Postpartum Flashcards
What causes uterine involution?
Decrease in myometrium cell size
Within 24 hrs uterus is about the size it was at ___ wks
20, at the umbilicus
Involution causes the fundus to descend into the pelvis at about ___ cm/day
1
After the placenta separates blood vessels in the _______ become occluded to prevent hemorrhage
Endometrium
Then superficial layers become necrotic and slough off
Endometrial tissue regenerates by ___ wks except at the placental site
2-3
The placenta site is about ___ cm following delivery and about ___ cm by 2-3wks
8-10
3-4
Describe lochia rubra
Day 1-3
Red
Bloody
Clots
Describe lochia serosa
Day 3-10
Pink
Bloody
Mucousy
Describe lochia alba
Day 10-14 or longer
Yellowish-white
Mostly mucousy
What is happening when a woman notices an inc in vaginal bleeding between pp day 7-14?
Normal
Superficial layers of placenta site slough off
Should only last 1-2 hours
Describe scant, light, moderate, and heavy bleeding in inches
Scant:
How much/how long does the cervix stay dilated?
2-3cm for first few days, ~1cm until end of first week
What can estrogen released from lactation do to the appearance of the vagina?
Delay formation of rugae (normally reappears in about 3wks)
Appears pale
What is the acronym used to assess the perineum?
REEDA redness Edema Ecchymosis Drainage Approximation
Following delivery adrenal glands decrease production of ___
Aldosterone
This leads to dec sodium retention and inc urine output
Renal and ureteral dilation resolve by ___wks
8
Glycosuria disappears by end of ___
First week
BUN increases to ~___mg/dl by end of first week
20
GFR renal blood flow and plasma creatinine return to normal by ___ wks
Six
How much urine can you remove at one time with a straight cath?
800 (to avoid hypotension)
After delivery of the placenta mom gets an auto transfusion of _____ml causing stroke volume to ___ and heart rate to ___
750-1000
Increase
Decrease
Does hct inc or dec after delivery?
Increases due to large reduction in plasma volume
Blood volume returns to baseline by ___weeks after delivery
1-2
WBC’s inc after delivery to ___
14-16k
Cardiac output begins to decrease ___ minutes after delivery
15
Prelabor levels one hour after labor
Prepregnancy levels by 2-3 wks
What helps the respiratory system to quickly return to prepregnant status after birth?
Sudden drop in progesterone
Emptying of uterus allows lung volume and tidal volume to normalize
Compensatory respiratory alkalosis gone in two days
GI motility is reduced after birth. What do we do for this?
Encourage ambulation
PO fluids
Stool softeners
BM by 2-3 days, normal pattern by 2 wks
Liver enzymes normalize by ___ wks
3
Joint stability normalizes by ___ wks
6-8
Diastasis recti (separation of abdominal wall is usually resolved by ___ wks
6
How many additional kcals/day do lactating women need?
500-1000
hCG is undetectable by ___, hPL is undetectable by ___
End of first wk, 24 hours
Estrogen levels ___
Prolactin levels ___
Drop
Rise
What is the acronym to remember for a postpartum assessment?
BUBBLES breasts Uterus Bowel Bladder Lochia Epis/lac pSychosicial
Baby blues usually lasts about ___ wks
3
What is endometritis/what are the symptoms?
Infection of uterus
Fever, inc abd pain, malaise, uterine tenderness, malodorous lochia
What is normal blood loss with a vaginal delivery? Csection?
500
1000
Early pp hemorrhage is one that happens in first ___ hours and can be caused by_______
First 24 hours
Atony Lacerations Retained products Accretas Rupture Inversion Coagulopathy
Late pp hemorrhage happens ____ and can be caused by _______
Between 24hrs-6wks pp
Infection
Retained products
Subinvolution
Coagulopathy
What are surgical interventions for a pp hemorrhage?
Uterine artery embolization
Uterine artery ligation
Uterine compression sutures
Hysterectomy
Most changes that occurred during pregnancy resolve by ___ wks. This postpartum period is also called ___
6-8
Puerperium
What are the three phases of maternal role attachment?
Taking in: first 48 hrs, dependent, relive birth experience, separates self from newborn
Taking hold: day 3-several weeks, active, desire to do infant care without help
Letting go: reconnects with others, inc confidence
What hormones are responsible for milk production and delivery?
Pituitary hormones:
Galactopoietic hormone- prolactin
Galactokinesis hormone- oxytocin
What is colostrum?
More protein and lactose
Less fat
Immunoglobulins and antibodies
There before milk comes in on day 2-5
How does lactation keep ovulation at bay?
Prolactin levels suppress lutinizing hormone
What is recommended for engorgement?
Mild analgesic
Ice pack
Frequent breastfeeding
What is mastitis?
Infection of breast
Usually unilateral
Fever, chills, malaise, tender, hard, red, swollen
Continue to nurse
Antibiotics
What are maternal warning signs ?
Temp >100
Severe cramps with abd pain, chills/fever
Heavy bleeding/large clots
Foul discharge
Inc tenderness, redness, drainage, separation
of stitches
Pain, burning, difficulty urinating
Red streaks/pain in calvesWhat are newborn warning signs?
Fever >100.4 60 Jaundice Bleeding from circ Foul discharge from umbilical cord Feeding problems
