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NURS787 Exam 3 > Postpartum Anatomy & Physiology > Flashcards

Postpartum Anatomy & Physiology Flashcards

1
Q

uterus position immediately PP

A

at level of umbilicus

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2
Q

uterus 1-2h PP

A

b/w umbilicus and symphysis pubis

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3
Q

uterus 12h PP

A

1cm above umbilicus

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4
Q

uterus 24h PP

A

1cm below umbilicus

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5
Q

uterus 3 days PP

A

3cm below umbilicus

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6
Q

uterus 7 days PP

A

at symphysis

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7
Q

uterus 14 days PP

A

non-palpable

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8
Q

How does involution occur?

A

myometrial cell autolysis - decrease in size, not number

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9
Q

What occurs to the endometrium PP?

A

Days 2-3: decidua basalis divides into 2 layers

1) superficial: protects from infection; later sloughs
2) basal: stays together to create new endometrium

Week 1: new epithelium

Weeks 2-3: regrows like pre-pregnancy

Week 6: vessels that were part of placenta exfoliated and sloughed –> endometrium remodeling

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10
Q

Describe lochia PP

A

rubra: ~3 days
serosa: ~ 7-10 days

eschar bleeding: ~7-14 days PP for a few hours

alba: up to 4wks

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11
Q

Describe vaginal changes PP

A

3-4w: vaginal rugae returns

6-10w: vaginal epithelium healed

labia minora no longer hide introitus

+/- decreased vaginal tone

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12
Q

What are the 3 phases of [perineal] healing?

A

1) hemostasis and inflammation
2) granulation and proliferation
3) remodeling

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13
Q

Why are pts w/ HTN, PEC, or CVD at increased risk of pulmonary edema/cardiac failure in the first 24-48h PP?

A
  • immediate auto-transfusion of blood volume
  • shifting of extracellular fluid into intravascular system
  • stroke volume and cardiac output increase by 80%
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14
Q

What occurs to cardiac output PP?

A

INCREASES d/t increased blood flow from:

  • loss of uteroplacental circulation
  • decreased pressure from pregnant uterus
  • mobilization of extracellular fluid
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15
Q

How much does cardiac out put change PP?

A
  • increases during first 48h PP

- slowly returns to normal by 6-12w

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16
Q

When does plasma volume return to pre-pregnancy values?

A

2w

17
Q

When does blood volume normalize?

A

2w

18
Q

What is transient anemia?

A

decreased H/H from hemodilution and blood loss in birth immediately PP and for 1w after

19
Q

When does transient anemia resolve?

A

4-6w PP

20
Q

When should pts expect to have their first BM PP?

A

2-3 days PP; normal GI function and bowel patters return 1-2w PP

21
Q

What is diastasis recti?

A

separation of rectus abdominus muscles

  • resolves in weeks
  • can vary in severity
22
Q

Why is there decreased peristalsis in early puerperium?

A
  • decreased progesterone –> increased motility BUT takes time
  • decreased bowel and abdominal wall tone
23
Q

Why may pts be constipated PP?

A
  • fear
  • perineal pain
  • narcotics in labor
  • c/s
  • dehydrationj
  • restriction of fluids/food during labor
  • iron supps
  • decreased activity
24
Q

Why is SOB/chest pain significant PP?

A

dyspnea should resolve almost immediately - SOB may indicate thromboembolic event

25
Q

What are 3 reasons for urine retention PP?

A

1) decreased bladder tone
2) decreased bladder sensation
3) increase in diuresis

26
Q

How are oxytocin and water related?

A

oxytocin promotes water reabsorption - decrease in oxytocin –> diuresis

27
Q

When do oxytocin levels decrease?

A

not breastfeeding: 7-14 days

28
Q

What is the effect of estrogen on the thyroid?

A

decreased estrogen PP –> decreased thyroid-binding globulin –> decreased T3, T4 –> return to pre-pregnancy levels

  • at risk for:
  • Grave’s disease
  • PP thyroiditis
  • thyroid storm
29
Q

When do FSH and LH levels return?

A

4-6w in nonlactating people

30
Q

Describe lactogenesis I

A

end 1st tri to 2nd half of pregnancy

  • milk duct system growing
  • secretion initiation
  • may see leaking at 16-18w GA
31
Q

Describe lactogenesis II

A

30-72h PP

  • secretory activation
  • plasma progesterone drops suddenly w/ expulsion of placenta
  • lactocytes secrete lactose –> increase in milk production
  • milk synthesis PLUS milk ejection
32
Q

What does suckling stimulate?

A

1) prolactin secreted from anterior pituitary –> milk secretion
2) oxytocin secreted from posterior pituitary –> milk ejection

33
Q

Describe lactogenesis III

A

galactopoiesis = established lactation; continued milk production

34
Q

What are the functions of breastmilk components?

A
  • bacteriostatic
  • anti-inflammatory
  • immune-modulation
  • stimulates infant GI
  • pinocytosis
  • chemotaxis
  • cell-mediated immunity for infant
35
Q

Describe lactogenesis IV

A

cessation of breastfeeding and involution of mammary glands

36
Q

Which hormones does lactation effect?

A

1) GnRH (suppressed by prolactin –>)
2) suppressed LH –> suppressed ovulation
3) FSH

37
Q

When does menstruation return?

A

non-lactating: 12w

lactating: ~38mo

38
Q

What is lactational amennorhea?

A

“nonfertile” ovulation

NURS787 Exam 3 (4 decks)

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