Postpartum Care: The Fourth Trimester Flashcards
Postpartum Physiology of the vagina and vaginal outlet?
- Gradually dimish in size (weeks) but do not return to prepregnancy dimensions
- rugae reappaer by week 3 but less prominant
- epithelium does not proliferate until 4-4 weeks (coincides with return of ovarian est.)
- lacerations generally fully healed by 4-6 weeks but may have remaining scar
postpartum physiology of the uterus?
- caliber of uterine vessels return to pregnancy state
- myometrium involutes
- endometrium regenerates
- songographically, the uterus and endometrium return to preravid size by 8 weeks postpartum
- sloughing of decidua, erythrocytes and epithelial cells and bacteria
- three types
Lochia
what are three types of lochia
- lochia rubra- for 3-4 days, red in color
- lochia serosa- more pale as presence of blood decreases
- lochia alba- by day 10 mix of leukocytes and fluid so white/yellow- white
when does the myometrium involute?
- begins 2 days after post-delivery and is complete by 4 weeks postpartum
- After each successive delivery, the uterus is usually slightly larger than before the most recent pregnancy
when does the endometrium regnerate?
- 2-3 days post delivery decidua becomes differentiated into two layers
- superficial layer becomes necrotic–> sloughed in the lochia
- basal layer adjacent to the myometrium is the source of the new endometrium
how does the cervix change after pregnancy?
- os narrows, thickens and endocervical canal reforms by week 1
- epithelium remodels- can cause regression of dysplasia
How long does it take for the abdominal wall to return to normal
- several weeks are required to return to normal
- exercises help and can start right after vaginal delivery and 6 weeks after C-section
- may need more intervention if diastasis or significant atony remains
- striae often do not disappear
weight loss after pregnancy looks like?
- delivery and normal blood loss acounts for 11-13lb (5-6kg) weight loss
- postpartum diuresis in the first 2-3 days results in additional 4.5-6.5 (2-3kg) of weight loss
- pregnancy weight loss is generally maximal by week 3 postpartum
up to 6 months to return to prepreg. weight; residual weight gain of 3lb
What are some challanges of postpartum period?
- lack of sleep
- pain
- stress
- new or exacerbated mental health disorders
- breastfeeding difficulties
- lack of sexual desire
Components of postpartum visit?
- infant care and feeding
- contracepting counseling
- warning signs for mood disorders
- immunizations for patient and family
- future screening based on pregnancy related. complications
- chronic disease management
what are major causes of postpartum mortality?
- maternal hemorrhage
- postpartum preeclampsia(all complaints of headache, vision changes, abdominal pain, and swelling need full evaluation)
- VTE
- sepsis
what is considered the “safe” intrapregnancy window?
- > 18months
- 6 months is the absolute minimum
May prevent pregnancy IF patient is exclusively breast/chest feeding, menses has not resumed and infant is less than 6 monts
Lactational amenorrhea
Challanges/Barriers to breast feeding
- lack of knowledge
- social norms
- poor family and social support
- embarassment
- lactation problems
- employment and child care
- barriers related to health service
