Chapter 20 Maternal Physiologic Changes

Front 1

Postpartum period

Back 1

the interval between birth and return of reproductive organs to their nonpregnant state.

Front 2

What is the postpartum period also known as?

Back 2

"puerperium" or "fourth stage of pregnancy"

Front 3

How long does the postpartum period last?

Back 3

traditionally 6 weeks but varies among women.

Front 4

Define Involution

Back 4

return of the uterus to nonpregnant state following birth.

Front 5

Involution progresses rapidly. The Fundus descends ____cm every ____.

Back 5

1-2; 24 hours.

Front 6

How long after childbirth does the uterus lie in the true pelvis?

Back 6

2 weeks.

Front 7

What is subinvolution?

Back 7

failure of uterus to return to nonpregnant state.

Front 8

What are the 2 common causes of subinvolution?

Back 8

1. retained placental fragments 2. infection

Front 9

How is postpartem hemostasis achieved?

Back 9

Primarily by compression of intramyometrial blood vessels as the uterine muscle contracts rather than by platelet aggregation and clot formation.

Front 10

Which hormone strengthens and coordinates uterine contractions?
Where is this hormone released from?

Back 10

Oxytocin; pituitary gland.

Front 11

What are Afterpains?

Back 11

-Uncomfortable cramping from periodic relaxation and vigorous contractions.
-More common in subsequent pregnancies (first time mothers usually only have mild cramping)
-more noticeable after births inwhich the uterus was overdistended (large baby, multifetal gestation, polyhydramnios)
-breastfeeding and exogenous oxytocic meds usually intensify afterpains because both stimulate uterine contractions.

Front 12

What happens to the placental site immediately after the placenta and membranes are expelled?

Back 12

vascular constriction and thromboses reduce the placental site to an irregular nodular and elevated area. A unique healing process occurs here: upward growth of the endometrium causes sloughing of necrotic tissue and prevents the scar formation characteristic of normal wound healing. This enables the endometrium to resume its usual cycle of changes and permit implantation and placentation in future pregnancies. Endometrial regeneration is completed by postpartum day 16; the placental site regeneration is complete 6 weeks after birth

Front 13

Lochia

Back 13

postbirth uterine discharge.
-for the first 2 hours after birth the amount should be about that of a heavy menstrual period, then steadily decrease.
-usually less with cesarean births
-usually increases with ambulation/breasfeeding
-tends to pool in the vagina when the woman is lying in bed; then a gush of blood falls when she stands.This should not be confused with a hemorrhage.
-oxytocic meds lower the flow to a scant amount until it wears off.

Front 14

Lochia rubra

Back 14

the bright red, bloody uterine discharge that occurs for the first few days (3 to 4)following birth; it consists primarily of blood and decidual tissue and trohoblastic debris

Front 15

Lochia serosa

Back 15

The pink to brownish uterine discharge that begins about 3 to 4 days after birth; it consists of old blood, serum, leukocytes, and tissue debris. Duration of 22-27 days.

Front 16

Lochia alba

Back 16

The yellowish white flow that begins about 10 days after birth and continues for 2 to 6 weeks; it consists of leukocytes, decidua, epithelial cells, mucous, serum and bacteria. Continues 2 to 6 weeks after birth.

Front 17

Describe the cervix immediately after birth.

Describe the cervix 2 to 3 postpartum days

What happens to the cervical os after birth?

Back 17

It is soft;

it has shortened, become firm, and regained form.

during labor it was dilated to 10, now closes gradually.

Front 18

Describe the ectocervix (part of the cervix that protrudes into the vagina) after birth.

Back 18

it appears bruised and has small lacerations - optimal conditions to develop infections.

Front 19

What is responsible for the thinness of vaginal mucosa and absence of rugae?

Back 19

estrogen deprivation.