Postpartum Adaptations

Question 1

Reproductive System & Associated Structures - Uterus

Answer 1

• 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

Question 2

Reproductive System & Associated Structures - Contractions After Birth

Answer 2

• 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

Question 3

Reproductive System & Associated Structures - Lochia Rubra

Answer 3

• Blood & decidual & trophoblastic debris
• Purplish/red
• Lasts 3-4 days

Question 4

Reproductive System & Associated Structures - Lochia Serosa

Answer 4

• Old blood, serum, leukocytes, & debris
• Pinkish/orange/brown
• Lasts 22-27 days

Question 5

Reproductive System & Associated Structures - Lochia Alba

Answer 5

• Leukocytes, decidua, epithelial cells, mucus, serum, & bacteria
• White/yellow
• Continues 2-6 wks after birth

Question 6

Reproductive System & Associated Structures - Cervix

Answer 6

• 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

Question 7

Decreased Estrogen

Answer 7

Responsible for the thinness of vaginal mucosa & absence of rugae

Question 8

When does vaginal rugae reappear

Answer 8

W/in 3 weeks

Question 9

When does thickening of vaginal mucosa happen

Answer 9

With the return of ovarian function

Question 10

S/S of Low Estrogen

Answer 10

• Dryness
• Coital discomfort & dyspareunia
• Can persist till ovarian func returns

Question 11

What can prolong dcr of estrogen

Answer 11

Breast feeding

Question 12

Introitus Post Birth

Answer 12

Erythematous/Edematous

Question 13

Episiotomies Healing Time

Answer 13

2-3 weeks

Question 14

Hemorrhoids

Answer 14

• Anal varicosities
• Common & dcr in 6wks postpartum

Question 15

Pelvic Muscle Support

Answer 15

• Exercise to encourage women for healing/strengthen pelvic floor
  > Kegel exercise
  > require up to 6 months to regain tone

Question 16

Abdomen

Answer 16

• 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

Question 17

Endocrine System - Placental Hormones

Answer 17

• 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

Question 18

Endocrine System - Pituitary Hormones & Ovarian Function

Answer 18

• Ovulation return depends on breastfeeding & breastfeeding pattern
  > non-BF mom’s menstruation canoccur w/in 27 days - 12 wks postpartum

Question 19

Urinary System

Answer 19

• 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

Question 20

Gastrointestinal System

Answer 20

• 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

Question 21

Breasts

Answer 21

• 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

Question 22

Cardiovascular System - Blood Volume

Answer 22

• 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

Question 23

Cardiovascular System - Cardiac Output

Answer 23

• 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

Question 24

Important to Assess since CO is at its Peak Postpartum

Answer 24

Assess for cardiac decompensation

Question 25

Neurologic System

Answer 25

• 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

Question 26

Musculoskeletal System

Answer 26

• Joints are completely stabilized by 6-8 wks after birth
• New mom may notice permanent incr in shoe size

Question 27

Integumentary System

Answer 27

• 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

Question 28

Integumentary System - Hyperpigmentation

Answer 28

• Areola/linea nigra may NOT regress completely after birth
• Stretch marks on breasts, abd, & thighs may fade but not disappear