Postpartum Flashcards
The six weeks following childbirth
Dramatic physical and psychological changes as the body returns to pre-pregnancy state
Resolve issues r/t labor & delivery
Adapt to new role as mother
Postpartum
Oxytocin-hormone responsible for involution and initiation of breastmilk let-down
–breastfeeding aids in faster involution–afterpains: ibuprofen (helps cramping), Tylenol (helps incisional pain), Percocet
Postpartum changes
returning of the uterus to normal size and position
involution
Position of uterus--fundal check – position mother flat on back, bladder emptied – support uterus with one hand firmlyplaced just above symphysis pubis,fundus palpated with pinkie side of other hand
Postpartum changes - involution
Position measured in relation to fingerbreadths from umbilicus After delivery--fundus at umbilicus or slightly below By 48 hours--2-3 fingers below umbilicus If above umbilicus or displaced to one side--check bladder distention
Involution - fundal check
Should be firm and about the size of a grapefruit
If not firm–”boggy”–risk for bleeding.
Perform fundal massage.
Report if tone becomes boggy after
massaged stopped. May need IV oxytocin
or methergine.
Teach client self fundal massage
Involution - uterine tone
stops post partum hemorrhage by constricting blood vessels
Know range of patient’s BP cause it will raise it
Methergine
1 cause of postpartum hemorrhage
caused by full bladder and cure is voiding
Uterine atony
Greater than 500 mL for vaginal Greater than 1000 mL for C-section #1 Cause--uterine atony Cervical or vaginal lacerations Hematoma--vulvar, vaginal, retroperitoneal Retained placenta
Postpartum hemorrhage
First hour following delivery most critical period
for hemorrhage - worried about uterine atony and lacerations and hemorrhage
Early hemorrhage
– Atony
– Lacerations
– Hematoma
Late hemorrhage
– Retained placenta
– Subinvolution - uterus is tired - at risk for PPH and infection
– Infection
Postpartum hemorrhage (2)
Vaginal discharge after delivery Composed of endometrial tissue, blood, and lymph Assess quantity--increases w/ activity – Heavy--1 large pad saturated w/in 1 hour – Moderate--less than 6 inches on pad – Light --less than 4 inches on pad – Scant--less than 1 inch
Lochia
Assess type (color)
– Rubra–red, duration 1-3 days, small clots,
fleshy odor
– Serosa–pinkish brown, duration 3-10 days, may
have fleshy odor
– Alba–white, mucus-like, 10-14 days, no odor - continues up to 6 weeks
Report foul odor, large clots, or if color returns to rubra
Lochia color
Cervix regains muscle tone but never closes as tightly as in pre-pregnant state Regains thickness and normal dilatation
within 12 hours postpartum May feel bumpy, irregularly shaped upon further cervical checks
Cervical changes
Regains muscle tone gradually
Rugae disappear during labor, reappear 3-4 weeks postpartum
Vaginal changes
Very tender with or without episiotomy or laceration Regains muscle tone in 2-3 weeks if no episiotomy Epis heals superficially in 5-6 weeks but still tender Deep healing may take 6 months Watch for S/S of infection or hematoma
Perineal changes
Ice pack provides comfort, reduces swelling Teach good perineal cares Topical anesthetics may be used – benzocaine spray, Tucks pads Prevent constipation NO intercourse, tampons, douching
Perineal changes (2)
Abdominal wall and muscles regain tone gradually. May exercise lightly during 6 weeks – walking, stretching, Kegels Blood volume returns to normal in 2 weeks – 4-6 # weight loss thru diuresis, blood loss – Hgb/Hct levels fluctuate
Other changes
