postpartum (ch 20, 21, 22) Flashcards
another term for post-partum period
puerpural/perperium
interval between birth and return of the reproductive
organs to their nonpregnant state
postpartum period
reverting of uterus back to nonpregnant state
-contractions
-afterpains
-placental site (healing w/o scar)
involution
when is uterine involution complete
5-6 weeks
immediately after birth where should uterus be?
after 24 hours?
immediately after: +1 cm above umbilicus
24 hours: at umbilicus
for each day after that: -1 cm below umbilicus
what increases risks of afterpains in uterus (3)
-multiparas
-mothers of large infants
-multiple gestation
when are uterine afterpains usually experienced
2-3 days after birth
what causes increased afterpains
breastfeeding
-oxytocin released from posterior pituitary (causing more uterine contractions)
what makes up the lochia
-sloughed off innermost lining of decidua
-RBCs
-WBCs
-cervical mucous
-bacterial cells
what could cause decreased lochia
c section
what could cause increased lochia (2)
-ambulation
-breastfeeding
3 different types of lochia
-lochia lubra
-lochia serosa
-lochia alba
characteristics of lochia rubra
-days 1-3 PP
-dark/bright red
-small clots
-possible musty odor
-variable flow (heavy to light)
characteristics of lochia serosa
-days 4-10
-pink/ pinkish brown
-no clots
-less odor
-moderate to scant flow
characteristics of lochia alba
-days 10-14 (can last 3-6 weeks)
-light yellow to creamy color
-no clots
-no odor
-scant flow
characteristics of perineum immediately after birth
-tender
-swollen
-bruising
-maybe sutures
-maybe laceration repair
pain control measures for perineum
-ice reduces swelling
-anti-inflammatory creams
-local pain control (epi-foam)
what hormones suppress milk production during prenatal period
estrogen
progesterone
changes in breast within 24 hours after birth
colostrum:
-yellowish fluid high in proteins and minerals
-provides initial infant immunities
changes in breast 3-5 days after birth
-breast milk production begins
-engorgement (painful over-filling, firm, warm to touch, tender)
cardiovascular and hematologic changes after birth
-blood loss (200-1000 mL)
-increased circulating blood volume 15-30%
-loss of vasodilating effects of pregnancy hormones
-shift of ECF into systemic circulation
-increased circulating volume leads to sweat and urination (fluctuating Hgb and Hct for 3-4 days)
-increased WBC during labor and immediately after birth (up to 30,000; back to normal by 4-7 days)
-thromboplastin released at placental site (fibrinogen and clotting factors remain high)
when is blood volume back to pre-pregnancy state
4th week PP
normal blood loss vaginal birth
200-500 mL
normal blood loss C/S
700-1000 mL