Lecture 1 - Introduction

Question 1

What is the antepartum period?

Answer 1

From conception to the onset of labour

Question 2

What is the intrapartum period?

Answer 2

From onset of labour to delivery of placenta

Question 3

How long does the postpartum period last?

Answer 3

Usually defined as up to 6 weeks following delivery
–> Up until uterus has returned to pre-pregnancy state

Question 4

How long does pregnancy typically last?

Answer 4

~280 days (40 weeks)

Question 5

How many weeks is considered term pregnancy?

Answer 5

37 weeks
–> A term baby is born after 37 weeks

Question 6

What is normal maternal temperature in the first 24 hours postpartum?

Answer 6

Up to 38°C can be normal d/t dehydration and stress. Should normalize after.

Question 7

What pulse changes are expected immediately postpartum?

Answer 7

Elevated for first hour can be normal, but should begin to normalize to between 60-100.

Question 8

What BP changes are normal immediately postpartum?

Answer 8

Should be normal (baseline). Transience of 5% during first few postpartum days can be normal.
–> Elevation d/t fluids or pain might be seen

Question 9

What resp rate is normal immediately postpartum?

Answer 9

Should be between usual postpartum range (12-24)

Question 10

What BP changes should be monitored for immediately postpartum?

Answer 10

Orthostatic hypotension

Question 11

What does BUBBLEE stand for?

Answer 11

B - Breasts
U - Uterus
B - Bladder
B - Bowel
L - Lochia
L - Legs
E - Episiotomy/laceration or caesarean incision
E - Emotional status

Question 12

What findings are normal in a breast assessment postpartum through the first 5 days?

Answer 12

Days 1-2: Soft
Days 2-3: Full
Days 3-5: Soften with breastfeeding

Colostrum can be expressed

Question 13

What is colostrum?

Answer 13

First breastmilk that is high in antibodies and nutrients that occurs in small quantities.

Question 14

How can lactation be suppressed in first 72 hours?

Answer 14

Goal is to reduce discomfort
–> Well fitted-sports bra, ice packs, cabbage leaves, or mild analgesia

Do not stimulate lactation if goal is to suppress lactation

Question 15

What is involution? When does it occur completely? What enhances it?

Answer 15

The process of the uterus returning to non-pregnant state (6-7 weeks)
–> Enhanced by effective uterine contractions that compress blood vessels (can cause afterpain)
–> Decreased estrogen + progesterone, increased oxytocin

Question 16

What are postpartum afterpains? In what population are they more common?

Answer 16

Strong and vigorous contractions that can last a week postpartum during involution. Occurs during breastfeeding as oxytocin is released.
–> More common with multiparity and with larger NB

Question 17

When does endometrial regeneration occur during involution of the uterus?

Answer 17

Almost complete after 3 weeks, except at placental site which takes 6-7 weeks.

Question 18

What is a major concern if a uterus is not contracting postpartum?

Answer 18

postpartum hemorrhage

Question 19

Where should the uterus be palpated in the first 24 hours postpartum?
What about 6 days?
When should it no longer be palpable?

Answer 19

Following delivery of placenta - 2cm below umbilicus
12 hours - level of umbilicus
24 hours - 1 cm below umbilicus

Should continue to descend 1-2 cm daily.
Should be halfway between umbilicus and symphysis pubis by day 6.
Not palpable by 2 weeks.

Question 20

What is subinvolution?

Answer 20

Failure of the uterus to return to a non-pregnant state.

Question 21

What are some factors that slow involution of the uterus?

Answer 21

Full bladder, prolonged or difficult labour, overdistention, incomplete expulsion of placenta, anesthesia

Question 22

What is a “boggy” fundus?

Answer 22

fundus is soft and spongy, not firm.

Question 23

What postpartum uterus assessment findings require intervention?

Answer 23

Fundus deviated from midline
Fundus higher than expected
Boggy fundus

Question 24

What interventions can be used to encourage involution?

Answer 24

Assist pt to empty bladder
Assess lochia
Gentle fundal massage

If no improvement, report to RM/MD

Question 25

What is considered an early postpartum hemorrhage? What causes it?

Answer 25

First 24 hours --> Caused by uterine atony (relaxation) --> May also be caused by lacerations or retained placental tissue

Question 26

How common are early PPHs?

Answer 26

Occur in ~5% of births

Question 27

What is considered a late postpartum hemorrhage? What causes it?

Answer 27

24 hours - 6 weeks PP --> Due to subinvolution --> May also be retained placental tissue, infection

Question 28

A spontaneous void should occur how soon PP?

Answer 28

Within 8 hours

Question 29

Diuresis occurs when during PP and lasts for how long?

Answer 29

Begins in first 12 hours PP and can be profuse for 3 days.

Question 30

How should patients be taught to prevent urinary incontinence PP?

Answer 30

Use of Kegel exercises to strengthen pelvic floor muscles.

Question 31

Bowel sounds should be present immediately following labour. How soon should a bowel movement occur PP?

Answer 31

2-3 days

Question 32

What are some factors that can contribute to decreased bowel activity PP?

Answer 32

Fear or pain or tearing sutures NPO status/decreased appetite Constipation d/t analgesia Hemorrhoids Dehydration Immobility

Question 33

What should lochia be assessed for? What is is a normal lochia volume?

Answer 33

~240-400 ml in total --> Assess for colour/amount/odour/clots or placental fragments which can prevent involution

Question 34

What are the three classification of lochia?

Answer 34

Rubra, serosa, alba

Question 35

What is considered heavy bleeding postpartum

Answer 35

If a pad is saturated in 1-2 hours

Question 36

What is considered lochial bleeding? What about non-lochial?

Answer 36

Lochial --> Uterine atony --> Retained placental fragments Non-lochial --> Unrepaired cervical or vaginal tears

Question 37

What is lochia rubra? How long does it last PP?

Answer 37

Dark/bright red blood containing decidual debris or small clots --> Lasts 3-4 days

Question 38

What is lochia serosa? How long does it last?

Answer 38

Pink/brownish red. Contains older blood, serum, leukocytes, and tissue debris --> Day 4-14 days (up to 4 weeks)

Question 39

What is lochia alba? How long does it last?

Answer 39

Yellowish white, contains leukocytes and decidual debris. --> Begins after 10-14 days, and may continue until 4-6 weeks after birth.

Question 40

What assessments should be done on the legs PP?

Answer 40

Edema: Some ankle edema normal for first few days Thrombophlebitis: Redness, tenderness, pain

Question 41

How common is DVT PP?

Answer 41

Occurs in less than 1% of births, more common in c-section

Question 42

What laceration/episiotomy findings are normal PP?

Answer 42

Edema reaches maximum by 24 hours PP and can cause difficulty urinating at this time. Edges should be well approximated

Question 43

What can be done to encourage healing and decrease pain from a laceration/episiotomy?

Answer 43

Ice packs for first 24 hours Perineal hygiene Sitz bath

Question 44

What are normal findings of a c-section incision?

Answer 44

Dressing should be clean and intact, suture line intact.

Question 45

PP blues appears around day 3, how long does it last typically?

Answer 45

Usually only 2 weeks - if not improving we begin to suspect PPD.

Question 46

What are some additional considerations for post-op care following a C-section?

Answer 46

Cough & Deep breathing Gradual ambulation Pain relief Rest Assess for signs of infection

Question 47

How long does full healing take after a c-section?

Answer 47

4-6 weeks.

Question 48

When is Anti-D Ig given to Rh- mothers?

Answer 48

Prophylactically at 28 weeks and within 72 hours of delivery (or up to 28 days) if fetus is Rh+.

Question 49

What is the role of the newborn admission nurse?

Answer 49

Responsible only for the newborn and know antepartum and intrapartum history. Prepared for neonatal resuscitation. --> Note time of birth, immediate NB assessment & intervention prn, APGAR score, identification.

Question 50

What questions should we ask during NB assessment?

Answer 50

1. Amniotic fluid clear of meconium 2. Breathing or crying 3. Muscle tone (flexion) 4. Is baby full term?

Question 51

What should be done immediately after a NB is born?

Answer 51

Place infant prone on birthing parent for skin to skin. Dry & stimulate NB. Assess airway and auscultate HR (>100)

Question 52

If the answer to any of the main 4 NB assessment questions is no, what should be done?

Answer 52

1. Place NB supine on radiant warmer 2. Suction using bulb syringe 3. Dry 4. Assess resp effort, HR, colour.

Question 53

What things are assessed in APGAR?

Answer 53

HR, resp rate, muscle tone, reflex irritability, colour. (Activity, pulse, grimace, Appearance, Respirations)

Question 54

When is an APGAR score performed?

Answer 54

1 minute and 5 minutes of life

Question 55

What is acrocyanosis?

Answer 55

cyanotic extremities.

Question 56

What care procedures are performed early in NB's life?

Answer 56

Identification Physical - weight, measure, gestational age Medication - erythromycin ophthalmic ointment (2hrs), Vit K (6hrs)

Question 57

What are signs of respiratory distress in the newborn?

Answer 57

Nasal Flaring Intercostal or subcostal retractions Grunting Resp rate outside of 30-60 range is concerning

Question 58

What NB HR is normal?

Answer 58

110-160 with variations

Question 59

Are murmurs normal in the NB?

Answer 59

Murmurs are common and usually temporary

Question 60

What is a normal NB temperature?

Answer 60

36.5-37.5°C, axillary

Question 61

Hypothermia of the NB can result in what complications?

Answer 61

Cold shock: Resp distress, hypoglycemia, jaundice (hyperbilirubinemia which crosses BBB)

Question 62

What is physiological jaundice and how common is it in NBs?

Answer 62

Physiological jaundice affects 60% of infants by day 2-5 of life. Considered pathological if it occurs in first 24 hours or persists beyond 7-14 days.

Question 63

How many voids are expected in first week of life?

Answer 63

1 void per day of life for first 5 days, then expect 6-7 wet diapers daily.

Question 64

Meconium should occur by what age? How long does it last?

Answer 64

Expect first stool by 24-28 hours, lasts up to 3 days.