Postpartum Physiologic Changes (Ch20, exam 3)

Question 1

the period of time between birth and the return of the reproductive organs back to their non pregnant state

Answer 1

postpartum period

Question 2

how long does the postpartum period approximately last

Answer 2

6 weeks

Question 3

return of the uterus to a non pregnant state

Answer 3

involution

Question 4

involution process starts

Answer 4

after the delivery of the placenta and then contraction of smooth muscle of the uterus occurs

Question 5

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)

Answer 5

subinvolution

Question 6

the self-destruction of excess hypertrophied tissue caused by decreased estrogen and progesterone

Answer 6

autolysis

Question 7

location of the uterus at the end of the third stage of labor

Answer 7

midline, 2cm below the umbilicus

Question 8

postpartum fundal movement

Answer 8

• within the first 12hrs, the fundus can rise 1cm above the umbilicus
• fundus will continue to descend 1-2cm every 24hrs

Question 9

fundus should not be palpable after

Answer 9

2 weeks

Question 10

fundus will return to nonpregnant location by

Answer 10

6 weeks

Question 11

lochia days 1-3 postpartum

Answer 11

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

Question 12

lochia days 4-10 postpartum

Answer 12

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

Question 13

lochia days 11-21 postpartum

Answer 13

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

Question 14

time when estrogen and progesterone levels are at their lowest

Answer 14

1 week post delivery

associated with diuresis of excel and extracellular fluid accumulated during pregnancy

Question 15

placental hormone changes post partum

Answer 15

decrease in:

• estrogen
• progesterone
• hCG
• autolysis

Question 16

metabolic changes postpartum

Answer 16

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)

Question 17

pituitary and ovarian function postpartum

Answer 17

increased or decreased prolactin (milk production)

Question 18

urinary system postpartum

Answer 18

• 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

Question 19

GI system postpartum

Answer 19

• 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)

Question 20

breasts postpartum

Answer 20

• first 24hrs = little to no change
• colostrum usually during first 24hrs
• milk in at 72-96hrs

Question 21

nonbreastfeeding postpartum

Answer 21

• 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

Question 22

blood volume postpartum

Answer 22

• plasma volume decreases during the first few days

- plasma volume is replenished by 3rd day PP

Question 23

cardiac output postpartum

Answer 23

• increased initially
• back to prelabor value within 1hr
• decreases gradually to pre pregnancy level

Question 24

postpartum vital signs

Answer 24

• 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

Question 25

blood components postpartum

Answer 25

• hgb, hct decreased for 3-4 days, then back to prepregnant levels by 8 weeks
• increased WBC

Question 26

coagulation postpartum

Answer 26

increased clotting factors and fibrinogen

Question 27

varicosities postpartum

Answer 27

varices empty rapidly, with complete or near complete emptying during the postpartum period

Question 28

postpartum respiratory

Answer 28

• decreased intraabdominal pressure

- chest wall compliance increases

Question 29

postpartum neuro

Answer 29

• neurological discomforts of pregnancy go away

- headaches are common, but warrant careful assessment

Question 30

postpartum musculoskeletal

Answer 30

• abdominal wall back to pre pregnancy state
• time for muscle tone return varies
• diastasis recti abdominis
• back pain resolves

Question 31

integumentary postpartum

Answer 31

• 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

Question 32

immune system postpartum

Answer 32

immune system will return to its pre pregnancy state

Question 33

BUBBLE-HE

Answer 33

Breast
Uterus
Bowel
Bladder
Lochia
Episiotomy/laceration

Homan sign (modified) or Hemorrhoids 
Emotions