Postnatal Examination

Question 1

Define puerpeium

Answer 1

A stage that starts after the delivery of the placenta and membranes (third stage of labour) and continues for 6 weeks

Question 2

Define involution

Answer 2

Process in which the uterus returns to its normal size, tone and position
Involves three stages: ischaemia, auto lysis and phagocytosis

Question 3

Define ischaemia

Answer 3

An inadequate blood supply to an organ or part of the body
Results from continued contraction and retraction of uterine muscle fibres compressing blood vessels

Question 4

Describe contraction in ischaemia

Answer 4

Temporary shortening of uterine muscle fibres

Question 5

Describe retraction in ischaemia

Answer 5

Muscle fibres are permanently reduced

Question 6

Define autolysis

Answer 6

Destroying cells, tissues and muscle fibres by enzymes resulting in the release of proteolytic enzymes from myometrial cells

Question 7

Describe the aftermath of autolysis

Answer 7

Lysosomes digest the excess uterine muscle fibres that are increased in pregnancy
The waste products pass into the bloodstream and is excreted in urine

Question 8

Describe phagocytosis in involution

Answer 8

Phagocytes Remove debris produced by autolysis
Some fibrous and elastic tissue remain so that the uterus never completely regains its ore pregnancy state

Question 9

Define coagulation

Answer 9

Takes place through platelet aggregation and the release of thromboplastin and fibrin

Question 10

Why is palpation important

Answer 10

To ensure that physiological changes are taking place
That the uterus is firm and well contracted
The uterus is non tender

Question 11

Describe vasoconstriction in the uterus

Answer 11

Happens to the overall blood supply in the uterus resulting in further reduction in blood loss

Question 12

Describe the procedure of assessing involution

Answer 12

1. Get informed consent
2. Ask for them to empty her bladder
3. Ensure privacy
4. Ask for them to lie down
5. Expose abdomen
6. Place lower edge of hand on abdomen
7. Palpate gently towards spine and gently
8. Note level, tone and tenderness
9. Ask about vaginal loss
10. Document and act on findings

Question 13

Define Lochia

Answer 13

The blood loss and unwanted products of conception

Question 14

Describe lochia rubra

Answer 14

Red, blood, decidua, lanugo, vernix, shreds of chorion and amnion, meconium

Question 15

Describe lochia serosa

Answer 15

Pink/brown , decidua, altered blood and serum, mucous, leucocytes

Question 16

Describe lochia alba

Answer 16

White/yellow, mucous, leucocytes, organisms

Question 17

Describe the hormonal changes postpartum

Answer 17

Delivery of placenta results in fall in placental hormones
initiating the return of body systems to post partum state

Question 18

what does a fall in oestrogen and progesterone do

Answer 18

stimulates the release of follicle stimulating hormone (FSH) from pituitary leading to the return of ovulation

Question 19

describe urinary output postnatal

Answer 19

diuresis happens in 1st 2-3 days
dysuria absent

Question 20

what is indicative of a UTI

Answer 20

frequency of urination especially associated with passing small amounts and stinging and abdominal/loin pain

Question 21

describe bowel action postnatally

Answer 21

should return to normal 2-3 days post birth

Question 22

circulation

Answer 22

oedema is normal
DVT not
increased blood volume of pregnancy decreases via reabsorption and excretion

Question 23

signs of DVT

Answer 23

swelling, redness, lumpy, hot, pain