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79 Cards in this Set
- Front
- Back
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What does NSVD stand for?
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Normal spontaneous vaginal delivery
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What are the 3 most important things to check during postpartum assessment?
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1. Bleeding
2. Pain 3. IV fluids (must have access) |
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How long is postpartum period?
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42 days or 6 weeks
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What is another term for the postpartum period?
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Puerperium or the 4th trimester
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Following the postpartum, what state does the reproductive organs go to?
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A non-pregnant state, not a pre-pregnant state
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What is involution?
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The reproductive organs returning to a non-pregnant state
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If a mother develops an infection within in 6 weeks of pregnancy, what does her health care provider consider?
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That the infection is a result of the pregnancy.
-Part of the postpartum period |
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Why is it important to monitor the mother during postpartum period?
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To maintain ability for the mother to have future children
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What are the two types of physiological changes that occur during the postpartum period?
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-Retrogressive: the organs going back down
-Progressive: changes moving forward because of birth |
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What does the body release as soon as the placenta comes off the uterine wall?
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Oxytocin: causes fundus to contract
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When does uterine involution occur?
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Immediately postpartum
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Where is endogenous oxytocin released from?
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THe pituitary gland
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What are the 2 main processes involved with oxytocin release?
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1. Ctx of the uterine smooth muscle fibers
-In time thrombi form w/in the uterine wall and permanently seal the area 2. Ctx continue reducing the size of the uterus (aids in decreased blood loss) |
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What can occur if the fundus is not dropping at the rate it should?
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Hemorrhage of the mom
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Where should the fundus be at 24 hours post birth?
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The UMBILICUS
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Immediately after birth, where is the fundus located?
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1/2 between the umbilicus and the symphysis pubis
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During postpartum, at what hour is the fundus one finger breadth above the umbilicus?
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12 hour post birth
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After the first 24 hour, at what rate should the fundus shrink?
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1-2 finger breadths (cms) a day.
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What day(s) during postpartum should the fundus no longer be palpable?
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10-14 days
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What is the most dangerous time for the mother during her postpartum period?
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1 hour after birth because of possible hemorrhaging
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What is uterine atony?
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A fundus that is not shrinking. Lacks tone and feels boggy
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What is subinvolution?
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Failure or DELAY of the uterus to return to the non-pregnant state
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What are the 2 possible reasons for subinvolution?
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1. uterine atony
2. Retain placental fragments in the uterus causing infection --> inflammation |
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What are afterpains?
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Uterine Ctxs that continue on during the pp period
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What does it mean if a women is primiparas?
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1st time pregnancy
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What are multiparas?
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Women who have had 2 or more pregnancies
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Who has stronger afterbirth contractions, pritip or multip?
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Multitip because their uterus is more distending due to previous pregnancies
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What is the Lochia?
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the decidual lining of the uterus
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When is endometrial regeneration complete during pp period?
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After 6 weeks
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How can a women improve her recovery of her vaginal and pelvic floor muscle tone during the pp period?
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By practicing Kegal's exercises
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What happens to progesterone during the pp period?
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It's production stops until first ovulation following pp period
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What reproductive change occurs in the breast during the pp period?
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The breast tissue begins to build up for lactation.
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How does lochia rubra appear?
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It is bright red
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When is lochia rubra seen during postpartum?
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Days 1-3
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What comprises lochia rubra?
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RBCs, small particles of decidual debris and mucus from the placenta
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What type of lochia is seen during days 3-10?
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Lochia Serosa
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What lochia is described as a pinkish/brown?
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Serosa
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What comprises serosa?
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Old blood, leukocytes and debris
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During days 10-11 and lasting up to 6 weeks, what kind of discharge will the mother experience?
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Lochia Alba
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What color is lochia alba?
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pale yellow --> white
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What lochia is comprised of cells, serum, leukocytes and bacteria?
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Lochia alba
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When a mother experiences a reversal of bleeding (becomes heavier and brighter) what does this indicate?
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The mother is doing too much. They need to increase resting to allow for healing
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What does moderate bleeding look like on the pad?
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Pad is about 1/2 full within an hour or so
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How fast is too fast to saturate a pad?
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20 mins is a big problem
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What are the 2 endocrine changes that occur during PP?
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1. Placental expulsion causes a chain reaction of hormonal changes
2. Pregnancy hormones decrease and lactation hormones increase |
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What hormones decrease during placental expulsion?
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1. human placental lactogen (hPL)
2. human chorionic gonadotropin (hCG) 3. Estrogen 4. Progesterone 5. cortisol |
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What two hormones are stimulated post placental expulsion? What are their functions?
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1. oxytocin: uterine contractions and milk let down
2. prolactin: initiates milk production |
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What happens to estrogen levels if a women is not breastfeeding?
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they will reduce after 2 weeks
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When is colostrum present in the breast?
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Immediately following birth and for the first 2-3 days
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When do the breasts begin to become full?
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Days 3-5 of pp period
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How do you get more breast milk?
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By feeding the baby. Supply and demand
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Why do they encourage no sex for 6 weeks pp?
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Because estrogen levels drop and the woman becomes more dry
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What does the external os look like 7 days post birth?
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the size of a pencil tip
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What changes can occur in the perineum pp?
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1. hemorrhoids
2. possible edema or bruising from the birthing process |
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If a mother has bleeding but her fundus is firm, what can this be an indication of?
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Possible tear in the cervix
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Human placental lactogen (hPL)
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1. promotes normal nutrition and growth of the fetus
2. promotes maternal breast development for lactation |
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human chorionic gonadotropin (hCG)
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helps to maintain the corpus luteum to persist for the first 6-8 weeks and helps to secrete progesterone and estrogen
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Function of estrogen during pregnancy
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1. causes enlargement of the breast
2. growth of the ductal system of the breasts 3. enlargement of the external genitalia |
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Function of progesterone during pregnancy
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promotes normal continuation of the pregnancy
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Function of cortisol during pregnancy
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1. It is increased during pregnancy to help with metabolism of glucose, protein, and fats
2. May also have an anti-inflammatory effect that is thought to help prevent rejection of the pregnancy |
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When does colostrum appear?
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First 2-3 days
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Sucking of baby causes continued release of
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Oxytocin
Prolactin |
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What is the normal hematocrit range?
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35-45%
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What is the normal hemoglobin range?
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12-15 gm/dL
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For every 250 mL of blood loss, what is the decrease in hematocrit? Hemoglobin?
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4 point decrease in hematocrit
1g decrease in hemoglobin |
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If a woman loses 500cc of blood, and her original hgb/hct count was 15/45, what is her new count?
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13/37
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If a woman loses 750cc of blood, and her original hgb/hct count was 15/45, what is her new count?
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???
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What is considered a normal amount of blood loss for a vaginal birth? C-section?
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Vaginal up to 500 cc
C-section up to 1000 cc |
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Should you be worried if a woman urinates 3000 cc/day during the postpartum period?
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No, this is normal
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Cardiac output increases during the PP period, remains elevated for the first ______ and returns to pre-pregnancy levels within _______.
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48 hours
2 weeks |
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Other PP changes
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1. Increased appetite
2. Delayed bowel evacuation 3. Urinary retention 4. Hemoconcentration 5. Elevated WBCs 6. Stabilization of joings 7. Reverse of hyperpigmentation 8. Hair "loss" |
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What could it mean if the fundus is off to the right?
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Full bladder
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1st degree laceration
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Involves the superficial vaginal mucosa or perineal skin
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2nd degree laceration
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Involves the vaginal mucosa, perineal skin, and deeper tissues, which may include muscles of the perineum
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3rd degree laceration
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Same as second-degree lacerations but involves the anal sphincter
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4th degree laceration
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Extends through the anal sphincter into the rectal mucosa
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Postpartum Blues
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50-80% prevalence
Emotionally labile Transient Peaks within first week and usually resolves by 2nd week Symptoms are usually unrelated to events (cry for no reason) |
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Postpartum Depression
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Occurs in 15-20% of PP women
SXS: 1. worsening of sleep disturbances 2. appetite change 3. worsening depression and irritability 4. withdrawal and social isolation 5. lacks compensatory measures 6. **Interaction with baby is burdensome and demanding** |
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What is considered a fever?
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>100.4 F
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