Postpartum Adaptations Flashcards
Reproductive System & Associated Structures - Uterus
- Involution process is the return of the uterus to a non-pregnant state following birth
- progresses rapidly
- fundus descends 1-2cm every 24hrs
- 2wks after childbirth the uterus is no loner palpable
- Returns to a non-pregnant state by 6wks
Reproductive System & Associated Structures - Contractions After Birth
- Postpartum hemostasis is achieved by the compression of intramyometrial blood vessels as the uterine muscle contracts
- Oxytocin is released from pituitary galnd to strengthen & coordincat uterine contractions
- Can be as strong a labor contractions
Reproductive System & Associated Structures - Lochia Rubra
- Blood & decidual & trophoblastic debris
- Purplish/red
- Lasts 3-4 days
Reproductive System & Associated Structures - Lochia Serosa
- Old blood, serum, leukocytes, & debris
- Pinkish/orange/brown
- Lasts 22-27 days
Reproductive System & Associated Structures - Lochia Alba
- Leukocytes, decidua, epithelial cells, mucus, serum, & bacteria
- White/yellow
- Continues 2-6 wks after birth
Reproductive System & Associated Structures - Cervix
- Soft immediately after birth
- During the next 12-18 hrs after birth cervix: shortens, becomes firm, and regains pre-preg form
- Cervical os closes gradually
Decreased Estrogen
Responsible for the thinness of vaginal mucosa & absence of rugae
When does vaginal rugae reappear
W/in 3 weeks
When does thickening of vaginal mucosa happen
With the return of ovarian function
S/S of Low Estrogen
- Dryness
- Coital discomfort & dyspareunia
- Can persist till ovarian func returns
What can prolong dcr of estrogen
Breast feeding
Introitus Post Birth
Erythematous/Edematous
Episiotomies Healing Time
2-3 weeks
Hemorrhoids
- Anal varicosities
- Common & dcr in 6wks postpartum
Pelvic Muscle Support
-
Exercise to encourage women for healing/strengthen pelvic floor
> Kegel exercise
> require up to 6 months to regain tone
Abdomen
- During 1st 2 wks abdominal wall remains relaxed
- Woman still has pregnant appearance
> not uncommon - Return to pre-preg state w/in 6wks
- Depends on previous tone, proper exercise, & amnt of adipose tissue
Endocrine System - Placental Hormones
-
When placenta is removed, it results in a big dcr in hormone tht maintained pregnancy
> chorionic somatomammotropin (hCS)
> cortisol
> estrogen
> progesterone
> placental enzymes insulinase - The dcr in these hormone results in the reversal of pregnancy
Endocrine System - Pituitary Hormones & Ovarian Function
-
Ovulation return depends on breastfeeding & breastfeeding pattern
> non-BF mom’s menstruation canoccur w/in 27 days - 12 wks postpartum
Urinary System
-
Postpartal Diuresis
> w/in 12hrs after birth women begin to diurese
> profuse diaphoresis often occurs at night for 1st 2-3 days -
Urethra & Bladder
> excessive bleeding can occur bc of displacement of uterus if bladder is full -
Pt Education
> may continue to have urgency to pee
> normal, body is trying to get rid of extra fluid
Gastrointestinal System
-
Appetite
> incrd after birth due to recovery analgesia, anesthesia, and fatigue -
Bowel Elimination
> constipation could occue for 2-3 days after birth - Required to at least pass gas prior to discharge
Breasts
-
Breastfeeding Moms
> before lactation colostrum (yellow fluid) can be expressed from nipples
> breasts become fuller & heavier; estimates when milk comes in: 72-96hrs after birth -
Nonbreastfeeding Moms
> engorgment resolves spontaneously
> dcrs w/in 24-36hrs
> comfort measures: cabbage leaves, binders, dcr stim to breast, NSAIDs
Cardiovascular System - Blood Volume
-
Changes in blood vol depend on several factors
> blood loss during childbirth
> amnt of extravascular water mobilized & excreted
> pregnancy-induced hypervolemia allow most women to tolerate blood loss during birth
Cardiovascular System - Cardiac Output
- Remains incrd for 48hrs after birth
- Incrd stroke vol is caused by return of blood to maternal systemic circulation
- Stroke vol, end-diastolic vol, & systemic circulation resistance remain elevated for 12 wks after delivery
Important to Assess since CO is at its Peak Postpartum
Assess for cardiac decompensation
Neurologic System
- Pregnancy induced neuro discomforts dcr after birth
- Carpal tunnel syndrome dcrs
-
Postpartum headache may be R/T:
> getational HTN
> stress
> leakage of CSF into extradural space during placement of spinal anesthesia
Musculoskeletal System
- Joints are completely stabilized by 6-8 wks after birth
- New mom may notice permanent incr in shoe size
Integumentary System
-
Skin complications tht Regress:
> spider angiomas
> palmar erythema
> epulis - A dcr in estrogen causes regression
- Spider nevi: can persist indefinitely for some
- Hair growth speed slows during postpartum
- Chloasma regress toward end of pregnancy
Integumentary System - Hyperpigmentation
- Areola/linea nigra may NOT regress completely after birth
- Stretch marks on breasts, abd, & thighs may fade but not disappear
