Postpartum Assessment

Question 1

Describe normal postpartum temperature.

Answer 1

• 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)

Question 2

Describe abnormal postpartum temperature.

Answer 2

• > 101
• Assess for potential causes: puerperal sepsis, mastitis, endometritis, UTI

Question 3

Describe normal postpartum HR.

Answer 3

• Normal: 50-90
• Remains elevated 1st hour after birth
• Gradually decreases over 1st 48 hours
• May be bradycardic (40-50)

Question 4

Describe abnormal postpartum HR.

Answer 4

• Tachycardia (>100bpm)
• Causes: hypovolemia, infection, fear, pain

Question 5

Describe normal postpartum respirations.

Answer 5

Normal: 16-24

Question 6

Describe abnormal postpartum respirations.

Answer 6

• Depressed respirations
• Causes: spinal anesthesia or an epidural opioid medication

Question 7

Describe normal postpartum BP.

Answer 7

• Slight increase from baseline (5% increase over 1st few days, return to baseline in a few weeks)
• Orthostatic hypotension (typically 1st 48 hours)

Question 8

Describe abnormal postpartum BP.

Answer 8

• Severe hypotension
• Causes: hypovolemia due to hemorrhage
• Hypertension (>140/90 x 2 )

Question 9

What are the normal lab value ranges of WBC pre-pregnancy, during pregnancy, and postpartum?

Answer 9

• Pre-Pregnancy: 5,000-10,000/mm3
• Pregnancy: ~ 12,000
• Postpartum: 20-25,000 (normal)

Question 10

What are the normal lab value ranges of Hgb pre-pregnancy, during pregnancy, and postpartum?

Answer 10

• Pre-Pregnancy: 12-16 g/dl
• Pregnancy: ~ 12
• Postpartum: May see initial drop of 1 g

Question 11

What are the normal lab value ranges of Hct pre-pregnancy, during pregnancy, and postpartum?

Answer 11

• Pre-Pregnancy: 37-47%
• Pregnancy: ~ 33-39
• Postpartum: Initial drop of 2-3%

Question 12

Describe Clotting Factors & Fibrinogen during pre-pregnancy, pregnancy, and postpartum.

Answer 12

• Pre-Pregnancy: normal
• Pregnancy: increased
• Postpartum: stay elevated in immediate PP

Question 13

What does BUBBLE-LP stand for?

Answer 13

• Breast
• Uterus
• Bowel/Abdomen
• Bladder/Urinary Tract
• Lochia
• Emotions

Plus

• Legs
• Perineum

Question 14

Expand on Breasts in BUBBLE-LP.

Answer 14

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

Question 15

Expand on Uterus in BUBBLE-LP.

Answer 15

• 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

Question 16

What is uterine involution?

Answer 16

• 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

Question 17

What is sub-involution of the uterus?

Answer 17

• 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

Question 18

Expand on Bowel/Abdomen in BUBBLE-LP.

Answer 18

• 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

Question 19

What is Diastasis Recti?

Answer 19

• 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

Question 20

Expand on Bladder/Urinary Tract in BUBBLE-LP.

Answer 20

• 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

Question 21

Expand on Lochia in BUBBLE-LP.

Normal estimated blood loss at delivery?

Answer 21

Normal Estimated Blood Loss at delivery: up to 1000ml, regardless of the mode of birth

Question 22

What are the different types of lochia?

Answer 22

• Rubra
• Serosa
• Alba

Question 23

Describe Rubra Lochia.

Answer 23

• Bright red
• 1-3 days postpartum
• Flow is like a heavy menstrual period

Question 24

Describe Serosa Lochia.

Answer 24

• Pinkish-brown
• 4-10 days
• Flow is moderate to small amount

Question 25

Describe Alba Lochia.

Answer 25

- Whitish-yellow - 10-14 days, up to 3-6 weeks - Flow is scant

Question 26

Expand on Emotions in BUBBLE-LP.

Answer 26

- 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

Question 27

Expand on Legs in BUBBLE-LP.

Answer 27

- 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!**

Question 28

Expand on Perineum in BUBBLE-LP.

Answer 28

- 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

Question 29

Cardiovascular changes that occur postpartum?

Answer 29

**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)

Question 30

Endocrine changes that occur postpartum?

Answer 30

- 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