Flashcards in Physiology of the Puerperium Deck (33)
The time from immediately after the end of labour until the reproductive organs have returned to their pre-gravid condition, a period estimated to be around 6-8 weeks
Define the postnatal period
A period after labour during which the attendance of a midwife upon a woman and baby is required, being not less than 10 days and for suck longer period as the midwife considers necessary
What is involution of the uterus?
The return of the uterus into the pelvis through a process of:
1. Contractions of the uterine muscle
3. Epithelial regeneration and proliferation
What is ischaemia?
After birth, the blood vessels of the uterus constrict and the blood circulation to the organs is reduced, causing tissue death
What occurs on expulsion of the placenta?
The muscle layers of the myometrium stimulate the action of ligatures that compress and occlude the large sinuses of the blood vessels to reduce blood loss
What is phagocytosis in relation to the puerperium?
- The body needs to remove the extra fibrous and elastic tissue (collagen and elastin)
- Macrophages and leucocytes engulf and ingest redundant tissue from autolysis and excrete it via the renal system
What is autolysis?
A process that uses proteolytic enzymes released from lysosomes to reduce the muscle size by removing redundant ischaemic muscle fibres
What is coagulation?
- Blood clotting
- Done through platelet aggregation and the release of thromboplastin and fibrin
What is lochia?
- The lining of the uterus being shed (decidua necroses)
- Contains decidua, blood and serum
- Woman may experience loss of lochia for up to 8 weeks
How long does it take for the new endometrial lining to develop?
- Starts after 10 days
- Complete after 6 weeks
- Develops from the basal layer
What should be felt on palpation?
- The fundus should be located centrally at same level/ slightly below umbilicus
- Should feel firm
- If uterus is not going down there may be something left inside or woman has full bladder
How much does the uterus weigh?
- 60g pre-pregnancy
- 900-1000g at term
What are the 3 types of lochia?
1. Lochia rubra (red)
2. Lochia serosa (pink)
3. Lochia alba (cream/white)
Describe lochia rubra
- Contains fresh blood from placental site and decidua
- This is discharged from the uterus up to 3-4 days
- Shouldn't be too heavy or contain too much blood
- BF women may get bigger gush of blood due to uterus contracting faster
- Less lochia for women who had CS
Describe lochia serosa
- Contains less fresh blood as placental site starts to heal
- Brownish/pink colour
- Contains WBC, necrotic decidua and mucus
- This is discharged up to 10-14 days
- Characteristic sweetish odour
Describe lochia alba
- Discharged up to 4-8 weeks
- Contains few RBC and is mostly serous fluid, WBC and mucus
What happens on day 7 with reference to lochia?
- Fibrin mesh that has formed over the placental site may be shed about day 7 as part of the healing process
- Lochia may become heavier and fresh blood stained
What is the average range of days that lochia is lost for?
How does the cervix change in the puerperium?
- After labour, the cervix has little tone but this rapidly increases during the first week and reduces in size
- The cervix never returns to its pre-pregnant shape - sometimes referred to as a multiple os
How does the vagina change in the puerperium?
- The increased vascularity of the vagina decreases by day 3 after delivery and any oedema is quickly resolved
- There is reduced tone after delivery but this quickly increases and the rugae of the vagina are evident after 3 weeks
How do hormones change in the puerperium?
- Oestrogen and progesterone levels decrease after placenta delivery
- Prolactin levels increase
- Oxytocin production
- FSH and LH eventually produces and ovulation begins again
- Hormonal changes affect woman's wellbeing (baby blues)
What is oxytocin production stimulated by?
- Let down reflex (suckling)
- Cuddling baby
- This affects uterine contraction and involution
How does the urinary tract change in the puerperium?
- Marked diuresis in first 48 hrs after birth due to decreased oestrogen levels which reduces plasma vol. of blood to pre-pregnant levels
- Possible water retention in first 48 hrs due to reduced progesterone which unbalances aldosterone levels
- Dilation of urinary tract and kidneys occurs in pregnancy due to progesterone; this resolves within 21 days
How does the cardiovascular system change in the puerperium?
- Blood vol. reduces rapidly and will reach pre-pregnant volume by 6-9 weeks
- Haemodilution effect decreased
- Cardiac output increases initially and then reduces and maternal pulse drops
- Coagulability remains high initially during puerperium so women are at risk of VTE
Why does cardiac output increase initially?
Uterus is no longer compressing the vena cava and the uteroplacental blood flow returns to the venous system
Why does coagulability remain high initially?
How does the respiratory system change in the puerperium?
- Full ventilation of the lungs can now occur as the gravid uterus is no longer compressing the lungs
- Tidal volume and respiratory rate return to pre-pregnant rates within 1-3 weeks after delivery
How does the musculoskeletal system change in the puerperium?
- The effects of relaxin and progesterone and progesterone can take up to 12 weeks to reduce fully
- Separated recti muscles, depending on severity, make take a few weeks to heal
- 1cm = fine
- 2cm = advise not to do abdominal exercise until this has reduced
- 3cm = refer to physiotherapist
How does the gastrointestinal system change in the puerperium?
- Due to reduced progesterone levels, there will be improvement in gastric emptying and motility
- Bowel movements return after 2-3 days
What are the signs of infection in the mother?
- Feeling unwell
- Has a temperature
- Strong, unpleasant smell
How may the uterus change if there is an infection?
- Sub-involution = uterus feels wide and boggy, meaning its poorly contracted
- Fundus may deviate to one size and not get smaller
- Woman may experiences tenderness on palpation
- Blood loss fresher and heavier and may be foul smelling
- May pass clots
What are the signs of wound infection?
- Inflammation and tenderness around the wound
- Slow healing or gaping at the skin edges
- Pain felt deeper in the wound area
- Clear/ purulent exudate (pus)