Post Partum Flashcards
Which semester is the post partum considered?
How long is the post partum?
What happens to the reproductive organs?
The 4th trimester
Lasts 6 weeks after birth.
They go back to the a non-pregnant state (not necessarily back to pre pregnant tho)
What are the benefits of skin to skin?
Stabilizes baby's temperature Baby self regulation of vitals Increases oxytocin Helps mom with feeding cues Promotes bonding
Will a mom and baby do skin to skin if there is any issue?
No baby must be stable. Mom needs to be stable too.
Your patient who just gave birth begins to shiver. What do you say?
That shivering is common and that she just has to stay warm and drink fluids. Make sure to reassure her.
What theories are there to explain the shivering/tremors have birth?
Pressure on nerves goes away
Adrenaline goes away
Reaction to epidural
Transfusion during placenta separation
Average blood loss from vaginal delivery?
What is too much for vaginal delivery?
Between 250-400 mL
Too much is above 500 mL
Average blood loss for a c-section?
Blood loss for c-sections should be less than 1000 mL
What is body Temp like postpartum?
Temp increased for 24 hrs until milk comes in but not everyone
What is pulse like in postpartum?
Pulse elevated for a few hrs then slow w post partal period w fluids so may be slow. You never wanna see it be actually tachycardia
What is blood pressure going to be like in postpartum?
What if she is hypotensive?
Hypertension?
Blood pressure will be elevated by around 10 points due to alteration of fluids.
- But don’t let her stand up too fast bc she will have orthostatic hypotension due to fluid shifting/loss
- Have her sit on the edge of the bed
Hypotensive indicates possible hemorrhage.
Hypertension may be due to pre-eclampsia.
Why do we check H&H after delivery and on who?
What will a minor drop in H&H after delivery be from tho?
H&H will reflect the amount of blood loss in delivery.
We won’t do continuous checks of this for everyone though. Really only for high risk people due to insurance purposes.
A minor drop is a dilution issue from fluid changes.
Why might WBC be elevated?
Probably due to neutrophil count going up to prepare for possible sepsis.
What will happen to the coagulation factors?
What intervention should mom be doing?
Coagulation factors will increase as to reduce possibility of hemorrhage w clotting.
^ women need to ambulate after delivery to reduce possible clots though now. Have her get up and go to the bathroom on her own and stuff.
What will BUN look like in postpartum and why?
BUN will be increased due involution (breakdown of uterus back to nonPG state)
How many weeks will creatine levels go back to normal?
What about proteinuria?
Will ketones be present?
Creatinine goes back to normal after 6 weeks.
Proteinuria resolves 6 weeks too.
Ketones should go away with rehydration.
When does involution or return of uterus to non pg state begin? And by what process?
Shrinking that occurs once placenta is delivered by doing autolysis of cells
What is exfoliation?
What drug/hormone stimulates contractions?
Exfoliation is what prevents scarring of the placental site during involution
Oxytocin which is used to help clamp and with breastfeeding.
What is it called when the uterus is soft, relaxed, and not clamping? What will lochia look like?
If the uterus isn’t clamping, what intervention do you anticipate?
Uterine atony which is essentially a sign of PPH. Lochia will be heavier with clots.
Get her to sonogram and to see if anything is left inside. Then get it removed.
T/F
Breastfeeding usually feels good after delivery
Sort of false.
Some women may have afterpains that accompany breastfeeding due to oxytocin. Just treat the afterpains with analgesics.
How would you check the uterus?
What can cause an inaccurate check of the uterus?
Put dominant hand on top of uterus. And then put other hand below to support the bottom. Should feel like a dome.
A full bladder may cause the uterus to be displaced.
What will uterus be like right after delivery?
What will uterus be like 12-24 hrs later?
How far does it descend per day?
What will the uterus be like 2 weeks after delivery?
After delivery, uterus is midline and firm.
12-24 hrs later uterus will be slightly above the umbilicus and firm.
Descends about 1 cm a day.
Two weeks later it will be at the pelvic cavity. And it really shouldn’t take longer than this.
- also the more gravidas you’ve had, the more often you’l see them use up the two weeks
How to check for Lochia?
Which has more; vaginal or c section?
Check for bloody mucus by having patient roll over. Check her labia. And just be thorough.
Vaginal will have more
- c section just gets sucked up
Endometrium heals when?
Placental site heals when?
Endometrium by 3 weeks
Placenta site by 6 weeks
The progression of Lochia
Rubra - dark red for 3 days
Serosa - Serosanuinos draining that is pink for 10 days
Alba - Serous drainage creamy yellow for 6 weeks
What is it called when the uterus fails to return to the non-pregnant state? Why?
What should you do?
Subinvolution
- the failure due to retaining fragments of placenta or an infection that is painful with foul smelling lochia
Check uterus at prescribed intervals
Empty bladder regularly
Massage fundus to firm it up
What if a gush of blood comes out when she’s standing
It is just from blood pooling
What if she passes clots
This is just due to blood pooling again.
What if she has night sweats
Due to body trying to get rid of the extra fluids she has
Afterpains cause
Who are they more common in?
More common in moms with multigravidas
Oxytocin and breastfeeding cause the cramping
What if her tummy is still huge after birth
Just remind her it takes some time. And the flat belly after birth is uncommon
Explain what cervix will be like after birth
spongy, flabby, and bruised
What will Os look like after birth
May gradually close and is irregular shaped to fish mouth
How will the vagina appear after birth?
When will it go back to normal with ruggae?
Vagina will be edematous and bruised with small superficial lacerations
Shrinks agaain and ruggae within 3-4 weeks
How can breastfeeding affect your menses
Lactation delays it but if you aren’t breastfeeding then you can expect return to be 4-6 weeks
What foods can help with elimination with an injured perineum?
What med?
What can make it feel better?
Warm coffee or tea . Fiber
Colace med to draw water into stool. MOM, mineral oil
Warm bath
What to assess perineum for?
bruising or hematoma
If you have a perineal laceration or rectum injury how long do you have to wait to do anal sex?
3rd or 4th week - nothing goes in.
But you shouldnt be having sex anyways tbh
Exercises to help elimination?
Kegels
T/F
Pain meds help with constipation
False. Pain meds cause constipation
REEDA
Which is the only thing you want?
When do you do the reeda assessment?
Redness Edema Ecchymosis/bruising Drainage Approximation
You only want approximation.
Do reeda for c section or perineal.
What will abdomen be like after pregnancy
Diastasis Recti Abdominins assessment
Loose and flabby
Diastasis recti - seperation of abdomen muscles
- she just needs to raise her head to feel it
Straie appearance
Linea nigra appearance
Fade off moms skin . Will fade but not disappear
Vertical line that fades.
- but may remain if on BC due to estrogen
What happens to bladder after pregnancy?
What instructions do we give to avoid uti?
How to check for residual?
It increases capacity due to swelling around urethra, not being able to feel fluid pressure, and decreased sensation if it being full.
Need to tell them to go to the bathroom frequently so there is no residual urine that leads to a uti
Use sono for residual
Why might urinary output be greater after pregnancy
Puerperal diuresis or shedding of fluid from pregnancy
What do dilated ureters cause?
Risk of urinary infection due to dilated ureters
If your patients bladder is full, where will the uterus be displaced to?
Uterus will be up and to the right
Two D’s of fluids that occur after pregnancy?
Which one is a must for all?
Diuresis due to kidney shift and Diaphoresis after 24 hrs.
Diuresis happens to everyone. Diaphoresis does not.
- Both are due to the need to get rid of excess fluid of PG
What is colostrum?
Creamy yellow substance that comes before the breast milk
Engorgement
How long will this occur?
Warm enlarged full breast that helps prepare for breast feeding
Engorgement will go away in women who choose not to breastfeed
What does breast milk look like?
Blue-white
If you are breastfeeding how should you care for your nipples?
Assess them daily and make sure to keep them moisturized to prevent cracks and dryness
Movements to avoid if you do NOT want to breastfeed
Do not stimulate breasts, massage, allow suckling, or use warm water on them
What type of bra should you wear to avoid breast feeding
A supportive, snug bra
How often should you ice breasts if not breastfeeding?
Ice for 20 min in axillary area qid
- can use frozen vegetables
Group of natural products to help with engorgement in women who do not want to breast feed?
Anti-galatogogues
- sage, parsley, peppermint, cabbage leaves
Homan’s sign desired result
Should see dorsiflexion
If there is any spasm or cramp - then it is a positive homans sign and it snot good
- can check for clotting in calf
- should be negative 2x
Initial weight loss post partum
10-12 ibs
Amount of weight lost in post partum diuresis
5 ibs
How soon could a woman return to old weight?
6 -8 weeks but depends on how much weight they gained
Why is it concerning to have an Rh- mom with an Rh+ newborn?
Types of tests for this?
Sensitized for life?
Antibody production will destroy the fetus RBC and cause anemia.
Indirect coombs on mother
Direct cooombs on infant
Means it’ll happen again in next PG i think?
What are postpartum blues?
Major symptoms?
Transient or short term feelings of depression that opens happen first few days of postpartum
crying, angry, anorexia, feeling let down
What may cause postpartum blues?
Lots of things.
- hormones
- fatigue
- high self expectations
- nonsupportive environment
- slow psych adjustment
- insecurity
Who is at risk for more postpartum depression?
Women without support!
- single or homeless especially
How should you handle postpartum blues in mom?
When is it too long to have it?
Let her cry and be supportive. If should go away around 2 weeks but if it remains, then she could genuinely be in the postpartum depression stage & she should be screened
What is the Newborns & Mother Health Protection Act of 1996
Allows for women to stay a certain time in hospital after birth.
Vaginal - 48 hr stay
Csection - 96 hr stay
You don’t have to ofc but no one is gonna kick you out.
How should mom interact with the baby?
Should interact often and speak caringly but also be caring. Do they change their diaper? Are they feeding the baby?
What is the En face position?
Really just having mom and baby looking at one another.
- Very encouraged to do this
What is it called when dads feel attached to the baby?
Engrossment
What is the Period of Purple Crying about?
How long does this period last?
Video program to help reduce Shaken Baby syndrome or when a parent shakes the baby due to their nonstop crying.
Crying for 2-4 months. Unsoothable crying.
PURPLE
Peak of crying Unexpected Resists soothing Plain face Long lasting Evening & late afternoon
Does Mom need to be superwoman?
What should the husband be willing to do?
No - just a super mom.
Husband needs to step up and help out. But dad’s need time with the baby too.
Who gets to get the Rh immune globulin? How many doses?
Unsensitized mom with no antibody production
- Prophylactic dose around 28 weeks
- Delivery dose with an RH+ infant only
Situations in life that may cause mixing of blood between mom and baby & thus need an Rh immune globulin?
- Abortion
- Ectopic PG
- invasive procedure
- maternal trauma or abruption
- CVS or amniocentesis
- External version
Types of RH immune globulins?
What to monitor baby for?
What is a good test?
Rhophylac IV
RhoGAM IM
- given to mom within 72 hrs of delivery
- Won’t give Rhoman tho if sensitized already bc it is a waste of money
Monitor baby for jaundice from rbc being destroyed. Anemia as well. Check bilirubin (12-14 will need phototherapy)
Kleihauer Betka test to see amount of fetal blood in maternal circulation
Worst type of blood to have for ABO incompatibility?
O- bc this type has antibodies to A or B blood types (and the baby is A or B. And the different means baby’s rbc are destroyed.
Rubella status means?
But what if you are PG and your titer is low?
What if you need to give a patient Rogam and Rubella (MMR)?
You want to be immune with a positive titer. And this is included in the MMR SUbq vaccine.
- if you get a negative, then you need to be immunized.
If you are PG and titer is low, then you can’t be treated due it being a live virus. Must be careful. Now in an emergency we can give an immune globulin.
Give the Rh rogam first. Rubella can be given later. Giving both can ruin effectiveness.
When do we update Tdap vaccine?
Third trimester due to helping protect newborns due to moms gift to baby. You can give this even when close together. Can give every 2 years
- you need all family members to update t dap
When can varicella be given?
Following delivery - but can’t get PG for a month.
- shouldn’t be having sex anyways
Other meds to give for PG
Motrin
Flu in second/third trimester
covid vaccine will be added.
Who created the phases of maternal adjustment?
Rebin
Phases of maternal adjustment
Taking in
Taking hold
Letting go
Taking in phase of maternal adjustment
Early stage where she is still focused on her and passive.
- I’m hungry, I need shower, I..
Will also want to talk about delivery experience
Taking Hold phase of maternal adjustment
What is this stage a good time to do?
Ready to assume role of control of body and mother role
Focused on baby
A good time to teach her about the baby& make sure to reassure her
Letting go phase of maternal adjustment
Assuming parent role and gains confidence.
She is letting go of her being PG and ready to be a mom
