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1. Postpartum Flashcards

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1
Q

Three divisions of the uterus

A

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

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2
Q

What is the isthmus?

A

The lower uterine segment

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3
Q

Early 20th century word for postpartum

A

Puerperium

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4
Q

Two types of physiologic changes during the postpartum period

A

Retrogressive: Uterus
Progressive: Nipples

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5
Q

Duration of postpartum period

A

6 weeks or 42 days

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6
Q

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

A

Uterine involution

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7
Q

What causes uterine involution?

A

Endogenous oxytocin released from the pituitary

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8
Q

Two main processes involved in uterine involution:

A

1) Contractions of the uterine smooth muscle fibers

2) Contractions continue reducing the size of the uterus

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9
Q

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

A

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

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10
Q

Fundus location: Immediately post-partum

A

Halfway between the symphysus pubis and the umbulicus

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11
Q

Fundus location: 12 hours post partum

A

One finger ABOVE the umbilicus

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12
Q

How quickly does the fundus descend?

A
  • In the first 12 hours, it ascends a little

- After that, it will descend 1-2 fingerbredths every 2 hours

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13
Q

Where should the fundus be 24 hours postpartum?

A

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

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14
Q

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

A
  • After ten days

* Breastfeeding may speed it up

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15
Q

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

A

Uterine atony and the resulting risk of hemorrhage

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16
Q

What is uterine atony? Why is it dangerous?

A

o Uterus has no tone – not contracting

o Can lead to hemorrhage: One of the top reasons women die worldwide.

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17
Q

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

A

PITOCIN:

  • 1000cc with 20 units of pitocin x2
  • Rate: 100 - 125cc / hr
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18
Q

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

A

Subinvolution

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19
Q

What causes subinvolution?

A

Infection or retained placental fragments

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20
Q

How long do uterine contractions continue?

A

Through the postpartum period

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21
Q

What causes the development of lochia?

A

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

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22
Q

What pregnancy hormones are reduced immediately postpartum? (2)

A

Estrogen, Progesterone

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23
Q

Progesterone ceases until ______

A

First ovulation

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24
Q

When does endometrial regeneration occur?

A

Within six weeks after delivery

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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

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