Postpartum Physiologic Canges PowerPoint Flashcards
What is postpartum period and how long does it last?
The period of time between birth and the return of the reproductive organs back to their nonpregnant state
last about 6 weeks
After delivery the uterus goes through a process called uterine involution which is :
The return of the uterus to a non pregnant state.
When does uterine involution start:
The process starts after the delivery of the placenta and then contraction of smooth muscle of the uterus occurs..
________ is the failure of the uterus to return to the non-pregnant state due to ineffective post uterine ctx. (Retained placental fragments is usually the cause)
Subinvolution
__________ the self-destruction of excess hypertrophied tissue caused by decreased estrogen & progesterone.
Autolysis
Why would oxytocin be continued after delivery ?
To sustain those uterine contractions and control the bleeding..
- we want a firm fundus with no s/s of hemorrhaging.
Uterus goes from ______ size -> _________ -> ______ -> then disappears back in to the pelvis
Melon; grapefruit; walnut
At the end of the third stage of labor (placenta delivered) the uterus is located:
At the midline and 2 cm below the umbilicus
Within the 1st 12 hours, the fundus can rise:
1 cm above the umbilicus
Fundus will continue to descend ______ cm every 24 hours
1 to 2
When should you no longer be able to palpate the fundus
After 2 weeks
When does the fundus return to the non pregnant location
By 6 weeks
What do you do with a foggy fundus :
Gently massage to firm up again
- also assessing for lochia
What is rubra ?
Blood from placenta site, trophoblastic tissue debris, vernix, lanugo, meconium
What is serosa?
blood, wound exudate, RBCs, WBCs, trophoblastic tissue debris, cervical mucous, microorganisms
What is alba?
WBCs, trophoblastic tissue debris
Time and a type:
Days 1-3 lochia is RUBRA
- What is the normal discharge?
- What is the abnormal discharge?
- Bloody; small clots; fleshy; earthy odor; red or red-brow
- Large clots; saturated perineal pads; foul odor
Time and a type:
Days 4-10 lochia is serosa
- What is the normal discharge?
- What is the abnormal discharge?
- Decreased amount; serosanguineous; pink or brown tinged
2. Excessive amount; foul smell; continued or recurrent reddish color
Time and a type:
Days 11-21 lochia is alba (can last up to 6 weeks)
- What is the normal discharge?
- What is the abnormal discharge?
- White, cream, or light yellow color; decreasing amounts
2. Persistent lochia serosa; return to lochia rubra; foul odor; discharge continuing
Placental hormones :
After delivery estrogen, progesterone, and HCG ________ and the body is in autolysis.
Decrease
- Estrogen & Progesterone level are at their lowest at 1wk post delivery (associated with diuresis of excel extracellular fluid accumulated during pregnancy.
Metabolic changes:
Human placental lactogen, estrogen, cortisol, insulinase, and T3 & t4 all ________ .
Decrease
- Decreased insulinase – responsible for immediate decrease in blood glucose levels immediately after delivery
- Thyroid (T3&T4) returns to normal levels by 4 weeks
What happens to prolactin?
It can decreases or increase depending if mom is breastfeeding or not.
- Prolactin – Milk production
- Oxytocin – milk let down & expression
What changes occur in the urinary system:
- Glycosuria disappears
- ↑ BUN
- ↓ excess fluid in the tissues
- May have ↓ urge to void
- ↑ diuresis
- Output of 3000mL daily or more during he first 2-3 days is normal. Increase diuresis also high first 2-3 days
What changes occur in the GI system?
- ↑ Appetite
- ↓ Bowel movements may take 2-3 days
- Decrease in BMs can be psychological as well as physical. Peristalsis is slow to return as well as muscle tone and dehydration directly after delivery. Also prelabor defecation. If laceration or episiotomy may fear pain, They haven’t eaten because in labor for so long.
What changes occur in the breasts?
- colostrum
- mature milk
- engorgement
*During 1st 24 hours little to no change. Colostrum – clear yellow – first or early milk – usually during 1st 24 hours. Milk in at 72-96 hours
Both need good fitting bras.
Non-breastfeeding: 3rd or 4th g=day engorgement can occur. Breast are warm and fuller. No milk expression and should start to decrease in 24-36 hours
NEED teaching if breastfeeding or not
Cardio vascular changes:
What occurs with blood volume:
- plasma volume decreases during the first few days
- plasma volume is replenished by 3rd pp day
Cardio vascular changes:
What occurs with cardiac output
- ↑ initially
- back to prelabor value within 1 hr
- ↓ decreases gradually to prepregnancy level
Cardiovascular changes:
What occurs to the vital signs:
- ↑ temp for during 1st 24 hr can be normal
- pulse ↑ x1 hr, then ↓ over the next 24 hr
- WNL
- transient increase in BP
Cardiovascular changes:
What occurs to the blood components:
- Hgb & Hct ↓ for 3-4 days, then back to prepregnant by 8 weeks
- ↑ WBC
- Sometimes takes weeks to months for BP & HR to return to prepregnancy values. Important to watch for pre-eclampsia & gesttinal HTN
Cardiovascular changes:
What happens to the coagulation factors:
- ↑ clotting factors & fibrinogen
Cardiovascular changes:
What happens to the varicosities?
- varices empty rapidly, with complete or near complete emptying during the postpartum period
What happens to the respiratory system?
- intraabdominal pressure ↓
- chest wall compliance ↑
What happens to the neurological system ?
- neurological discomforts of pregnancy go away
- headaches are common, but warrant careful assessment
What happens to the musculoskeletal system:
- Abdominal wall back to prepregnancy state
- Time for muscle tone return varies
- Diastasis recti abdominis
- Back pain resolves
What happens to the integumentary system?
- melasma (chloasma)
- hyperpigmentation of areolae and linea nigra
- striae gravidarum
- spider veins
- Melasma usually disappears, linea nigra may not disappear completely. Striae gravidarum will not go away but will fade. Spider veins usually regress
What happens to the immune system ?
- immune system return to its prepregnancy state
What does BUBBLE- HE stand for?
B=breast U=uterus B=bowel B=bladder L=lochia E=episiotomy/laceration
H=Homan sign (modified) or hemmoroids
E=emotions
