2-5?
Increase in urine output.
All the excess plasma volume of pregnancy is leaving.
What is a woman at in increased risk for in post partum period?
Thrombus formation (highest at 2 week mark)
This is because her body has an increased ability to form clots during normal pregnancy. High levels of clotting factors in blood.
Educate:—Signs of DVT (warm, red, pain, edema) and importance of mobility–
What is diastasis recti?
Separation of rectus muscles of abdomen.
Suggestions for mom who has no rubella antibodies.
Rubella vax recommended after childbirth (never given during pregnancy) to prevent problems in future pregnancies.
What vaccine should all mom’s receive in third trimester?
TdAP-will give baby antibodies at birth
What are some things that could prevent uterus from contracting postpartum?
Clots-NEVER expel clots from boggy uterus. Massage until firm first-then expel clots.
Full bladder
What should uterus feel like 24 hours postpartum?
Firm grapefruit around umbilicus
Management of boggy uterus.
Massage (Firm circles while stabilizing bottom of uterus)
Find cause
Express clots
Empty bladder
Oxytocin
Methergine (IM) 0.2mg—-watch for hypertension—-
Cytotec
Hemabate (refrigerated, Deep IM)
Major side effect of methergine.
Hypertension
Prevention steps of thrombus formation.
Ambulate early and often.
ROM exercises
Compression devices
Stay hydrated
What is puerperal infection?
Bacterial infection of genital tract within 42 days postpartum
What is normal elevated WBC range Post partum?
14-16K
–If extremely high (20K and above) make sure no underlying infection–
What are some signs of distended bladder or urinary retention?
Displaced fundus
Excess lochia
Retention:
Frequent voiding but small amount
When are RhoGam shots needed?
Negative blood type (mom)
or O blood type
What is minimum output per hour until concerning?
30 mL/hour
What is the taking in phase postpartum?
First stage
Mom focused on self
Passive and dependent
What is taking hold phase?
Second stage
Attention on NB
More independent (starts taking care of herself…(showers, makeup, get dressed and taking care of baby)
—Best time for education–
What is letting go phase?
Third stage
Process disappointments with labor and delivery, look of baby
Relinquish her previous life before this new role
Bleeding in uterus will present as…
Clots
Need massage, maybe Pitocin
IV fluids, careful monitoring
What medications is given for severe postpartum hemorrhage/hypovolemic shock?
Methergine (IM or PO) 0.2 mg
Can give IV in emergency situations but must be given slowly while monitoring BP
Raises BP
–Side effects: hypertension, N/V, diarrhea–
Hemabate
What is treatment for DVT?
Heat, elevate, anticoags, hydrate
—No massage–
