Unit 1 - SLOs

Question 1

Describe the physiological adaptations which occur after the delivery of a baby:

• Involution
• Subinvolution
• Lochia
• Afterpains
• CV
• Pulse and BP
• Coagulation

Answer 1

• Involution
  
  • Fundus descends 1 cm (1 fingerbreadth) per day
  • 1 week to 50% reduction
  • Within pelvis after 10 days
  • 6 weeks to original weight (2 oz)
  • Contributing (helpful) factors
    
    • Full expulsion of amniotic membranes
    • Complication-free labor and birth
    • Breast-feeding
    • Early ambulation
• Subinvolution
  
  • Due to
    
    • Prolonged labor and birth
    • Incomplete expulsion
    • Over-distention of uterine muscles (d/t multiple gestation, hydramnios, large fetus)
    • Full bladder (displaces uterus)
    • Anesthesia (relaxes muscles)
    • Close childbirth spacing
• Lochia
  
  • Check first on pp assessment
  • Should always have fleshy smell - foul odor indicates infection
  • Three types
    
    • Rubra
      
      • d1-3
      • red, bloody
      • must measure
      • consists of mucus, tissue, and blood
    • Serosa
      
      • d3-10
      • pink/brown
      • consists of leukocytes, RBCs, serous fluid
    • Alba
      
      • d10-14 (may last 3-6 weeks and still be normal)
      • creamy white or light brown (or clear)
• Afterpains
  
  • Experienced by all, but may be more painful when breast-feeding
  • Caused by oxytocin release/uterine contraction
• Cervix
  
  • Returns to prepregnant state by week 6
• Vagina
  
  • Returns to prepregnant state ~ week 3
• Perineum
  
  • Edematous and bruised for 1-2 days
• CV system
  
  • Blood volume drops rapidly after birth
  • Normal w/in 4 weeks
  • 500 mL loss vaginal
  • 1000 mL loss c-section
  • Hematocrit remains relatively stable (d/t diuresis)
• Pulse and BP
  
  • CO and SV are increased during pregnancy - begin to diminish after birth
  • Bradycardia (40-60 bpm) for up to 2 weeks
  • CO returns to baseline by 3 months
  • Tachycardia postpartum requires investigation
• Coagulation
  
  • Increased coagulation in pregnancy and remains elevated after birth
    *