Fourth Stage of Labor Flashcards
fourth stage
begins with placental expulsion until one hour postpartum
Where is the uterus immediately postpartum?
- midline
- several cm below umbilicus
- drapes over sacral promontory; easily palpable
When should the uterus no longer be palpable?
10-14 days postpartum
What occurs during uterine involution?
- uterine contraction
- myometrial cell shrinkage
- reestablishment of endometrium
Describe lochia rubra
- dark red
- 3-4 days PP
- blood, decidua, cervical discharge
Describe lochia serosa
- pinkish brown
- 4-10 days
- leukocyte, wound exudate, some blood
Describe lochia alba
- whitish yellow
- lasts 10-28 days
- leukocytes, some decidual cells
Describe auto-transfusion immediately postpartum
- auto-transfusion of 10-15% blood volume
- removal of placenta
- shifting of extracellular fluid into intravascular system
Describe changes in stroke volume and cardiac output
increase by 80%
What are CVD risks postpartum?
Pts w/ HTN, pre-e, or CVD at increased risk for pulmonary edema or cardiac failure in first 24-48h
What contributes to increased cardiac output postpartum?
- loss of uteroplacental circulation
- decreased pressure from pregnant uterus
- mobilization of extracellular fluid
What are the 3 key attributes of a mutual relationship?
1) proximity
2) reciprocity
3) commitment
What is commonly “prescribed” for fourth stage pain?
- NSAIDs 600mg q6h; max 3200mg/day (more effective than acetaminophen or aspirin)
! ALL NSAIDs have ceiling effect at ~400mg
- acetaminophen 500mg q6h; max 4g/day
- ketorolac for post-op pain
What are the 3 goal of laceration repair?
1) hemostasis
2) return to functional integrity
3) cosmetic repair
