Postpartum care Flashcards
Involution
rolling or turning inward- the reduction in size of the uterus following childbirth to a nonpregnant state.
Fundus
the top portion of the uterus situated midway between the symphysis pubis and the umbilicus
What is Lochia? What are the 3 types?
maternal discharge of blood, mucus, and tissue from the uterus that occurs for several weeks after birth
RUBRA- red, blood-tinged vaginal discharge that occurs following birth and lasts 2-4 days after birth
SEROSA- pink, serous and blood-tinged discharge that follows rubra and lasts until the 7-10 days after birth
ALBA- white discharge that follows lochia serosa that lasts from day 10-21 after birth
What are Afterpains? How long do they normally last?
cramp-like pains that occur after childbirth due to contractions of the uterus. They are more common in multiparas, tend to be most severe during breast-feeding, and last 2-3 days
What is an Episiotomy?
intentional incision of the perineum during childbirth to facilitate birth and to avoid laceration or tearing of the perineum
Homan’s Sign
discomfort behind the knee on forced dorsiflexion of the foot; a sign of thrombosis in the lower limb
Diastasis Recti
separation of the recti abdominis muscles along the median line. In women, it is seen with repeated childbirths or multiple gestations.
Sitz bath
a warm, shallow bath that cleanses the perineum, which is the space between the rectum and the vulva or scrotum. A sitz bath can be used for everyday personal hygiene. It can also provide relief from pain or itching in the genital area, and can help promote healing after childbirth
REEDA
Acronym used to describe the condition of wounds Redness Edema Ecchymosis Drainage Approximation
What does PIH stand for?
Pregnancy Induced Hypertension, can lead to preeclampsia or toxemia
What does PROM stand for?
Premature Rupture of Membranes
-when the amniotic sac ruptures (the mother’s water breaks) more than one hour prior to the onset of labour
What does PPH stand for?
Persistent pulmonary hypertension- respiratory disease resulting from right to left shunting of blood away from the lungs and through the ductus arteriosus and patent foramen oval
What is Hydramnious?
an excess of amniotic fluid, leading to overdistention of the uterus. Frequently seen in pregnant women who have diabetes, even if there is no coexisiting fetal anomaly.
What causes Diastasis Recti in the newborn?
incomplete development
What are the 3 phases in the first stage of labour and delivery
Latent- starts when contractions become regular and painful and cervical effacement and dilation commence (up to 3cm)
Active- labour is well-established with contractions becoming more painful and more frequent and longer (4-8cm)
Transition- contractions are more expulsive, women feel the need to bear down (8-10 cm)
What is the difference between braxton hicks and true labour?
braxton hicks produce contractions that can be both regular and painful, but they do nothing to the cervix so L&D are not progressing
When is it appropriate to give women in labour and delivery analgesia?
usually wait until active phase, because giving it too early can stall early labour. However, if the mom is in severe pain, they can be given earlier
What is meant by the term “anterior lip”?
this means that the cervix is on the forehead of the baby but not around the head. Sometimes mom can push through this, BUT, if mom is only 8-9 cm dilated, DO NOT PUSH, as it can cause swelling which can revert her to 5-6cm
What occurs during the second stage of labour?
commences with full dilation of the cervix and ends with the birth of the baby.
-fetal head descends under the pubic arch and gradually thins and stretches the vaginal opening
How does the second stage of labour differ for primips and multips?
for primips, this stage can last up to 3 hrs, but usually lasts around 60 mins, whereas for a multip, this stage can be less than 20 mins long, since their muscles are familiar with this process and tend to progress much quicker
What occurs during the third stage of labour? How long does this stage usually last?
this refers to the time between when the baby is born and when the placenta and membranes are delivered.
- once the infant is born, the uterus contracts and retracts, which causes the placenta to pull away from the wall of the uterus.
- Usually occurs within 20-30 mins
Explain the 4th stage of labour
1-4 hours after birth (typically 2 hours)– time of physiologic adjustment and stabilization for the mom and newborns adjustment to extrauterine life.
How long does the “post-partum” stage last?
up to 6 weeks after birth, which is as long as it takes for mom to physical and psychological adjustments to a pre-pregnant state
what does it mean that postpartum is considered both retrogressive and progressive?
Retro- everything returning back to pre-pregnancy state
PRO- “healing” from process, such as episiotomy or tearing
Where would you expect to palpate the uterus immediately postpartum?
about 5cm below the umbilicus, with the fundus approx. half way between the symphysis pubis and the umbilicus
How long does it take for the uterus to lift up to the umbilicus? When would you expect the uterus to return back to its normal location?
6-12 hrs postpartum.
- usual descent is 1cm/day, so it should return to normal within 10 days
When you assess your patient postpartum, you palpate that the uterus is boggy and high. What is your biggest concern?
This patient is at increased risk of bleeding and clot formation
When you assess your patient postpartum, you palpate that the uterus is firm and deviated to the side. What does this indicate? How would you intervene?
usually a full bladder- often the first void after delivery is difficult because mom doesnt feel the same urge to go. Bladder scan, encourage mom to void q2h to allow complete emptying of the bladder
The uterus decreases in weight after delivery. Why is this?
during pregnancy, mom experiences uterine hypertrophy, or an increase in the size of uterine cells. Once the baby is born, the uterine cells atrophy in order to return to pre-pregnancy state
