Postpartum Care Flashcards
Ideally, the first postpartum visits after uncomplicated vaginal birth occur at….
2 weeks check in, and 6 weeks comprehensive visit
First postpartum visits after uncomplicated cesarean birth occur at….
1 week incision check, 6 weeks comprehensive visit
Tupler technique is used to assess….
diastasis recti
The gestational diabetes 75g 2-hr OGTT postpartum must be…..
fasting
Puerperium lasts approximately…
6-12 weeks
The uterus returns to baseline size by around….
4-6 weeks
The uterus is no longer palpable abdominally by….
days 10-12
The uterus should return to being a pelvic cavity by….
2 weeks
The fundal height drops approximately…..
1 fingerbreadth each day (after rising slightly on days 1-3 as muscle regains tone)
Immediately after birth, the fundal height should be around…..
the umbilicus
Regaining firmness of the uterus can take….
4-6 (up to 10) weeks
The placental site is restored by around….
6 weeks (with some residual scarring)
There is an immediate inflammatory reaction after explusion of the placenta that continues for _____ days and provides…..
10 days, antibacterial barrier
Main contributor to postpartum vaginal discharge
placental attachment site
There can be a normal transient increase in lochia to a more dark red appearance around days ____, which represents….
7-14 days, represents sloughing of the placental eschar
Lochia rubra is highest in
blood
Lochia serosa is higher in
wound exudate
Lochia alba is higher in
mucus
Lochia rubra lasts approximately….
day 0 to days 3-4
Lochia serosa lasts approximately….
days 5-9
Lochia alba lasts approximately….
days 10-28
Which lochia is mucopurulent and somewhat malodorous
serosa (r/t wound exudate)
Normal appearance of the cervix after vaginal delivery
edematous, ecchymotic, lacerations
By ____ pp, most changes to the cervix have resolved
6 weeks
Non-lactating women may begin to ovulate as early as ____ postpartum
27 days (1 month)
Average return to menstruation/ovulation by ______ in nonlactating women
7-10 weeks
Prolactin falls to BL by ______ in nonlactating women
3 weeks
Can ovulation occur before the resumption of menses?
Yes!
Vaginal ruggae return by …
3 weeks pp
Vaginal muscles gradually regain tone over….
6-8 weeks
Perineal pain may last for as long as…..
3 months or longer
Women experience an immediate postpartum weight loss of approximately….
10-13lbs
1/3 of women return to pre-pregnant weight by _____, remainder by approximately……
6 weeks; 6 months
Pregnancy can increase the volume of the thyroid by as much as ____ and takes ____ weeks to return to normal
30%, 12 weeks
Thyroid hormones return to normal by approximately….
4 weeks pp
Thyroid changes during pregnancy leave the woman at risk for ________ in the first year postpartum
transient autoimmune thyroiditis > hypothyroid
Most women with isolated GDM can stop taking their insulin or oral anti-hyperglycemics by…..
at birth (with monitoring of ongoing need)
HR and SV remain elevated for……
30-60 minutes pp
There is a transient rise in BP for ______ pp
4 days (only 5% rise)
Greatest risk for coagulability is in the first ______ pp
48 hours
“Normal” EBL in vaginal vs cesarean birth
vaginal = 500 mL cesarean = 1000 mL
Cardiac remodeling during pregnancy should return to BL by about….
6-12 weeks pp
eGFR should normalize by around….
8 weeks pp (urinary tract and renal function generally by 6 weeks)
Why may a woman have increased risk of UTI immediately postpartum? (4)
frequent use of catheters, bladder or urethral trauma, overdistention of bladder, incomplete emptying (r/t pain and/or decreased sensation)
Stress urinary incontinence is common pp, r/t….
laxity of the urinary sphincter
Stress incontinence postpartum can last….
many months
True or false: Lactational bone loss is reversible and does not have long term adverse effects for most women
true!
4T’s of postpartum hemorrhage
tone, trauma, tissue retention, thrombin disorder
Pelvic floor tone should return by….
1 year ( Leakage of urine during intercourse would be normal for up to 1 year)
Risk of thromboembolism persists for….
6 weeks postpartum
How long does alcohol remain in the breast milk
1 serving of alcohol, wait 2-3 hours. 2 servings, wait 4-5 hours.
Do not use these CAM herbs during pregnancy
cohosh, tinctures (prepared in alcohol), wintergreen, rosemary (abortiofacient)
Use of red raspberry leaf during pregnancy
Red raspberry leaf - can be bought in bulk. Lecturer drank 1 quart per day. Its more herb-y than fruity. Supposedly a good uterine tonic. Some women use early in pregnancy if history of recurrent loss. In late pregnancy, it isnt a uterine stimulant but it might tone the uterus for an easier labor. Anecdotally, supposed to reduce postpartum blood loss.
Use of witch hazel during pregnancy
Witch hazel - common post-partum. In tux pads. Cooling, soothing anti-inflammatory
Use of comfrey during pregnancy
Comfrey - postpartum for healing perineal lacerations. Brew in path and take bath postpartum with comfrey and witch hazel
Use of horse chestnut during pregnancy
Horse chestnut for varicose veins. Ropey, painful veins on legs and vulva. This is a pill taken PO
Use of fenugreek postpartum
may cause maple syrup smell. Used as a galactogogue often in conjunction with brewer’s yeast. Lactation cookies. Put oatmeal (high in iron), fenugreek, brewers yeast, chocolate - make lactation cookies. Would need to eat a ridiculous amount of cookies to actually get an effect, just preys on women’s fears that they won’t make enough milk
Use of peppermint pregnancy vs. postpartum
In pregnancy, peppermint is helpful for nausea. Couple drops on a gauze pad, and if someone is nauseous, can take a few whiffs from a closed bag. Helpful for nausea in labor.
Postpartum, can be used to reduce milk supply in women choosing not to breastfeed and in weaning. 3 cups per day of peppermint tea
Use of magnesium during pregnancy
Too high doses of magnesium will cause diarrhea. Works well for pregnancy-related constipation.
Pulsatilla homeopathy is used during pregnancy to….
turn a breech baby
Castor oil use during pregnancy
She likes castor oil for women whose water breaks but they are not in labor. She has had good success using this to get labor started. She used this at a birthing center. They would mix it in a frostee - 2oz in a frostee milkshake – hides the texture. Have them eat that. If it doesn’t work in 4 hours you can take another dose one time. You usually know if it will work within an hour. Can cause vomiting and severe diarrhea, which can cause dehydration. Taking it with a fat, like almond butter, may make absorption slower and lessen GI effects and diarrhea.
EPDS >____ may indicate depression, and always look at answer to Q _____
10, 10
PP warning sign: Bleeding (3)
saturating maxi pad <1 hour, passing more than 1 golf-ball sized clot, a return of bright red bleeding after lochia has passed (excepting transient increase days 7-10 for eschar)
PP warning sign: Tempterature
> 101 fever
PP warning sign: Neuro (3)
severe headache, visual disturbances, seizure
100.4F temperature is ______ celsius
38
PP warning sign: lower extremity
warm area, pain, or swelling in the calf
PP warning sign: urinary
Difficulty or pain with urination may indicate UTI
PP warning sign: infection
pus, redness, or foul odor at the incision or laceration
Normal pregnancy edema of the legs has usually dissipated by…
2 weeks pp
The uterus is about the size of a non-pregnant uterus by about…..
6 weeks pp
On day 3 pp, the uterus should be approximately ______ below the umbilicus
3 fingerbreadths (3cm)
If woman had a cesarean birth, when can she begin abdominal exercises?
When all abdominal soreness is gone and incision has healed
Women who do not breastfeed will experience engorgement on days ______ pp and should be educated that…..
2-4 days pp. Refrain from stimulating the breasts, wear form-fitting bra to sleep, use cold compresses and NSAIDs. May take several weeks to stop lactating
Combined hormonal contraceptives are contraindicated for _____ pp r/t …..
21-42 days r/t risk for VTE. 21 absolute contraindication, 21-42 is a risk benefit analysis, and after 42 days standard criteria is used to evaluate candidacy
While progestin only pills are safe to use immediately postpartum and during breastfeeding, is it recommended that one wait _______ r/t….
until the milk supply is well established, r/t concerns that it can affect milk supply
within _____ pp, the diuresis and diaphoresis is complete
3 weeks
By ______ pp, most perineal lacerations should be healed
3 weeks
Transient increase of bleeding from the sloughing of placenta eschar should only last….
a few hours (if longer, be evaluated)
Women should be cautioned to stop exercise if they experience…. (4)
bright red vaginal bleeding, increased pain, shortness of breath, light-headedness
If a woman had an uncomplicated vaginal birth, when can she begin abdominal exercises?
anytime
For a woman who is formula feeding, when does milk production typically cease and breasts return to pre-pregnant state
6 weeks
Herniation of the bladder into the vagina
cystocele
Sign used to evaluate possible DVT
Homans sign
