Postpartum Physiologic Changes (Ch20, exam 3) Flashcards
the period of time between birth and the return of the reproductive organs back to their non pregnant state
postpartum period
how long does the postpartum period approximately last
6 weeks
return of the uterus to a non pregnant state
involution
involution process starts
after the delivery of the placenta and then contraction of smooth muscle of the uterus occurs
failure of the uterus to return to the non pregnant state due to ineffective post uterine contractions
(usually caused by retained placental fragments or infection)
subinvolution
the self-destruction of excess hypertrophied tissue caused by decreased estrogen and progesterone
autolysis
location of the uterus at the end of the third stage of labor
midline, 2cm below the umbilicus
postpartum fundal movement
- within the first 12hrs, the fundus can rise 1cm above the umbilicus
- fundus will continue to descend 1-2cm every 24hrs
fundus should not be palpable after
2 weeks
fundus will return to nonpregnant location by
6 weeks
lochia days 1-3 postpartum
lochia rubra
- bloody, small clots, fleshy, earthy odor, red or red-brown
(blood from placental site, trophoblastic tissue debris, vernix, lanugo, meconium)
abnormal: large clots, saturated perineal pads, foul odor
lochia days 4-10 postpartum
lochia serosa
- decreased amount, sero-sanguineous, pink or brown-tinged
(blood, wound exudate, RBCs, WBCs, trophoblastic tissue debris, cervical mucosa, microorganisms)
abnormal: excessive amount, foul smell, continued or recurrent reddish color
lochia days 11-21 postpartum
lochia alba
(may last until 6th week for some women)
- white, cream, or light yellow color; decreasing amount
(WBCs, trophoblastic tissue debris)
abnormal: persistent lochia serosa, return to lochia rub, foul odor, discharge continuing
time when estrogen and progesterone levels are at their lowest
1 week post delivery
associated with diuresis of excel and extracellular fluid accumulated during pregnancy
placental hormone changes post partum
decrease in:
- estrogen
- progesterone
- hCG
- autolysis
metabolic changes postpartum
decrease in:
- human placental lactogen
- estrogen
- cortisol
- insulinase (responsible for immediate decrease in BG levels immediately after delivery)
- T3 and T4 (returns to normal levels by week 4)
pituitary and ovarian function postpartum
increased or decreased prolactin (milk production)
urinary system postpartum
- Glycosuria disappears
- increased BUN
- decreased excess fluid in the tissues
- may have decreased urge to void
- increase diuresis
urine output of >3000mL daily or more during the first 2-3 days in normal
GI system postpartum
- Increased appetite
- decreased bowl movements may take 2-3 days (can be psychological and physical; peristalsis and muscle tone is slow to return after delivery)
breasts postpartum
- first 24hrs = little to no change
- colostrum usually during first 24hrs
- milk in at 72-96hrs
nonbreastfeeding postpartum
- 3rd or 4th g=day engorgement can occur
- breasts are warm and fuller
- no milk expression and should start to decrease in 24-36hrs
NEED teaching whether or not they’re breastfeeding
blood volume postpartum
- plasma volume decreases during the first few days
- plasma volume is replenished by 3rd day PP
cardiac output postpartum
- increased initially
- back to prelabor value within 1hr
- decreases gradually to pre pregnancy level
postpartum vital signs
- increased temp during 1st 24hr can be normal
- increased pulse x1hr, then decreased over the next 24hr
- WNL
- transient increase in BP
sometimes takes weeks to months for BP and HR to return to pre pregnancy values
blood components postpartum
- hgb, hct decreased for 3-4 days, then back to prepregnant levels by 8 weeks
- increased WBC
coagulation postpartum
increased clotting factors and fibrinogen
varicosities postpartum
varices empty rapidly, with complete or near complete emptying during the postpartum period
postpartum respiratory
- decreased intraabdominal pressure
- chest wall compliance increases
postpartum neuro
- neurological discomforts of pregnancy go away
- headaches are common, but warrant careful assessment
postpartum musculoskeletal
- abdominal wall back to pre pregnancy state
- time for muscle tone return varies
- diastasis recti abdominis
- back pain resolves
integumentary postpartum
- melasma (cholasma) will usually disappear
- hyperpigmentation of areolae and lines nigra (may not disappear completely)
- striae gravid arum will not go away but will fade
- spider nevi (spider veins) usually regress
immune system postpartum
immune system will return to its pre pregnancy state
BUBBLE-HE
Breast Uterus Bowel Bladder Lochia Episiotomy/laceration
Homan sign (modified) or Hemorrhoids Emotions
