Postpartum Ch. 20

Question 0

Most changes that occur postpartum are called what?

Answer 0

Retrogressive because changes that occurred during pregnancy are reversed.

Question 1

How long does the Postpartum period occur for?

Answer 1

Also called puerperium it occurs for 6 weeks after birth.

Question 2

What are the three processes of involution of the uterus?

Answer 2

Constriction of muscle fibers
Catabolism
Regeneration of uterine epithelium

Question 3

What happens to the endometrial layer postpartum?

Answer 3

The outer portion is expelled with the placenta and the decidua separates into two layers with the superficial layer being expelled via lochia and the basal layer becoming the new endometrial layer- regeneration takes about 16 days.

Question 4

Placental site postpartum?

Answer 4

8-10 cm it heals via exfoliation new endometrium is formed via glands and tissue and this leaves uterine free of scarring.

Question 5

Where is the fundus after delivery?

Answer 5

Palpated midway between symphysis and umbilicus.

Question 6

Fundus 12 hours after delivery?

Answer 6

Umbilicus

Question 7

Per day thereafter?

Answer 7

1cm per day by 14th day it is in the pelvic cavity.

Question 8

What are after pains and what are some contributing factors?

Answer 8

Intermittent contractions more acute for multiparas, over distention, large infant, hydramnios, retained blood clots.

Question 9

Goal for after pains?

Answer 9

Analgesics for short term pain relief that doesn’t harm infant.
Benefits are comfort and relaxation which facilitate milk-ejection reflex or letdown reflex.

Question 10

Scant lochia

Answer 10

Less than 2.5 cm stain on a Peri pad

Question 11

Light lochia

Answer 11

2.5- 10 cm stain

Question 12

Moderate lochia

Answer 12

10-15 cm

Question 13

Heavy

Answer 13

Saturated pad

Question 14

Excessive

Answer 14

Pad saturated in 15 minutes
- important to determine time the peri pad has been in place
What appears light may be moderate if Peri pad has been in use less than 1 hour.

Question 15

What about lochia for women who have a cesarean?

Answer 15

Less of it than vaginal because some of endometrial lining is removed with surgery, but it will go through the same phases.

Question 16

When is lochia heavier?

Answer 16

When mother first gets out of bed duh?!

Question 17

How is that cervix after childbirth?

Answer 17

Formless flabby and wide brah

Question 18

What is another hardship of breastfeeding that occurs due to ovarian function not being well established during lactation?

Answer 18

Well ovarian function means estrogen function as without estrogen women might experience vaginal dryness and dyspareunia. (Sex sucks)

Question 19

How long does an episiotomy site take to heal?!

Answer 19

2-3 weeks but COMPLETE? 4-6 months

Question 20

What activities are the muscles of the perineum involved in?

Answer 20

Well, you basically hate life because waking sitting stooping squatting bending urinating defecating all suck.
•don’t forget about hemorrhoids (distended rectal veins) which are pushed out of the rectum during the second stage of labor.

Question 21

Care for perineum will include?

Answer 21

Ice, skin care, topical anesthetic, and analgesics.

Question 22

EBL vaginal versus cesarean?

Answer 22

Vaginal: 500 mL

C/S: 1000mL

Question 23

Will CO go up or down after childbirth?

Answer 23

Tricky tricky! Well, there is a transient increase in CO despite blood loss because blood from uteroplacental unit returns to central circulation and there is decreased pressure from fetus and uterus on vessels, also there is mobilization from excess extra cellular fluid into vascular compartment.
CO returns to prelabor output within ad hour after delivery and decreases to prepregnancy values by 6-12 weeks.

Question 24

Okay, you have all this plasma volume- what now?

Answer 24

Sweaty and Pissing like a race horse!
•Diuresis: decline in aldosterone and oxytocin urinary output of 3,000 mL/day is common! Especially day 2-5
• dam girl you sweating! Give her showers dry clothes and change her sheets also explain why!

Question 25

What are those dam leukocytes doing during labor and postpartum?

Answer 25

Going crazy! They average 14-16k but go as high as 30k! But they fall back to normal values 6 days after birth.

Question 26

Well, we know Hct and Hgb values are skewed but when do they return to normal? Barring excessive blood loss that is : )

Answer 26

4-6 weeks

Question 27

What increases risks for clots postpartum?

Answer 27

Plasma fibrinogen and other factors increase during pregnancy and fibrinolytic activity decreases.

Question 28

Tell me about care for woman getting a C/S as it relates to clots?

Answer 28

Prophylactic care that includes heparin and pneumatic compression devices applied before CS delivery.

Question 29

How’s a woman’s appetite after birth?

Answer 29

Feed that beast! She has been sweating mouth breathing and not eating to drinking- give her fluids and food!!!

Question 30

What are some factors that contribute to constipation?

Answer 30

• Not eating or drinking during labor
• Residual effects of progesterone on bowel tone and intestinal mobility
• perineal trauma, episiotomy, and hemorrhoids.
• woman anticipating pain.

Question 31

When do they have a bowel movement postpartum?

Answer 31

2-3 days, normal patterns resume 8-14 days.

Question 32

What puts mother at risk for bladder distention and what are some complications?

Answer 32

Diminished sensitivity due to trauma of birth and regional anesthetic
Diuresis that occurs postpartum
• this can lead to incomplete emptying and urinary retention which causes urinary stasis and can lead to a UTI. Distention caused uterine ligaments to be displaced upward and laterally by the bladder inhibiting uterine contraction and increasing bleeding.

Question 33

Why are you stressing your incontinence?

Answer 33

Begins during pregnancy or postpartum ad usually improves within 3 months from healing and pelvic floor exercises.

Question 34

What would a urinalysis reveal postpartum?

Answer 34

Mild Proteinuria due to catabolic activity and acetone suggesting dehydration.

Question 35

How are her muscles and joints postpartum?

Answer 35

Muscle fatigue and aches in shoulders neck and arms
• give this woman a massage to increase circulation provide comfort and relaxation.
•Relaxin gradually subsides and ligaments and cartilage return to normal. BUT! Can can experience hip t joint pain because of this (it’s normal) promote good mechanics and posture.

Question 36

How about them abdominal muscles? What’s it called when they separate?

Answer 36

Weak soft and flabby postpartum!
If the longitudinal muscles separate it’s called diastasis recti! : /
Abdominal exercise: woman inhales and supports abdomen with her hands exhaling, the woman raises her head as she pulls abdominal muscles together.

Question 37

Headaches postpartum- can be critical finding or normal. What? Explain.

Answer 37

The first week due to fluid and electrolytes changes woman can have frontal and bilateral headaches, BUT if it’s a headache with proteinuria, photophobia blurred vision and abdominal pain- report that shit and check her BP!