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71 Cards in this Set
- Front
- Back
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What is the postpartum period?
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The interval between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state
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What is puerperium?
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The postpartum period, or the fourth trimester of pregnancy
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What is involution?
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The return of the uterus to a nonpregnant state after birth
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When does involution occur?
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Immediately after expulsion of the placenta with contraction of the uterine smooth muscle
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What is the rate of descent of the fundus during the puerperium?
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1 to 2 cm every 24 hours
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What is the weight of the uterus in a full term pregnancy?
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About 5000 g (or 11 times its prepregnancy weight)
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What is the weight of the involuted uterus by 1 week after birth?
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500 grams
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What is the weight of the involuted uterus by 2 week after birth?
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350 grams
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What is the weight of the involuted uterus by 6 week after birth?
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50 to 60 grams
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What hormones are responsible for stimulating the massive growth of the uterus during pregnancy?
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Estrogen and progesterone
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How does prenatal uterine growth occur?
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By hyperplasia and hypertrophy
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What is hyperplasia?
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An increase in the number of muscle cells
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What is hypertrophy?
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Enlargement (increase in size) of existing cells
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What process is responsible for the involution of the uterus?
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Autolysis
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What is autolysis?
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The self-destruction of excess hypertrophied tissue
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What is subinvolution?
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The failure of the uterus to return to a nonpregnant state
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What is the normal presentations of the postpartum woman?
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1. Uterine tone is good
2. Fundus is firm 3. She only perceives mild uterine cramping |
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What is afterpains?
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Periodic relaxation and vigorous contractions that may cause uncomfortable cramping
(also called AFTERBIRTH PAINS) |
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When are afterpains more noticeable?
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After births in which the uterus was overdistended (i.e. large baby, multifetal gestation, polyhydramnios)
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What can intensify afterpains?
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Breastfeeding and exogenous oxytoxic medications because they stimulate uterine contractions
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What is lochia?
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Postchildbirth uterine discharge
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What is the normal amount of lochia during the first 2 hours after birth?
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Approximately that of a heavy menstrual period
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What is lochia rubra?
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Bright red lochia that occurs during the first 1-3 days postpartum
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What does lochia rubra consist of?
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1. Mainly blood
2. Decidual and trophoblastic debris |
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What is lochia serosa?
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Brownish lochia that lasts 3-10 days postpartum
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What does lochia serosa consist of?
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1. Old blood
2. Serum 3. Leukocytes 4. Tissue debris |
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What is lochia alba?
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Yellow to white creamy lochia that occurs lasts 10-14 days postpartum
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What does lochia alba consist of?
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1. Leukocytes
2. Decidua 3. Epithelial cells 4. Mucus 5. Serum 6. Bacteria |
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What is the effect of oxytoxic medications on lochia?
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The flow of lochia will remain scant until the medication wears off
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What increases the flow of lochia?
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Breastfeeding and ambulation
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What is the effect of bed rest on lochia?
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Lochia tends to pool in the vagina when the woman is lying in bed; upon standing, the woman may experience a gush of blood (which should NOT be confused with hemorrhage)
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What causes recurrence of lochia bleeding approximately 7 to 14 days after birth?
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Healing of placental site
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What may indicate endometritis?
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Continued flow of lochia serosa or lochia alba by 3 to 4 weeks after birth, particularly if fever, pain, or abdominal tenderness is present with the discharge
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What should lochia smell like?
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Normal menstrual flow
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What does an offensive odorous lochia indicate?
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Infection
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What is the presentation of nonlochial bleeding?
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1. Bloody discharge spurts from the vagina, instead of trickling
2. Amount of bleeding continues to be excessive and bright red, instead of changing to brown and then yellow or white by the 10th day |
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What is the most common postpartum complication?
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Infection
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What are the signs of infection?
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1. Pain
2. Redness 3. Warmth 4. Swelling 5. Discharge |
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What is an episiotomy?
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An incision into the perineum during labor and birth to increase the size of the os
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What should the episiotomy be assessed for postpartum?
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1. Signs of infection
2. Loss of approximation |
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What is loss of approximation?
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Separation of the incision edges
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What is pelvic relaxation?
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Lengthening and weakening of the fascial supports of the pelvic structures
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What are the pelvic structures?
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1. Uterus
2. Upper posterior vaginal wall 3. Urethra 4. Bladder 5. Rectum |
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When does the hormone human chorionic gonadotropin (hCG) disappear from maternal circulation?
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Within 14 days postpartum
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When does ovulation occur postpartum in nonlactating women?
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As early as 27 days after birth, with a mean time of about 70 to 75 days
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When does ovulation occur postpartum in breastfeeding women?
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About 6 months
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When does menstrual flow return to normal?
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After 3 to 4 cycles
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What does the return of abdominal muscle tone depend on?
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1. Previous muscle tone
2. Proper exercise 3. Amount of abdominal adipose tissue |
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What is diastasis recti abdominis?
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Separation of the abdominal muscles during and after pregnancy due to overdistention of the abdomen
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What is the effect of a distended bladder postpartum?
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1. Excessive bleeding can occur because a distended bladder pushes the uterus up and to the side, thereby preventing the uterus from contracting firmly to promote clotting
2. Untreated hemorrhage can lead to infection and/or death |
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Why is it important to empty the bladder during labor and postpartum?
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To restore uterine tone and prevent hemorrhage
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When does bladder tone return to normal?
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5 to 7 days after childbirth, with adequate emptying and voiding
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When does spontaneous bowel evacuation return postpartum?
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2 to 3 days after childbirth
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What causes delay of spontaneous bowel evacuation?
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1. Decreased muscle tone in the intestines
2. Prelabor diarrhea 3. Lack of food 4. Dehydration |
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What is colostrum?
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A clear, yellow fluid that contains high concentrations of nutrients found in the breasts before "true milk" comes in
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What is "true milk"?
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Bluish-white milk with a skim-milk appearance
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When does "true milk" come in?
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About 72 to 96 hours after birth
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How are full milk ducts distinguished from cancerous nodules?
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The nodularity associated with milk production tends to shift in position, whereas cancerous nodules are palpated consistently in the same location
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How do engorged breasts appear?
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1. Distended (swollen)
2. Firm 3. Tender 4. Warm to the touch (because of vasocongestion) |
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What methods can be used to relieve discomfort from engorgement?
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1. Breast binder
2. Well-fitted supportive bra 3. Ice packs (p. 582) 4. Warm compresses 5. Fresh cabbage leaves 6. Mild analgesics |
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What should be avoided during engorgement?
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Nipple stimulation
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How much blood is normally lost during birth?
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1. 500 mL during single fetus vaginal birth
2. About 1000 mL during cesarean birth |
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What postpartum physiologic changes protect the woman by increasing circulating blood volume?
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1. Elimination of uteroplacental circulation reduces the size of the maternal vascular bed by 10% to 15%
2. Loss of placental endocrine function removes the stimulus for vasodilation 3. Mobilization of extravascular water stored during pregnancy occurs |
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What is the normal leukocytosis of pregnancy?
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Averages about 12,000/mm^3
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What is the leukocytosis during the first 10 to 12 days after childbirth?
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Between 20,000 and 25,000/mm^3
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What may obscure accurate diagnosis of acute infection during the first 2 weeks postpartum?
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Leukocytosis and an increased erythrocyte sedimentation rate
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What are varicosities?
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Abnormally or unusually enlarged or swollen veins in the legs (usually seen on calf)
(also known as VARICES) |
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What neurological finding requires further investigation?
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Headache
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What causes postpartum headache?
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1. Postpartum-onset preeclampsia
2. Stress 3. Leakage of CSF into the extradural space during epidural or spinal anesthesia administration ("spinal headache") |
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What pregnancy effect on the musculoskeletal system may be permanent?
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Increase in shoe size
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What is chloasma?
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Light-brown freckles
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