Maternal Assessment Flashcards
Postpartum period
interval between birth and return of reproductive organs to their nonpregnant state
lasts 6 weeks
Involution process
return of uterus to true pelvis after birth
Progresses rapidly
Fundus descends 1 to 2 cm every 24 hours
2 weeks after childbirth uterus lies in true pelvis
sub involution
failure of uterus to return to non-pregnant state
Common causes are retained placental fragments and infection.
Uterus
Contractions
Hemostasis achieved by compression of blood vessels as uterine muscle contracts (as opposed to platelet aggregation or clot formation).
Hormone oxytocin, released from pituitary gland, strengthens and coordinates uterine contractions. Breast feeding also.
After pains
Placental site (vascular constriction & thrombosis reduce the placental site)
Lochia
post birth uterine discharge
Rubra
- Bright red flow
- Blood and decidual debris (mucosal lining of uterus)
- Duration of 3 to 4 days
Serosa (pink/brown)
- blood, serum, leukocytes, and debris
- Median duration of 22 to 27 days
Alba (yellow/white)
- Leukocytes, decidua, epithelial cells, mucus, serum, and bacteria
- Continues 4 to 8 weeks after birth
Cervix
Soft immediately after birth
Within 2 to 3 postpartum days, cervix is 2 to 3 cm, and by 1 week, it is about 1 cm.
Ectocervix (portion that protrudes into vagina) appears bruised and has small lacerations—optimal conditions to develop infections
Vagina and perineum
Estrogen deprivation: responsible for thinness of vaginal mucosa and absence of rugae (muscular folds on internal wall of vagina)
Vagina gradually decreases in size and regains tone (never completely returns to pre-pregnancy state)
Thickening of vaginal mucosa occurs with return of ovarian function.
Dryness and coital discomfort (dyspareunia) may persist until return of ovarian function
Episiotomies heal within about 2 weeks
Hemorrhoids (anal varicosities) are common and decrease within 6 weeks of childbirth
Pelvic muscular support
Breastfeeding
Colostrum – early milk (yellowish fluid can be expressed from nipples)
Tenderness may persist for 48 hours after start of lactation.
Non breastfeeding mothers
Engorgement resolves in 24 – 36 hours after milk comes in
Breast binder /tight bra, ice packs, fresh cabbage leaves, or mild analgesics may be used to relieve discomfort.
Lactation ceases within a few days to 1 week
Average blood loss for vaginal birth
up to 500 mL
Average blood loss for c-section
500-1000 mL
Respiratory system
Immediate decrease in intra-abdominal pressure at birth causing an increase in chest wall compliance
Decreased pressure on diaphragm
Rib cage elasticity can take months to return to normal state
PaCO2 levels rise with loss of placenta
Placental hormones
Expulsion of placenta = decreased estrogen and progesterone levels
decreases in HCS which becomes normal again with maternal circulation (AKA human placental lactogen), estrogen, cortisol, insulinase
What do the placental hormones do?
reversal of the diabetogenic effects of pregnancy leading to significant lower blood sugar levels
Postpartum headaches
may be due to postpartum-onset pre-eclampsia, stress, and leakage of cerebrospinal fluid into the extradural space during placement of the needle for administration of epidural or spinal anaesthesia.
When to do a postpartum assessment for SVD
every 15 minutes for one hour after birth
at 2 hours post delivery
once per shift
as required
When to do a postpartum assessment for c-section
every 15 minutes for one hour, at 2 hours post delivery
every 4 hours for the first 24 hours, then once a shift
as required
