Post Partum Flashcards
Which semester is the post partum considered?
How long is the post partum?
What happens to the reproductive organs?
The 4th trimester
Lasts 6 weeks after birth.
They go back to the a non-pregnant state (not necessarily back to pre pregnant tho)
What are the benefits of skin to skin?
Stabilizes baby's temperature Baby self regulation of vitals Increases oxytocin Helps mom with feeding cues Promotes bonding
Will a mom and baby do skin to skin if there is any issue?
No baby must be stable. Mom needs to be stable too.
Your patient who just gave birth begins to shiver. What do you say?
That shivering is common and that she just has to stay warm and drink fluids. Make sure to reassure her.
What theories are there to explain the shivering/tremors have birth?
Pressure on nerves goes away
Adrenaline goes away
Reaction to epidural
Transfusion during placenta separation
Average blood loss from vaginal delivery?
What is too much for vaginal delivery?
Between 250-400 mL
Too much is above 500 mL
Average blood loss for a c-section?
Blood loss for c-sections should be less than 1000 mL
What is body Temp like postpartum?
Temp increased for 24 hrs until milk comes in but not everyone
What is pulse like in postpartum?
Pulse elevated for a few hrs then slow w post partal period w fluids so may be slow. You never wanna see it be actually tachycardia
What is blood pressure going to be like in postpartum?
What if she is hypotensive?
Hypertension?
Blood pressure will be elevated by around 10 points due to alteration of fluids.
- But don’t let her stand up too fast bc she will have orthostatic hypotension due to fluid shifting/loss
- Have her sit on the edge of the bed
Hypotensive indicates possible hemorrhage.
Hypertension may be due to pre-eclampsia.
Why do we check H&H after delivery and on who?
What will a minor drop in H&H after delivery be from tho?
H&H will reflect the amount of blood loss in delivery.
We won’t do continuous checks of this for everyone though. Really only for high risk people due to insurance purposes.
A minor drop is a dilution issue from fluid changes.
Why might WBC be elevated?
Probably due to neutrophil count going up to prepare for possible sepsis.
What will happen to the coagulation factors?
What intervention should mom be doing?
Coagulation factors will increase as to reduce possibility of hemorrhage w clotting.
^ women need to ambulate after delivery to reduce possible clots though now. Have her get up and go to the bathroom on her own and stuff.
What will BUN look like in postpartum and why?
BUN will be increased due involution (breakdown of uterus back to nonPG state)
How many weeks will creatine levels go back to normal?
What about proteinuria?
Will ketones be present?
Creatinine goes back to normal after 6 weeks.
Proteinuria resolves 6 weeks too.
Ketones should go away with rehydration.
When does involution or return of uterus to non pg state begin? And by what process?
Shrinking that occurs once placenta is delivered by doing autolysis of cells
What is exfoliation?
What drug/hormone stimulates contractions?
Exfoliation is what prevents scarring of the placental site during involution
Oxytocin which is used to help clamp and with breastfeeding.
What is it called when the uterus is soft, relaxed, and not clamping? What will lochia look like?
If the uterus isn’t clamping, what intervention do you anticipate?
Uterine atony which is essentially a sign of PPH. Lochia will be heavier with clots.
Get her to sonogram and to see if anything is left inside. Then get it removed.
T/F
Breastfeeding usually feels good after delivery
Sort of false.
Some women may have afterpains that accompany breastfeeding due to oxytocin. Just treat the afterpains with analgesics.
How would you check the uterus?
What can cause an inaccurate check of the uterus?
Put dominant hand on top of uterus. And then put other hand below to support the bottom. Should feel like a dome.
A full bladder may cause the uterus to be displaced.
What will uterus be like right after delivery?
What will uterus be like 12-24 hrs later?
How far does it descend per day?
What will the uterus be like 2 weeks after delivery?
After delivery, uterus is midline and firm.
12-24 hrs later uterus will be slightly above the umbilicus and firm.
Descends about 1 cm a day.
Two weeks later it will be at the pelvic cavity. And it really shouldn’t take longer than this.
- also the more gravidas you’ve had, the more often you’l see them use up the two weeks
How to check for Lochia?
Which has more; vaginal or c section?
Check for bloody mucus by having patient roll over. Check her labia. And just be thorough.
Vaginal will have more
- c section just gets sucked up
Endometrium heals when?
Placental site heals when?
Endometrium by 3 weeks
Placenta site by 6 weeks
The progression of Lochia
Rubra - dark red for 3 days
Serosa - Serosanuinos draining that is pink for 10 days
Alba - Serous drainage creamy yellow for 6 weeks
What is it called when the uterus fails to return to the non-pregnant state? Why?
What should you do?
Subinvolution
- the failure due to retaining fragments of placenta or an infection that is painful with foul smelling lochia
Check uterus at prescribed intervals
Empty bladder regularly
Massage fundus to firm it up
What if a gush of blood comes out when she’s standing
It is just from blood pooling
What if she passes clots
This is just due to blood pooling again.
What if she has night sweats
Due to body trying to get rid of the extra fluids she has
Afterpains cause
Who are they more common in?
More common in moms with multigravidas
Oxytocin and breastfeeding cause the cramping
What if her tummy is still huge after birth
Just remind her it takes some time. And the flat belly after birth is uncommon
Explain what cervix will be like after birth
spongy, flabby, and bruised
What will Os look like after birth
May gradually close and is irregular shaped to fish mouth
How will the vagina appear after birth?
When will it go back to normal with ruggae?
Vagina will be edematous and bruised with small superficial lacerations
Shrinks agaain and ruggae within 3-4 weeks
