Flashcards in post-partum (unit 2) Deck (110)
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1
uterus involution
•uterus returns to pre-pregnant size/shape
•causes sharp afterpains (ct.)
•lowers 1 cm/day
•by PP day 10, uterus within pelvis and non palpable
*WNL at 4-6 weeks pp
2
lochia-discharge
•Rubra- birth-PP 3
•Serosa- PP day 4-10
•Alba (yellow)- PP day 11-wk 6
3
Why might a patient
“gush” blood upon
standing up from a
supine position?
•blood may have pooled in the vaginal vault while the patient rested in a supine position
•also have some clots
•As long as the increased flow resolves and the patient’s uterus is firm and ML, she is ok
4
cervix PP
•immediately post SVD, wide enough for hand
•after 1 wk- pencil eraser
•external os from round to slit
•possible lacerations
5
vagina PP
•immediately post SVD- edematous w/ rugae
•after 6 wk- pre-preggo size
•atrophic until menses resumes
•lacerations possible
6
dyspareunia
•dryness and itching of vagina
•r/t declining estrogen levels b/c diminishes lubrication
•esp. common in BF b/c prolactin antagonizes estrogen
7
perineum PP
•edema/bruising
•lacerations (1-4 degree)
•episiotomy
•lacerations
8
1st degree perineal laceration
•extends thru skin/structures to superficial muscles
9
2nd degree perineal laceration
•extends thru muscles of perineal body
10
3rd degree perineal laceration
•extends thru anal sphincter muscle
11
4th degree perineal laceration
•involves anterior rectal wall
•rare
•require more intervention
12
perineum discomfort tx
•ice for first 48 hrs
•then sit baths bid
13
estimated blood loss (EBL)
•lose 500cc blood SVD
•lose 1000cc blood C/S
•also lose blood volume when diaphoresis/diuresis PP
*orthostatic hypotension common
14
what does declining estrogen levels PP cause
•no lubrication of vagina
•diaphoresis
15
why don't mom's go into hypovolumetric shock during delivery?
•blood flow to placenta diverted during delivery
•rapid reduction in uterine size
16
cardiac output PP
•elevation of pulse, SV, and CO for first hr
•gradual decrease to prepreggo
•brady common 1-2 days PP b/c dec. blood volume (trying to maintain CO)
•if tacky check for infection
•baseline by 8-10 wks
17
coagulation PP
•hypercoagulated in pregnancy and PP for 2-3 wks b/c have increased fibrinogen
**risk for DVT for up to 6 months
18
labs PP
•elevated WBC (25,000) for 2 wks
•H&H hard to assess and only addressed if hct <18 and symptomatic
-dizzy
-pallor
-weak
19
GI PP
•constipation
•BM incontinence if operative vaginal birth
•hunger
•thirst
*keep NPO until sounds, then clear liquids until flatus
20
why constipation PP
•inc. progesterone slows peristalsis
•long NPO
•painful BM from trauma
21
why hunger/thirst PP
•long NPO
•large energy expenditure
•early diuresis
22
urinary system PP
•excessive diuresis w/in 2 days (3000cc/day)
•r/o distended bladder d/t
-dec. tone
-trauma
-diuresis
-anesthesia (epidural -> retention)
*high risk for UTI/postpartum hemorrhage
23
musculoskeletal PP
•aches/pains/fatigue
•relaxin WNL w/in few days, but can cause early hip pain
•diastasis recti possible
24
musculoskeletal 6-8 wks PP
•joint return to normal
•feet permanently enlarged
•muscle tone restored b/c progesterone dec.
25
integumentary PP
•melanin dec. -> linea nigra, chloasma fade
•estrogen dec. -> palmar erythema, spider nevi fade
•striae gravidarum fade to silver (never go away)
26
endocrine PP
•menses w/in 4-6 wk (if not BF)
•ovulation before menses so BC crucial
•estrogen, progesterone, HPL, HCG decline
•prolactin decline at 3 wk if not BF
•resolution of GDM
27
why does prolactin delay menses/ovulation
•suppresses the release of LH and FSH
•still need BC
28
what causes lactation
•rapid falling levels of estrogen and progesterone
•increasing levels of prolactin
•increasing oxytocin (let down)
29
weight loss PP
•12 lbs at delivery
•8-9 lbs at 2 wks
•pre-preggo at 6 mo-yr
*BF slower loss of adipose tissue INITIALLY
30
