Physical Changes During The Postpartum Period

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Physical Changes During The Postpartum Period
A. Involution
1. Reduction in size of uterus after delivery to pregrgnant size caused by uterine contractions that constrict and oclude underlying blood vessels at placental site

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Physical Changes During The Postpartum Period
B. Fundus
1. Top portion of uterus is a palpable indicator of involution
2. If contractions of uterine muscle are interrupted, a boggy uterus results (one that is soft, relaxed) and is likely to cause hemorrhage

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Physical Changes During The Postpartum Period

Factors that Influence Involution
Enhance: uncomplicated L&D, breast-feeding, early ambulation, complete expulsion of placenta and membranes
Slow: prolonged labor and difficult delivery, anesthesia, grand multiparity, retained placental fragments or membranes, full urinary bladder, infection, overdistention of the uterus

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Physical Changes During The Postpartum Period
C. Lochia
1. Discharge of blood and debris following delivery; types include lochia rubra, lochia serosa, and lochia alba
2. Should not contain large clots
3. Total volume is 240 to 270 mL, and daily volume gradually decreases
4. Amount may be increased by exertion or breast-feeding
5. Pooling in uterus or vagina may occur while reclining, with increased bleeding upon arising
6. Unexplained increase in amount or reappearance of lochia rubra is abnormal

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Physical Changes During The Postpartum Period
D. Afterpains
1. Caused by intermittent uterine contractions following delivery
Occur in all women but are more painful in multip and breast-feeding women

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Physical Changes During The Postpartum Period

Characteristics of Lochia
Lochia rubra (1-3 days) dark red, bloody; fleshy, musty, stale odor that is nonoffensive; may have clots smaller than a nickel
Lochia serosa (4-10 days) Pink or brownish; watery; odorless
Lochia alba (11-21 days, may persist to 6 weeks in lactating women) Yellow to white; may have slightly stale odor

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Physical Changes During The Postpartum Period
E. Cervix
1. Soft, irregular, and edematous; may appear bruised with multiple small lacerations
2. Closes to 2 to 3cm after several days, admits a fingertip after 1 week
3. Shape permanently changes after first delivery from round, dimplelike os of nullip to lateral slitlike os of multip woman

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Physical Changes During The Postpartum Period
F. Vagina
1. Smooth walls, edematous with multiple small lacerations
2. Client should be free from perineal pain within 2 weeks
3. Low estrogen levels postpartum lead to decreased vaginal lubrication and vasocongestion for 6 to 10 weeks, which can result in painful intercourse

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Physical Changes During The Postpartum Period
G. Abdominal wall
1. Abdominal wall soft and flabby with decreased muscle tone
2. Striae, or stretch marks, that were red during pregnancy will fade to silver or white in Caucasian women; darker-skinned women will have darker striae that remain darker
3. Diastasis recti, separation of rectus muscles of abdomen, may improve postpartum depending on awoman's physical condition, number of pregnancies, and type and amount of exercise

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Physical Changes During The Postpartum Period
H. Cardiovascular
1. Returns to prepregnant state w/in 2 wks
2. Increase in blood volume by 40% during pregnancy is eliminated primarily by diuresis
3. First 48h pp pose the greatest risk of complications forclients with heart dz
4. Blood pressure should remain consistent with pregnancy baseline
5. Bradycardia of 50 to 70 bpm is common during first 6 to 10 days; tachycardia is related to increased bloods loss, temp elevation, or difficult, prologed labor and birth
6. Inc fibrinogen continues for 1 wk resulting in inc sedimentation rate and risk for thrombophlebitis
7. Inc wbc up to 30,000 does not necessarily mean infection or may mask signs of infection; an inc of more than 30% in 6h indicates pathology
8. Decreased hemoglobin is r/t the amt of blood loss during delivery; should return to prelabor value in 2 to 6 wks depending on degree of decrease
9. Hematocrit inc by third to fifth day postpartum r/t diuresis; a drop indicates abnl blood loss

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Physical Changes During the Postpartum Period
I. Urinary
1. Inc bladder capacity and dec bladder tone lead to dec sensation and inc risk of urinary retention and infection
2. PP diuresis of 2,000 to 3,000mL inc output in first 12 to 24h after delivery and accounts for a 5-lb wt loss
3. Increased glomerular filtration rate assists in diuresis
4. A full bladder displaces uterus, inc risk of uterine atony and postpartum hemorrhage
5. Fluids are also lost through diaphoresis w/inc perspiration most commonly occurring @ night

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Physical Changes During the Postpartum Period
J. Gastrointestinal
1. Hunger and thirst are common following birth
2. Risk for constipation inc b/c of dec peristalsis, use of narcotic analgesics, dehydration and dec mobility during labor, and fear of pain from having a bm
3. Risk for hemorrhoids inc b/c of pressure from pushing during second stage of labor

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Physical Changes During the Postpartum Period
K. Endocrine
1. Estrogen and progesterone levels drip rapidly after delivery of placenta
2. Menstruation usually resumes at 7 to 9 wks for nonlactating women with 90% experiencing a menstrual perod by 12 wks; first cycle is usually anovulatory
3. Ovulation and menstruation return time is prolonged in lactating women and affected by length of time the woman breast-feeds and whether formula supplements are used; may vary from 2 to 18 mo
4. Lactation
a. Nipple stimulation leads to release of oxytocin from pit gland; this stimulates release of prolactin from pit gland, which caused prod of milk and the let-down reflex, release of milk by contractions of alveoli of breast
b. Colostrum is first milk secreted and is rich in protein and immunoglobulins
c. Primary engorgement occurs on second or third day as supply of blood and lymph in the breast is inc and transitional milk is produced
d. Mature milk is produced after 2 wks and appears watery and slightly bluish in color, similar to skim milk

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