Postpartum Care Flashcards
Postpartum
Postpartum: delivery through 6 weeks
“4th trimester”
AKA “puerperium”, from the Greek “puerperos”, meaning “to bear young”
Puerperal = postpartal
Key task: involution
Involution
Uterus returns to its normal position, shape, size
Position: pelvic organ
Shape: upside-down pear
Size: fruit-basket pear
Uterus Decreases in Size
- Uterine contractions
- Autolysis
- Catabolic process
- Muscle fibers get smaller
- Protein from myometrial cells reabsorbed
Endometrial Changes
- Uterine contractions decrease placental site to ½ predelivery size
- Blood loss controlled
- Compression of blood vessels that supply decidual sinuses
- Compression of sinuses themselves
- Clot formation in vessels that supply decidua - endometrium
WBCs
Infiltrate placental site, blood vessels, and surrounding tissues
Necrosis begins
3 weeks total for decidual necrosis/regeneration
+
3 weeks for placental site necrosis/regeneration
Lochia (Postdelivery Flow)
After delivery, almost entirely blood
As sinuses compressed, clots form, less blood
Forms
1. Rubra (red)
2. Serosa (pink)
3. Alba (yellowish-white)
Lochia Rubra: 2-3 Days
Blood + mucus + decidual particles + cellular debris from placental site
Endometrial cavity sterile initially, then bacterial growth + WBCs contribute to lochia
Lochia Serosa: At 3-4 Days
L_ess oozing blood, more watery (serous)
Pinkish-tan color_
Involution of placental site continues: blood decreases, WBC + cellular debris
predominate
Lochia Alba: By Day 10
Yellowish-white to white in color
Gone by end of 3rd PP week or brownish mucoid discharge few days
Peripad Assessment (1 Hour)
Scant; Light; Moderate; Heavy saturated
PPH (Postpartum Hemorrhage)
Early PPH
Within first 24 hours
Uterine atony #1 ( uterus without tone, not contracting) , also genital tract lacerations and retained placenta
Late PPH
After first 24 hours
Retained placenta
Fundal Height
Fundus ( top portion of the uterus ) - at or below the level of umbilicus
Empty bladder - two-handed approach - palpate the abdoemn gently feeling for the top of the uterus while the other hand is placed on the lower segment of the uterus to stabilize it.
* By the 10th day PP, uterus is no longer palpable abdominally
if it is palpable - subinvolution due to retained placenta
Fundal Characteristics
Should be firm, in the midline
Reference position to the umbilicus
FF U/0 (at the level of umbilicus) , FF U/1 (1 cm below) , etc. !!!!!!
FF ( fundus firm) 1/U ( 1 cm above) , FF 2/U ( 2 cm above) , etc.
Boggy Uterus
Uterus not firm? Massage & reassess.
Support base of uterus
Massage fundus straight down towards patient’s spine
Note passage of clots, retained placenta, pieces of amniotic sac
Full Bladder
Too high? Over to right side? Probably full bladder. Have patient void & reassess.