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Flashcards in 1. Postpartum Deck (89):
1

Three divisions of the uterus

1) Corpus (Fundus)
2) Isthmus
3) Cervix (Neck)

2

What is the isthmus?

The lower uterine segment

3

Early 20th century word for postpartum

Puerperium

4

Two types of physiologic changes during the postpartum period

Retrogressive: Uterus
Progressive: Nipples

5

Duration of postpartum period

6 weeks or 42 days

6

The rapid return of the uterus to the non-pregnant state refers to what?

Uterine involution

7

What causes uterine involution?

Endogenous oxytocin released from the pituitary

8

Two main processes involved in uterine involution:

1) Contractions of the uterine smooth muscle fibers

2) Contractions continue reducing the size of the uterus

9

What is one result of the uterine contractions (of the smooth muscle fibers)?

o In time, thrombi form within the uterine wall and permanently seal the area.

10

Fundus location: Immediately post-partum

Halfway between the symphysus pubis and the umbulicus

11

Fundus location: 12 hours post partum

One finger ABOVE the umbilicus

12

How quickly does the fundus descend?

- In the first 12 hours, it ascends a little
- After that, it will descend 1-2 fingerbredths every 2 hours

13

Where should the fundus be 24 hours postpartum?

At 24 hours, the fundus should be at umbilicus or one finger breadth (cm) below the umbilicus.

14

How much time does it take before the fundus is no longer palpable? What factor might speed this up.

• After ten days
• Breastfeeding may speed it up

15

What is one factor that makes the first hour after birth so dangerous for a woman?

Uterine atony and the resulting risk of hemorrhage

16

What is uterine atony? Why is it dangerous?

o Uterus has no tone – not contracting
o Can lead to hemorrhage: One of the top reasons women die worldwide.

17

Prophylactic treatment for uterine atony. What is the dose and rate?

PITOCIN:

• 1000cc with 20 units of pitocin x2
•Rate: 100 - 125cc / hr

18

The failure or delay of hthe uterus to return to the non-pregnant state refers to __________.

Subinvolution

19

What causes subinvolution?

Infection or retained placental fragments

20

How long do uterine contractions continue?

Through the postpartum period

21

What causes the development of lochia?

Blood vessels clamp down, uterine lining sloughs out, maternal blood goes with it.

22

What pregnancy hormones are reduced immediately postpartum? (2)

Estrogen, Progesterone

23

Progesterone ceases until ______

First ovulation

24

When does endometrial regeneration occur?

Within six weeks after delivery

25

What comprises lochia?

Uterine discharge of blood, waste

26

What are the three types of lochia?

Lochia rubra
Lochia serosa
Lochia alba

27

What is lochia rubra?
• Days after birth
• Color
• Composition (4)

• Days after birth: 1-3
• Color: Bright red
• Composition: Leukocytes, bacteria, white blood cells, fragments of lining

28

What is lochia serosa?
• Days after birth
• Color
• Composition

• Days after birth: 3-10
• Color: Pinkish brown
• Composition: Leukocytes invade the area and help heal

29

What is lochia alba?
• Days after birth
• Color
• Composition

• Days after birth: Day 10 or 11 to 3 weeks (can last up to 5 weeks)
• Color Pale (Amount is decreased)
• Composition: Cells, serum, leukocytes, bacteria

30

Bleeding: What is the first thing you do?

Massage the fundus

31

How does the fundus respond to massage?

If it's soft, it will contract.

32

Any time you enter any patient's room, you should assess what three things?

• Pain
• Bleeding
• IV site

33

Define scant lochia

<2.5 cm (1 in ch) stain

34

Define light lochia

2.5 - 10 cm (1-4") stain

35

Define moderate lochia

10-15cm (4 to 6") stain

36

Define heavy lochia

Saturated in 1 hours time

37

What causes pregnancy hormones to decrease?

Expulsion of placenta

38

Five hormones that decrease with placental expulsion

o Human Placental Lactogen (hPL)
o Human chorionic gonadotropin (hCG)
o Estrogen
o Progesterone
o Cortisol

39

Functions of Human placental lactogen (hPL) in pregnancy (2)

• Promotes normal nutrition and growth of the fetus
• Promotes maternal breast development and lactation

40

Function of human chorionic gonadotropin (hCG) in pregnancy (2)

• Helps to maintain the corpus luteum and persist for the first 6-8 weeks of pregnancy
• Helps to secrete progesterone and estrogen

41

Function of Estrogen in pregnancy (3)

• Breast enlargement
• Growth of breast ducts
• Enlargement of the external genitalia

42

Function of progesterone in pregnancy (1)

• Promotes normal continuation of pregnancy

43

Function of Cortisol in pregnancy (2)

• Helps with metabolism of glucose, protein, fats
• Anti-inflammatory effect that is thought to prevent rejection of pregnancy.

44

What is lactation?

The formation of breast milk

45

What stimulates the growth of milk glands?

Estrogen level produced by the placenta

46

What causes breasts to increase in size? (2)

• Larger glands
• Accumulated fluid

47

Changes in breasts postpartum

o First two days: Very little difference in a woman
o First 2-3 days: Colostrum
o 3-5 days: Breasts becomes full

48

Role of suckling (2)

o Causes continued release of oxytocin and prolactin
o Production of milk depends on the suckling of the infant or the use of a breast pump.

49

What happens to the vagina post-partum?

Rugae

50

How can you advise a mother to tighten her vagina?

Kegels

51

Changes to the cervix post-partum (timing)

o Contraction of cervix toward its pre-preganant state begins at once.
o By the end of the seventh day, external os opening narrows to the size of a pencil.

52

Changes in the perineum postpartum (3)

• Edema
• Bruising
• Hemorrhoids

53

The cervix of someone who never had a baby is known as:

Nulliparous cervix

54

The cervix of someone who has had a baby is known as:

Parous cervix

55

How does a nulliparous cervix differ from a parous cervix?

The nulliparous cervix has a round os, the parous cervix has a slit os.

56

For every 250 mL of blood loss (2 changes)

o Four point increase in hematocrit
o 1g decrease in hemoglobin

57

How much blood loss at birth is considered normal for:
- Vaginal birth
- Caesarean birth

• Vaginal birth: Up to 500 cc
• Caesarean birth: Up to 1000 cc

58

What happens to maternal cardiac output postpartum? What is the risk?

Increase in maternal cardiac output

**RISK: HTN

59

What causes increase to maternal cardiac output postpartum (4)?

o 1) Blood from the uteroplacental unit now returns to the maternal central.

o 2) Pressure on the blood vessels from gravid uterus is gone

o 3) Excess extracellular fluid returns

o 4) Also, blood vessels are constricting

60

o During the postpartum period, the body rids itself of excess plasma volume that was needed during pregnancy by two main routes:

o Diuresis: 3,000 cc/day
o Diaphoresis: Especially at night (2nd night: wakes up soaked)

61

Cardiac output postpartum (timing)

o Remains elevated for at least 48 hours postpartum
o Returns to pre-pregnancy levels within 2 weeks postpartum

62

Post-partum changes: Blood levels

• Hemoconcentration (due to volume loss, RBCs become more concentrated)
• Elevated WBCs (Not a concern unless there's a source of infection)

63

Other postpartum changes (6)

o Increased appetite
o Delayed bowel evacuation
o Urinary retention
o Stabilization of joints
o Reverse of hyperpigmentation
o Percieved Hair Loss

64

When should you worry about postpartum urinary retention?

Cath if mom doesn’t pee for 6-8 hours after labor

65

What makes a postpartum woman's hips hurt?

Relaxin ⇒ Makes hips pliable. Sometimes painful.

66

What are "normal" causes of fever postpartum?

Related to dehydration and exhaustion

67

8 Components of postpartum nursing assessment

o Vital signs
o Breasts and nipples
o Abdomen
o Uterus / fundus
o Bladder
o Perineum: Intact? Episiotomy?
o Lochia
o Lower extremities

68

If the fundus is to the _____, it is likely because _______.

If the fundus is to the right, it is likely because she has a full bladder.

69

Fundal assessment: Possible abnormal findings

• Fundal height greater than expected
• Fundus not firm (“boggy”)

70

Woman's position for a perineal assessment

Side-lying position, bent knee

71

Three things to check for during a perineal assessment

• Edema
• Bruising
• Well-approximated wound margins form an episiotomy / laceration tear

72

What is an episiotomy?

A surgical incision of the perineum to prevent tearing and help to release pressure on the fetal head at birth

73

What is a laceration?

• When the woman tears on her own
• A jagged cut or tear that may involve only the skin layer or may penetrate deep subcutaneous tissues or tendons

74

How long does it take lacerations / repairs to heal?

2-3 weeks postpartum

75

A laceration affecting the _______ may cause a woman to have difficulty urinating after birth

Periurethral

76

Tears in the _____ may be a source of significant bleeding after birth

The Cervix

77

What does a 1st degree perineal tear involve?

Superficial vaginal mucosa or perineal skin

78

What does a second degree perineal tear involve?

Deeper tissues, may include muscles of perineum

79

What does a third degree perineal tear involve?

Anal sphincter

80

What does a third degree perineal tear involve?

Anal sphincter into rectal mucosa

81

Perineal care: Six items

o Mesh underwear
o Should change pad each time she goes to the bathroom
o Tucks: Hemorrhoid cream: Keep it in the fridge; put it in the fold of incision or hemorrhoid.
o Peripad (ice)
o Peripodal
o Sitz bath: Great for hemorrhoids or an episiotomy. “The poor man’s bidet.”

82

Plan of care / interventions (7)

o Prevention of infection
o Prevention of excess bleeding
o Promote comfort, rest, ambulation, exercise
o Promote nutrition
o Promotion of normal bowel and bladder functions
o Breast feeding promotion or lactation suppression
o Health promotion / protection of future pregnancy

83

Nutrition needs: Pregnancy v. Postpartum

• 500 additional calories per day to breastfeed
• 300 additional calories a day for pregnancy

84

Five components of postpartum psychological assessment

o Impact of birth experience
o Maternal self image / sexuality
o Family structure and functioning
o Impact of cultural diversity
o Adaptation to parenthood / parent

85

3 stages of maternal postpartum adjustment

•1st phase: Dependent: “Taking it in”
•2nd phase: Dependent-independent: “Taking hold”
•3rd phase: Interdependent: “Letting Go”

86

3 stages of paternal postpartum adjustment

• Stage 1: Expectations
• Stage 2: Reality
• Stage 3: Transition to mastery

87

Postpartum blues
• Prevalence
• Timing
• Symptoms

• Approximately 50-80% prevalence
• Peaks by within the first week and usually resolves by the second week
• Symptoms are usually unrelated to events. Emotionally labile, Transient

88

Postpartum depression prevalence

15-20% of women

89

Signs and symptoms of postpartum depression (6)

• Worsening of sleep disturbances
• Appetite change
• Worsening depression and irritability
• Withdrawal and social isolation
• Lacks compensatory measures
• Interaction with baby is burdensome and demanding