Uncomplicated Postpartum

Question 1

What happens to the circulation and blood volume during postpartum?

Answer 1

• Blood flow is diverted to women’s circulation after delivery of placenta
• Blood volume is decreased (returns after 1pp week)

Question 2

What is the expected body weight loss after giving birth?

Answer 2

• about 5-6kg loss after birth
• 2-3kg during 1st week

Question 3

How often should we monitor the postpartum mother?

Answer 3

V/s q15mins for the first hour
V/s q1hr for the next 4 hours

If >100HR may indicate hemorrhage or infection
BP is relative stable
And Temperature

Question 4

What are expected clinical manifestations after giving birth?

Answer 4

• Increased WBC
• Increased Coags (encourage to move)
• Hemoglobin (after birth is pregnancy level, returns to pre-pregnant levels in 6 weeks)
• Anemia
• Abd: soft tone, gradually back to pre-pregnant state
• Heartburn: sphincter and stomach pressure increases
• Constipation: BM after 2-3 days

Question 5

How to assess for Breast and Nipple?

Answer 5

• Soft filling (d1-2: soft, d2-3: nodular, d3-5: volume, sensitive, full)
• Engorgement: sentivitiy, pain/sore
• Let down reflex: tingling or heaviness
• Nipple: soft/uncracked
• Poor latch: trauma/soreness
• Symmetry

Question 6

How to assess for Uterine/Fundus?

Answer 6

1. Tone
2. Height (1st 24hrs: u, d1: u/1, d2: u/2)
   3: Location: midline

• Firm, midline. involuation 1-2cm/day
• Fundus massage (if bleeding, massage, and oxytocin)
• Soft boggy: don’t leave the woman

Question 7

How to assess for Bladder Function?

Answer 7

• Time of last void
• Urinary Retention and Distension
• Full bladder may displace uterus
• Spontaneous voiding resume after birth

Question 8

How to assess for Bowel Function?

Answer 8

• After 2-3 days
• Passing Flatus
• Abd soft
• Bowel Sounds (c/s)
• Encourage fluid and movement
• Consider comfort: relaxation, taking time, positioning, pillow to their stomach

Question 9

How to assess for Lochia?

Answer 9

• Rubra (red d1-3), Serosa (pink 4-10), alba (yellow 10-onwards)
• Scant (<1in), light (<4in), moderate (<6in), saturated (covered in 1hr)
• If saturated, ask when the last time they changed their pad
• If lying on their back, vaginal pooling
• If says: I have a little gush, check pad for PPh

Question 10

How to assess for Legs?

Answer 10

• If prominent during pregnant, may be normal
• Red, tender, pain, VTE
• Education: Fluid, movement, drinking helps fluid shift

Question 11

How to assess for Episiotomy/Laceration/ C/s

Answer 11

• [Normal] Mild Edema
• Well approximated
• c/s dressing D&I, suture intact
• Rectal area: no hemorrhiods, soft/pink
• For dressing off: REEDA
• Tears: 1st (small), 2nd (lining around), 3rd (anus sphincter), 4th (anus)
• Pain

Question 12

How to assess for Emotional Status

Answer 12

• Mood
• Fatigue
• Affect
• Support
• History
• Bonding

Question 13

What is Postpartum Blues?

Answer 13

• d3-10, peaks d4
• Resolves by 2nd or 3rd weeks
• Signs: mood swings, crying, restless, fatigue, insomnia, headache, anxiety, difficulty concentrating, loss of appetite, sadness, anger

Question 14

What is Postpartum Depression?

Answer 14

• May last for weeks, months
• Risks Factors: fam hx, prenatal mental health, stress, unstable relationship, lack of social support, past hx

Question 15

What is Postpartum Psychosis?

Answer 15

<2%
- Within 2 weeks
- Depression, mania, or rapid fluctuation
- Hallucinations, delusion, disordered thoughts/behaviour, disturbed sleep, confused and disoriented

Question 16

If Perinatal mood disorder is untreated?

Answer 16

Mother:
- Interferes with care and pleasure, prolonged recovery time

Infant:
- insecure attachment, delayed cognitive/behaviour problems, increased risk of depression

Question 17

What is the treatment for perinatal mood disorders?

Answer 17

• Primary: guide/education, support, discuss motherhood myths
• Secondary: goal to limit severity and prevent complicated