Postpartum Flashcards by Ella Karll

postpartum period (PP)

period between birth and the return of the reproductive organs to their normal nonpregnant state
approx 6 weeks

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involution

return of the uterus to the nonpregnant space

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fundal assessment

firm :)
boggy :( = massage fundus
12 hrs after delivery= at level of umbilicus
may go up slightly, then descend.
descends about 1cm every day.
by 2 weeks postpartum= fundus should not be palpable

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oxytocin

hormone released by pituitary gland
strengthens and coordinates uterine contractions (compresses blood vessels and promotes hemostasis)

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pitocin administration

contracts the uterus
causes cramping

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rubra lochia

ruby (dark) red
1-4 days after delivery
(if over one week, concerning)

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lochia serosa

pink brown
4-9 days after delivery
(old blood, old tissue)

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lochia alba

white yellow
10-14 days after delivery, up to a few months
(leukocytes, endothelial cells, mucus)

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lochia amount

scant- less than 2in stain on a pad
excessive- saturation of a pad within 15 min
can be decreased for csection deliveries
can increase with ambulation and breastfeeding (oxytocin release causes contraction)

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placenta

detaches from uterine wall and passes within 30 minutes of delivery
endometrial regeneration occurs for 6 weeks

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perineal care

warm water in peri bottle
sitz bath (15 min)
cold pack
witch hazel pads (pain r/t hemorrhoids)
topical anesthetic (benzocaine spray)

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breast engorgement

encourage emptying breasts completely with each feeding
(the more we empty, the more it fills back up)
apply warm compress to breast before feeding
can lead to mastitis

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colostrum

higher protein, fats, antibodies than normal breast milk
lasts for 1-2 days

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if pt does not want to breastfeed..

wear supportive bra for 72 hrs after birth
apply fresh cold cabbage leaves to breast
avoid warm water/stimulation on breasts

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breast care

apply breast milk to sore nipples

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postpartum immunizations (PRN)

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rubella immunity

if not immune, give MMR
AFTER pregnancy.
do not get pregnant within 28 days of vaccination

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varicella immunity

give first dose in hospital
second dose 6 wks later
avoid pregnancy for 28 days following both doses

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tdap

given at 30-32 weeks of pregnancy
but if not given during pregnancy, give before discharge

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Rho gam

Rh immunoglobin
given within 72 hrs of delivery
if mom is Rh -

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postpartum hemorrhage

vaginal delivery- 500mL+
csection- 1000mL/1L+
saturating pad in less than 15 min
soft boggy fundus
blood clots larger than an egg
constant flow of blood from vagina

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hypovolemic shock

from pph
tachycardia
hypotension
tachypnea
cool clammy skin

risk factors for pph

uterine atony (causes boggy fundus)
birth canal trauma
precipitous delivery (quick)
retained placental fragments
subinvolution
DIC or ITP
multipolarity (multiple pregnancies)
multifetal birth (twins)
fetal macrosomia

labs from PPH

decreased H/H (below

treatment of pph

massage fundus admin oxygen admin fluids (LR) elevating legs eliminate bladder distention uterine stimulants (pitocin, methergin, hemobate) bimanual compression (MD only) uterine packing (MD only) surgical intervention (hysterectomy)

uterine stimulant considerations

pitocin 10-40u in 1000ml LR no methergin if hypotensive no hemobate if asthmatic

primary PPH

early, acute within 24 hrs

secondary PPH

later, 24hrs-6 weeks

risk factors for puerperal infections

c section patients immunocompromised pts

endometritis

infection of the endometrium/uterus fever!! suprapubic pain excessive malodorous lochia tachycardia hypotension

risk factors for endometritis

c section births chorioamniocitis retainedd placental fragments prolonged membrane rupture prolonged labor internal fetal monitoring multiple cervical exams

endometritis treatment

antibiotics analgesics

mastitis

inflammation of breast flu like symptoms malaise, body aches, fever unilateral pain, erythema, and swelling of the breast

mastitis risk factors

infrequent feeding feeding only on one breast a clogged milk duct nipple damage (from improper latch) poor hand hygiene

mastitis treatment

antibiotics analgesics apply heat prior to feeding fully empty breast (pump or manual expression PRN)

malasma

darkening of the face "mask pregnancy"

change in vitals postpartum

temp may be elevated due to metabolic demand and dehydration pulse elevated for first hr

preeclampsia (dx, risk factors, and signs)

BP of 140/90+ on two occasions 4hrs apart protein in urine risk factors: signs: HA, blurred vision, right sided epigastric pain (r/t liver enzyme elevation), thrombocytopenia

preeclampsia treatment

give magnesium sulfate to reduce seizure risk

antidote for magnesium sulfate

calcium gluconate give if decreased respirations and no reflexes

TORCH infections

teratogenic, transferrable toxoplasmosis (parasitic, do not clean cat box) other (varicella, parvo, syphilis) rubella cytomegaly virus herpes simplex

risk factors for retained placenta

uterine surgeries (removing fibroids) past c sections

nonadherent retained placenta

free floating retained placenta

adherent retained placenta / placenta accreta

grows into uterine muscle

placenta increta

placenta is midway through muscle

placenta percreta

placenta perforates entire uterus can be seen on US usually requires hysterectomy

we wait _____ for placenta to fall out

30 minutes

inversion of the uterus

life threatening uterus exiting vagina caused by excessive oxytocin use or baby pulling on chord

placenta previa

placenta implanted on or over the cervical opening causes bleeding in 3rd trimester dx by US signs: painless bright red bleeding

risks to not breastfeeding

formula is expensive decreased antibodies to baby GI risk for baby increased SIDS risk increased PPH risk increased ovarian and breast cancer risk

lactogenesis

prolactin prepares breasts to secrete milk supply meets demand oxytocin- let down reflex

main immunoglobin in breastmilk

IgA

benefits of breastfeeding for mom

decreased cancer risk increased bone density may enhance postpartum weight loss

risk factors for birth trauma

geriatric moms (35+) young moms (under 16) primigravida (1st pregn) uterine dysfunction CPD (baby head too big) macrosomia (big baby) difficult presentation (breach) obstetric birth techniques (forceps, vaccum) oligohydramnios (not enough fluid)