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116 Cards in this Set
- Front
- Back
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How long does the PP period last?
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birth - 6 wks
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Define uterus
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a hollow, thick-walled, muscular organ shaped like an upside down pear
it houses and nourishes the fetus until birth and then contracts rhythmically during labor to expel the fetus |
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What are the 3 divisions of the uterus?
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1. corpus
2. isthmus 3. cervix "neck" |
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What does the corpus contain?
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the fundus (top)
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What is the isthmus?
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the lower uterine segment
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3 components of the cervix?
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1. internal os
2. cervical canal 3. external os |
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What is the first part of the uterus that you see with a speculum during an exam?
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external os
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Another name for the PP period?
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puerperium
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What major even is occurring during the postpartum period?
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return of reproductive organs to their non-pregnant state
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Do organs ever return to their pre-pregnant state?
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no, the body never goes back to the way it was
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What are two types of physiologic changes that occur during the PP period?
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1. retrogressive
2. progressive |
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What is retrogressive change? ex?
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the body goes back to how it was before
ex: uterus shrinking |
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What is progressive change? ex?
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the body is changing forward
ex: lactation |
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Why is the PP period referred to as the 4th trimester?
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it is important to monitor women because we want to preserve her reproductive function for future babies
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see slide for body parts affected in PP period
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see slide for body parts affected in PP period
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What vascular state is the body in during pregnancy? Why?
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a vasodilated state
to get more blood to the baby |
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Contractions from the fundus push down to push out...
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-the baby
-the placenta -pushes the uterus back to size |
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When is the body notified that it is no longer in a non-pregnant state?
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as soon as the placenta comes out
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What is UTERINE INVOLUTION?
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the rapid return of the uterus to its non-pregnant state
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Which H is involved in uterine involution?
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endogenous oxytocin released from the pituitary
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What are 2 main processes in uterine involution?
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1. ctx of the uterine smooth muscle fibers
2. ctx continue reducing the size of the uterus |
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What does contraction of the uterine smooth muscle fibers promote?
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in time, THROMBI from within the uterine wall will form and permanently seal the area (to prevent bleeding/ smaller surface area to lose blood)
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How long do contractions continue for?
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until they return to normal size
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T/F: uterine involution occurs at a predictable rate
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T
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Where is the uterus located right after delivery?
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halfway between the symphysis pubis and the umbilicus
*overcorrects at first, slows after this |
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At 12 hr post birth, what is the position of the uterus?
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at the umbilicus or 1 cm above
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After 12 hr, what is the rate that the uterus descends?
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1-2 cm/ 24 hr
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When is the fundus no longer palpable?
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day 10
(abs by day 14) |
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How long does it take for the uterus to return to nonpregnant weight and size?
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6 wk
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What part of the PP period is potentially most dangerous for women? Why?
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first hour after birth
UTERINE ATONY: bleeding to death occurs without clotting/contractions *most important part of recovering |
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PPH (PP hemorrhage) is in the top 3 causes of death in women. What is a medical intervention meant to prevent this from occurring?
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administering pitocin after birth
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What does pitocin do?
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it helps make contractions so that the bleeding gets stopped
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Does pitocin threaten the health of the baby?
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not after delivery
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What is subinvolution?
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failure or delay of the uterus to return to the non-pregnant state
*ie, may be going down, but not at a predictable rate |
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What is the cause of subinvolution (2)?
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1. infection
2. retained placental fragments (ie, when placenta comes off in pieces and gets left in) |
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In uterine atony, the uterus remains inadequately contracted. What is the danger?
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you are bleeding from a large surface area
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What are afterpains?
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uterine contractions that continue into the PP period, especially with pitocin
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What is a primiparas?
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a woman pregnant for the first time
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What is a multiparas?
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a woman who has had multiple pregnancies
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What occurs during afterpains?
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sloughing of the uterine lining and the development of lochia
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What is lochia?
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uterine discharge of blood and waste
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What happens to the pregnancy H as soon as the placenta comes off?
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E and P decrease
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How long does the cessation of progesterone production occur?
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until 1st ovulation
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When does endometrial regeneration occur?
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within 6 weeks after delivery
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What occurs to the vagina and pelvic floor muscles in the PP period?
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recovery of muscle tone
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What changes occur in the breast tissue after placental exit? why?
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build up of breast tissue for lactation
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Muscle has memory. With each subsequent pregnancy, you look bigger and bigger. The stretched out uterus has to work ___ to return to the pre-pregnancy state
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harder
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Are afterbirth pains weaker or stronger with subsequent births?
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stronger
(compounded by the increase in oxytocin from breastfeeding, which also strengthens contractions) |
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What are 3 types of lochia?
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1. lochia rubra
2. lochia serosa 3. lochia alba |
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What is lochia rubra?
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-bright red
-particles of decidual debris + blood + some mucus from the placental site |
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When does lochia rubra appear?
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PP day 1-3
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What is lochia serosa?
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less blood + leukocytes invade area and mix with blood to make it pinkish/brownish
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When does lochia serosa occur?
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PP days 3-10
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What is lochia alba?
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old blood + leukocytes + debris
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When does lochia alba appear?
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PP day 10/11 - 3wks
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How long does lochia alba last?
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up to 6 wks PP
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What color is lochia alba?
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pale
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What does lochia alba consist of?
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cells + serum + leukocytes + bacteria
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If bleeding is not decreasing in color and in amount, what should you tell your pt?
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to rest, they're probably doing too much
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What are the 4 quantifications of lochia?
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1. scant <2.5 cm stain
2. light 2.5-10 cm stain 3. moderate 10-15 cm stain 4. heavy -saturated in 1 hr |
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Before you do any intervention, you must first __
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assess
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If you see a patient with a saturated pad, what should you do first?
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ask her when was the last time she changed her pad
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Which delivery type bleeds more?
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vaginal
in c-sections, they scrape the blood out |
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Which PLACENTAL H are decreased with placental expulsion?
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1. human placental lactogen (hPL)
2. human chorionic gonadotropin (hCG) 3. E 4. P 5. Cortisol |
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Which H are stimulated in production/release?
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1. oxytocin
2. prolactin |
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What is the fxn of oxytocin?
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1. needed for milk ejection (letdown)
2. helps with contractions |
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What is the function of PRL?
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helps with milk production
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Fxn of human placental lactogen (hPL)? (2)
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1. promotes normal nutrition and growth of fetus
2. promotes maternal breast development for lactation |
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Fxn of human chorionic gonadotropin (hCG)? (2)
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1. helps to maintain the corpus luteum to persist for the first 6-8 wks
2. helps to secrete P and E |
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Fxns of estrogen? (3)
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1. causes enlargement of the breast
2. growth of the ductal system of the breasts 3. enlargement of the external genetalia (hypertrophy occurs so it doesn't rip) |
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Fxn of P?
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promotes normal continuation of the pregnancy
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Fxn of cortisol? (2)
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1. is increased during pregnancy too and helps with metabolism of glucose, protein, and fats
2. may also have an anti-inflammatory effect that is thought to prevent the rejection of the pregnancy |
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T/F: a woman chooses if she wants to produce milk.
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F: begins in a PP woman whether or not she plans to breastfeed
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What does E produced by the placenta simulate in breasts?
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growth of milk glands
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Why do breasts increase in size? (2)
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1. larger glands
2. accumulated fluid |
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Describe changes in a woman's breasts in the first 2 days PP.
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very litter difference
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Describe women's breasts first 2-3 days PP
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colostrum formed
*most perfect substance for baby |
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Describe women's breasts 3-5 days PP
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breasts become full
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What does continued milk production depend on?
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the suckling of the infant at the breast or the use of a breast pump
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Suckling of a baby causes continued release of which H?
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1. oxytocin
2. PRL *dept on supply & demand |
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If a woman doesn't want to breastfeed, what should you tell her?
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no nipple stimulation for 2 wk
wear a tight bra |
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What changes occur in the vagina PP?
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rugae (folds) are not as prominent after stretching
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What changes occur in the cervix PP?
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1. contraction of cervix to its pre-pregnant state begins at once
2. by the end of the 7th day, external os opening narrows to the size of a pencil |
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What might you see in a cervix PP?
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edema, bruise, laceration
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Which day PP does the cervix go back to its size and shape?
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2-3 days PP
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Which changes occur in the perineum PP?
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1. hemorrhoids
2. possible edema or bruising from the birthing process |
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What are hemorrhoids?
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outpouching of BVs
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What should you do if a woman is bruised at the perineum?
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put ice between the pad and the perineum in the first 24 hr
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What causes hemorrhoids?
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pressure from the baby pushing down
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If a woman can't sit due to hemorrhoids, what should you give her?
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a donut or a tuxpad
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Why might you want to massage the uterus?
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to increase contraction and reduce bleeding
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If you assess a woman who is bleeding with a firm fundus, where is the bleeding coming from?
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not the uterus
most likely from cervical laceration (doorway ex) *most heal on their own |
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What does a nulliparous cervix look like?
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external os is ROUND
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What does a parous cervix look like?
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external os looks like a SLIT
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How much blood loss does a woman experience from birth?
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a 4 point decrease in the Hct
and a 1g decrease in Hb values **with each 250 mL of blood loss |
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How much blood loss occurs in a vaginal delivery?
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up to 500 cc
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How much blood loss occurs in a C-section?
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up to 1000 cc
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3 reasons why there is a PP increase in maternal CO?
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1. blood from the uteroplacental unit now returns to the maternal central
2. P on the BVs from the gravid uterus is now gone 3. mobilization of excess ECF now finds its way into the maternal vascular components |
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How much blood loss is considered a PP hemorrhage?
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800 cc loss
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In PP, how does the mom's body rid itself of excess plasma volume that was needed during pregnancy?
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1. diuresis
2. diaphoresis |
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How much does a woman experience diuresis? For how long?
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3000 cc/day
for 2-5 days |
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A woman experiences diaphoresis especially at night, how long does it last for?
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2-5 days
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If a woman is experiencing diaphoresis and diuresis, it is important to educate her so that she doesnt think she's having a __
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UTI
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Initially in PP period, what change occurs in the CO?
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initially elevated
*from extra volume going into mom's vascular system |
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How long does a mom's CO remain elevated in the PP?
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for at least 48 hr
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When does the mom's CO return to pre-pregnancy levels?
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within 2 weeks PP
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Why does a PP woman experience increased appetite?
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1. women have to be NPO in case they need anesthesia
2. extra work |
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Why do PP women have delayed bowel evacuation?
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1. nothing out if nothing is in
2. pushing down slows the bowel |
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Why do PP women experience urinary retention?
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body may not feel the need to urinate since the bladder and uterus fight for space
*may need to straight cath 1x |
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Why does a PP woman experience hemoconcentration?
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due to the loss of blood volume without the loss or destruction of RBCs
*eventually returns to normal |
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What happens to a PP woman's experience with hyperpigmentation?
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it reverses after the placenta is gone
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What caused hyperpigmentation?
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mask of pregnancy (linea negra) occurs from pregnancy H
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Which H is released to relax joints like the pelvis during pregnancy?
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relaxin
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What type of hair loss occurs in PP?
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perceived: hair growth rate decreases and the amount of hair loss remains the same after pregnancy
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Why do PP women have elevated WBCs?
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when they are dehydrated & exhausted (from delivery), extra neutrophils from inflammation
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What is a normal elevated WBC level PP?
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14-17 (normal in pregnancy, so not concerned, numbers will go down)
[norm WBC= 3.4-11] |
