PP-NORMAL Flashcards
Postpartum
Postpartum period, also called the puerperium, last from delivery to placenta until - weeks
6-12 weeks
What pregnancy changes remain present for months to years?
Pelvic musculature and cardiac remodeling
The pregnant uterus at term–excluding stuff inside–weighs about 1000g, 10-20x heavier than the nonpregnant uterus. Involution back into the pelvis usually occurs around week __ and usually back to it’s size by week ___
Week 2: back into pelvis
Week 6: normal size
By day __, the endometrium is fully restored via regeneration
16 (2.5wks)
How is hemostasis accomplished right after birth?
Arterial smooth muscle contraction and compression of vessels by the involuting uterus.
A sudden but transient increase in bleeding occurs between day _ and _
& should be evaluated if lasts longer than _ and __ hours
7-14 days
1-2 hours.
Describe phases of lochia
Lochia rubra–flow of blood last several hours, then rapidly diminishes to a reddish brown d/c through day 3-4.
Lochia serosa: mucopurulent, somewhat malodorous d/c that lasts on avg 22-27days (with bleeding from healing placenta location occurring around day 7-14.)
Lochia alba: yellow-white d/c occurs afterward.
T or F: Breastfeeding and use of COCs affect lochia
False;
BF may just help decrease amount of bleeding immediately PP
Mgmt plan for abnormal uterine bleeding in the PP period
ultrasound; uterine evacuation and curettage
Meds: Pit, Cytotec, Methergine, Hemabate, Dinoprostone, TXA
Labs: CBC w/diff, coags
Give: extra IV fluids, O2, 2nd IV line for possible transfusion
Cont. to monitor VS
Determine cause: 4 T’s- Tone, Tissue, Trauma, Thrombin
Mean-time to ovulation in the breastfeeding and nonlactating mothers?
Lactating: 6 mons
Nonlactating: Day 70-75 (week 9), earliest being 27 d after delivery
Thyroid panel should be drawn at week _, month__, and month __ in women who have thyroid disease
6 wks
3 months
6 months
TSH should be 0.4-5mU/L
Hyperthyroidism is best treated with…
1st: beta blockers
2nd: Methimazole and propylthiouracil, which are SAFE during BF
Hypothyroidism is best treated with…
thyroid supplementation: synthroid
Plasma volume decreases by about _____cc after delivery secondary to blood loss, and by the third day PP, is replenished by fluid shift.
1000cc
By __ weeks, red cell mass has rebounded and hematocrit is usually normal
8wks
Due to cardiac remodeling, this remains higher than prepregnancy values 1 year after delivery
Cardiac output
When are PP women most likely to clot?
Greatest level of coagulability: immediately after delivery, up to 48 hours after
up to 6 wks PP
By week __, dilation and tone of ureters and renal pelvis decrease back to prepregnancy state
6
What is telogen effluvium
Period of diffused, rapid hair turnover, up to 3 mons, returns to normal within a few months
When does bone loss usually resolve by?
& what can you do to prevent it?
12-18 mons PP
aerobic exercises in the PP period
Management/tx for constipation & to prevent straining?
Stool softeners (colace), high fiber diet, fluid intake, laxatives, suppositories (avoid if 3rd/4th degree lac), limit opioid use if possible.
Treatment for hemorrhoids
Witch hazel compresses, hydrocortisone suppository, corticosteroids, stool softeners, cold/warm sitz baths or compresses, anesthetics
When does BP return to baseline after delivery
Usually within 24 hrs-4 days
T or F: A low-grade fever is not normal in the PP period
False, can have low-grade fever 1-3 days PP
When should a woman with GDM be assessed for DM in the PP period?
6-12 wks PP with a 75g 2-hour glucose challenge
Should check annually thereafter
75g 2-hr <140mg/dL
Fasting <100mg/dL
What does BUBBLE PLEB stand for?
Breasts Pain
Uterus Legs/lacs
Bladder Emotional status
Bowels Bonding
Lochia
Episotomy/Extremities
What causes rapid diuresis in the first 48 hours PP?
Withdrawal of estrogen (return to baseline hematocrit levels)
A decrease in progesterone helps remove excess fluid from tissues (return to baseline CO and BP)
Define immediate, early and late PP
Immediate: first 24 hours after placenta expulsion
Early: First 72 hours
Late: 6-8 weeks
Describe involution and subinvolution
Involution: uterus contracts to non-pregnant state
Subinvolution: uterus is slow or fails to return to non-pregnant state (size & position)
What are the preferred opioids for pain relief in the breastfeeding mother?
morphine, hydromorphone, and butorphanol
When does lactogenesis II (seen as engorgement) occur and how long does it last?
48-72 hrs, but sometimes takes up to 7 days
Lasts 24-48 hours
What labs should you collect in the PP period?
CBC w/diff (r/o infection and/or anemia)
Rh screen in NB if mom is Rh negative
