T3 -Maternal Physiological Changes (Josh) Flashcards
— is return of uterus to non-pregnant state after birth .
— is failure of uterus to return to normal size and condition
Involution
Subinvolution
What is the first process to take place when the placenta is expelled from the uterus?
Uterine Involution
What is Autolysis?
tissue regeneration w/out leaving a fibrous scar at site of implantation
What is the second process of involution?
Autolysis
***makes implantation of future pregnancies possible
Where is the Fundus immediately after birth?
1-2 cm below the umbilicus
What happens to the Fundus within 12 hrs post-birth?
rises to umbilicus (or slightly above) then descends 1-2 cm (fingerbreath) every 24 hours
When would we expect the fundus to be nonpalpable?
by 2 wks
When the fundus starts descending, what is the rate of descent/
1-2 cm (fingerbreaths) q 24 hrs
By the — postpartum day, the fundus is back into the pelvic cavity and non-palpable.
9th or 10th
By 24 hours, the uterus is the size it was at — gestation.
20 wks
Where is oxytocin secreted?
Posterior Pituitary
— initiates and maintains uterine contractions.
Oxytocin
What do contractions do post-birth?
control bleeding at placental site by compression of blood vesselsreduce size of uterus
What should fundus assessment be post-delivery?
midline
firm
appropriate location for time past delivery
Where would the fundus be on PP day 3, 10 and 6 wks?
PP day 3: 2-3 fingerbreaths below umbilicus, firm, midline
PP day 10: non palpable
PP 6 wks: back to non-pregnant location
Who are afterpains (associated w/ contractions) more severe with?
multigravidas
breast feeding clients
What interventions for afterpains?
offer pain meds or NSAIDs (ibuprofen) BEFORE breast feeding
What causes afterpains?
cramping from oxytocin release after birth
***intensifies w/ breastfeeding
— is responsible for milk production.
— is responsible for milk letdown.
Prolactin
Oxytocin
What enhances milk let down?
comfort and relaxation
When would afterpains resolve?
3-7 days
***assure client that afterpains are helping uterus return to prepregnant size and shape
Interventions to enhance contracted state of uterus?
Empty bladder q 2hr
Manual massage or relaxed uterine muscle
Pitocin or Methergine
Breast feeding
When would Methergine be contraindicated?
BP 140/90
***causes increased BP
When is Lochia Serosa?
days 4-9
When is Lochia Alba?
days 10-14
When is Lochia Rubra?
days 1-3
Normal Lochia Rubra:
Bright red
SMALL clots
Blood, decidual & trophoblastic debris
Normal Lochia Serosa:
Pink/Brownish
Decreases over time
Serum, leukocytes, tissue debris & old blood
Normal Lochia Alba:
Creamy
Disappears over time
Leukocytes, epithelial cells, mucous, serum & bacteria
Signs of Uterine Infection
Lochia has an offensive odor
Lochia reverts to an earlier stage of color/amount
Lochia persists beyond normal time
What is classified as hemorrhage post-partum?
blood loss of 500 mL or greater
***can be early or late
What is the critical time for an early hemorrhage?
1 hr post delivery
- may be related to lacerations
What would an early hemorrhage look like?
continuous trickle of blood in spite of contracted uterus
When would a late hemorrhage happen?
24 hrs or more post delivery
What causes a late hemorrhage?
retained fragments of placenta in uterus
***associated w/ infections
How should the cervix look after birth?
Soft immediately
Bruised w/ many small lacerations (watch for infections)
2-3 cm open for several days (1 fingertip after 1 wk)
When does the cervial Os return to prepregnant round state?
never
it changes from round to lateral, slit-like shape
What is the shape of the Os for multiparas?
Nuliparas?
lateral, slit-like shape
round
What happens to the Vagina post-delivery?
Mucosa thin and without rugae
Prepregnancy size by 6-10 wks
What causes the thinning of the mocosa in vagina post-delivery?
post-partum estrogen deprivation
What happens to the Perineum post-partum?
Edema and Erythematous
How long does it take episiotomy to heal?
2-3 wks but can take as long as 4-6 wks
What does REEDA stand for?
Redness
Edema
Ecchymosis
Discharge (of EPISIOTOMY, not lochia)
Approximation of episiotomy
What position should we put mom in to examine the episiotomy?
lay on side and lift butt cheeks
***need a penlight
1st degree laceration
superficial vaginal mucosa or skin of perineum
2nd degree laceration
deeper tissues including muscles of perineum
3rd degree laceration
same as 2nd but extends to include ANAL SPHINCTER
4th degree laceration
extends through anal sphincter into the RECTAL MUCOSA
What type of laceration tears into the area of the urinary urethra?
Periurethral
No suppositories with which type of lacerations?
3rd and 4th degree
How long does it take pelvic muscles to regain tone postpartum?
up to 6 mths
***Kegel exercises promote tone
What happens to Progesterone and Estrogen postpartum?
decrease rapidly and at lowest levels within 1 wk
Nursing actions w Type 1 DM moms?
may require much less insulin for several days after birth
Mothers who required lots of insulin during pregnancy may have a sudden — in insulin requirements.
drop
***diabetogenic effects of pregnancy are reversed
Which hormones have an inverse relationship during postpartum stage?
Estrogen (decreases)
Prolactin (increases)
***suppresses ovulatoinq
When menstruation returns, what will it look like?
1st cycle will be very heavy
return to normal after 3-5 cycles
What influences the duration of Anovulation?
Frequency of breastfeeding
Duration of breastfeeds
Assessment of Lactating Breasts:
Soft (Ear) - 1st or 2nd day
Filling (Nose) - 3rd or 4th day
Engorged
What is engorged breast?
breast distention r/t stasis of venous and lymphatic fluid. Hard to touch and client complains of pain
Colostrum is high in – and – and low in – and –
protein and immunologic factors
fats and carbs
When is Colostrum secreted?
When is True Milk secreted?
first 2-3 days
by days 3-4 (fully mature at 2 wks)
Milk increases in direct proportion to —
sucking of infant
If you don’t want to breast feed, what should you avoid?
hot showers b/c they stimulate milk let down
***don’t let dad play with them either
In non-lactating women, when would menstrual cycle resume?
7-9 wks
***6 mths for lactating
– and – are influenced by breast feeding.
Ovulation
Menstrual cycle
***BF is NOT an effective form of BC
— blood loss from vaginal birth
— blood loss from C-section.
500 mL
1000 mL
***plasma levels decrease first few days due to diuresis
What is the body’s response to blood loss during postpartum stage?
fluid shifts as uteroplacental circulation is eliminated and circulating vol increases
By the 3rd PP day, what happens to extravascular fluid?
return to intravascular spaces
How is all the extra fluid volume eliminated postpartum?
diuresis and diaphoresis
***output may > 3000 mL/day
Why are postpartum moms predisposed to blood clots?
activation of blood-clotting factors and immobility
What do WBCs look like postpartum?
remain elevated w/ values b/t 20,000 and 25,000 mm3
***WBC is not always a good indicator of infection postpartum b/c it remains elevated
When do vital signs return to normal postpartum?
few days
What are we concerned about w/ increased leukocytosis postpartum?
elevated WBCs may obscure an infection
***monitor other signs including Temp
Why is peristalsis slowed postpartum?
progesterone
decreased muscle tone
***also scared to strain b/c of pain
Encourage — postpartum.
voiding
- client may have decreased sensitivity to fluid pressure
Client education r/t potential UTI
empty bladder q2h at minimum
What is urinary frequency w/ overflow?
urge to pee frequently but don’t empty bladder
Integumentary System changes postpartum:
Chloasma disappears
Areolae and Linea Nigra may NOT disappear totally
Striae Gravidarum will fade but NOT GO AWAY
If a high fundus, what should we first suspect?
full bladder
*** can also cause excessive bleeding
Why get them moving ASAP postpartum?
prevent blood clots due to activation of clotting factors
