Postpartum Assessment Flashcards
Describe normal postpartum temperature.
- May be mildly elevated for first 24 hrs (dehydration)
- PP Chill (fluid shifts, nervous system response to work of labor)
- PP Diaphoresis (elimination of excess fluid)
Describe abnormal postpartum temperature.
- > 101
- Assess for potential causes: puerperal sepsis, mastitis, endometritis, UTI
Describe normal postpartum HR.
- Normal: 50-90
- Remains elevated 1st hour after birth
- Gradually decreases over 1st 48 hours
- May be bradycardic (40-50)
Describe abnormal postpartum HR.
- Tachycardia (>100bpm)
- Causes: hypovolemia, infection, fear, pain
Describe normal postpartum respirations.
Normal: 16-24
Describe abnormal postpartum respirations.
- Depressed respirations
- Causes: spinal anesthesia or an epidural opioid medication
Describe normal postpartum BP.
- Slight increase from baseline (5% increase over 1st few days, return to baseline in a few weeks)
- Orthostatic hypotension (typically 1st 48 hours)
Describe abnormal postpartum BP.
- Severe hypotension
- Causes: hypovolemia due to hemorrhage
- Hypertension (>140/90 x 2 )
What are the normal lab value ranges of WBC pre-pregnancy, during pregnancy, and postpartum?
- Pre-Pregnancy: 5,000-10,000/mm3
- Pregnancy: ~ 12,000
- Postpartum: 20-25,000 (normal)
What are the normal lab value ranges of Hgb pre-pregnancy, during pregnancy, and postpartum?
- Pre-Pregnancy: 12-16 g/dl
- Pregnancy: ~ 12
- Postpartum: May see initial drop of 1 g
What are the normal lab value ranges of Hct pre-pregnancy, during pregnancy, and postpartum?
- Pre-Pregnancy: 37-47%
- Pregnancy: ~ 33-39
- Postpartum: Initial drop of 2-3%
Describe Clotting Factors & Fibrinogen during pre-pregnancy, pregnancy, and postpartum.
- Pre-Pregnancy: normal
- Pregnancy: increased
- Postpartum: stay elevated in immediate PP
What does BUBBLE-LP stand for?
- Breast
- Uterus
- Bowel/Abdomen
- Bladder/Urinary Tract
- Lochia
- Emotions
Plus
- Legs
- Perineum
Expand on Breasts in BUBBLE-LP.
Engorgement:
- Typically starts day 1.5-2 in multiparous person
- Starts day 3-4 primiparous person
- Lasts 24-48 hours
- Breastfeeding to reduce swelling and discomfort, set up supply/demand
Nipples:
- Assess for soreness, skin breakdown, eversion
- Breastfeeding: how frequently, assess latch/suck/swallow
Expand on Uterus in BUBBLE-LP.
- After birth, the uterus should be:
- Firm
- Midline
- At or below the umbilicus
- Within 12 hours after birth, the fundus typically one cm above the umbilicus
- After postpartum day one: Descends 1-2 cm/24 hours
What is uterine involution?
- Process by which the uterus returns to the non-pregnant state
- Begins after expulsion of the placenta
- Returns to non-pregnant location by 6 week postpartum
What is sub-involution of the uterus?
- Uterus does not contract and decrease in size
- In the first few days postpartum, sub-involution often presents as uterine atony (boggy uterus)
- Increases risk of postpartum hemorrhage
Expand on Bowel/Abdomen in BUBBLE-LP.
- Abdominal exam
- soft vs. distended
- bowel sounds in all 4 quadrants
- Diastasis Recti
- Eat when hungry
- Prevent constipation
- Post-op: NPO if nauseated, vomiting, no bowel sounds
What is Diastasis Recti?
- Condition that occurs when the rectus abdominal muscles in the front of the belly separate
- Normal in many postpartum people and can be reversed
- Postpartum support underwear—provide cross-body support to pull together separated abdominal muscles
Expand on Bladder/Urinary Tract in BUBBLE-LP.
- First 24 hours postpartum: bladder edematous, congested, hypotonic
- Day 2-4: Diuresis – large volume of urine
- Pericare done frequently
- Distended bladder
- May displace fundus – usually up and right
Expand on Lochia in BUBBLE-LP.
Normal estimated blood loss at delivery?
Normal Estimated Blood Loss at delivery: up to 1000ml, regardless of the mode of birth
What are the different types of lochia?
- Rubra
- Serosa
- Alba
Describe Rubra Lochia.
- Bright red
- 1-3 days postpartum
- Flow is like a heavy menstrual period
Describe Serosa Lochia.
- Pinkish-brown
- 4-10 days
- Flow is moderate to small amount
Describe Alba Lochia.
- Whitish-yellow
- 10-14 days, up to 3-6 weeks
- Flow is scant
Expand on Emotions in BUBBLE-LP.
- Postpartum Blues
- Day 3 – Day 10
- Occurs in 80% of birthing people
- Postpartum Depression
- Lasts beyond the 1st 2 weeks and/or interferes with functioning; 25% of people
- Psychosis: psychiatric emergency
- High mood with racing thoughts
- Severe confusion, paranoia
- Hallucinations (auditory or visual)
- Begin suddenly within 2 weeks after childbirth
Expand on Legs in BUBBLE-LP.
- Increased edema the first few days
- Soreness from labor (not pain)
- Normal reflexes
- Assessment: edema, tenderness, varicosities, pain in calf
-
Abnormal Signs:
- Unilateral leg pain/edema
- Warmth/tenderness
- Abnormalities require immediate evaluation for signs of venous thromboembolism!
Expand on Perineum in BUBBLE-LP.
- REEDA
- Redness
- Edema
- Ecchymosis
- Drainage
- Approximation
- Hemorrhoid
- Size and color
- Pressure/itch vs. pain
- Hard or soft
- Hematoma
- Bleeding under skin from leaking vessel- may be black or blue
Cardiovascular changes that occur postpartum?
Blood volume decreases:
- Diuresis begins within 12hrs PP
- Extracellular fluid plus delivery blood loss
- Cardiac output increases by 60-80% immediately post delivery
- Returns to pre-labor values within 1 hour of birth
- Returns to pre-pregnancy levels by 6-8 weeks postpartum
- Varicosities
- Most resolve in the postpartum period
- Shivering – not uncommon in the first few hours following birth, caused by sudden transition in body state (sympathetic nervous system release)
Endocrine changes that occur postpartum?
- Triggered by delivery of placenta
- Estrogen & progesterone drop dramatically
- Increased prolactin supports production of milk
- Oxytocin produced in response to nipple stimulation -triggers let-down reflex
- Return of ovulation
- Differs between lactating and non-lactating women
- 6-9 weeks postpartum, non-lactating
- Breastfeeding average 6 months
- Differs between lactating and non-lactating women
