Postpartum

Question 1

What causes uterine involution?

Answer 1

Decrease in myometrium cell size

Question 2

Within 24 hrs uterus is about the size it was at ___ wks

Answer 2

20, at the umbilicus

Question 3

Involution causes the fundus to descend into the pelvis at about ___ cm/day

Answer 3

1

Question 4

After the placenta separates blood vessels in the _______ become occluded to prevent hemorrhage

Answer 4

Endometrium

Then superficial layers become necrotic and slough off

Question 5

Endometrial tissue regenerates by ___ wks except at the placental site

Answer 5

2-3

Question 6

The placenta site is about ___ cm following delivery and about ___ cm by 2-3wks

Answer 6

8-10

3-4

Question 7

Describe lochia rubra

Answer 7

Day 1-3
Red
Bloody
Clots

Question 8

Describe lochia serosa

Answer 8

Day 3-10
Pink
Bloody
Mucousy

Question 9

Describe lochia alba

Answer 9

Day 10-14 or longer
Yellowish-white
Mostly mucousy

Question 10

What is happening when a woman notices an inc in vaginal bleeding between pp day 7-14?

Answer 10

Normal
Superficial layers of placenta site slough off
Should only last 1-2 hours

Question 11

Describe scant, light, moderate, and heavy bleeding in inches

Answer 11

Scant:

Question 12

How much/how long does the cervix stay dilated?

Answer 12

2-3cm for first few days, ~1cm until end of first week

Question 13

What can estrogen released from lactation do to the appearance of the vagina?

Answer 13

Delay formation of rugae (normally reappears in about 3wks)

Appears pale

Question 14

What is the acronym used to assess the perineum?

Answer 14

REEDA
redness
Edema
Ecchymosis
Drainage
Approximation

Question 15

Following delivery adrenal glands decrease production of ___

Answer 15

Aldosterone

This leads to dec sodium retention and inc urine output

Question 16

Renal and ureteral dilation resolve by ___wks

Answer 16

8

Question 17

Glycosuria disappears by end of ___

Answer 17

First week

Question 18

BUN increases to ~___mg/dl by end of first week

Answer 18

20

Question 19

GFR renal blood flow and plasma creatinine return to normal by ___ wks

Answer 19

Six

Question 20

How much urine can you remove at one time with a straight cath?

Answer 20

800 (to avoid hypotension)

Question 21

After delivery of the placenta mom gets an auto transfusion of _____ml causing stroke volume to ___ and heart rate to ___

Answer 21

750-1000
Increase
Decrease

Question 22

Does hct inc or dec after delivery?

Answer 22

Increases due to large reduction in plasma volume

Question 23

Blood volume returns to baseline by ___weeks after delivery

Answer 23

1-2

Question 24

WBC’s inc after delivery to ___

Answer 24

14-16k

Question 25

Cardiac output begins to decrease ___ minutes after delivery

Answer 25

15 Prelabor levels one hour after labor Prepregnancy levels by 2-3 wks

Question 26

What helps the respiratory system to quickly return to prepregnant status after birth?

Answer 26

Sudden drop in progesterone Emptying of uterus allows lung volume and tidal volume to normalize Compensatory respiratory alkalosis gone in two days

Question 27

GI motility is reduced after birth. What do we do for this?

Answer 27

Encourage ambulation PO fluids Stool softeners BM by 2-3 days, normal pattern by 2 wks

Question 28

Liver enzymes normalize by ___ wks

Answer 28

3

Question 29

Joint stability normalizes by ___ wks

Answer 29

6-8

Question 30

Diastasis recti (separation of abdominal wall is usually resolved by ___ wks

Answer 30

6

Question 31

How many additional kcals/day do lactating women need?

Answer 31

500-1000

Question 32

hCG is undetectable by ___, hPL is undetectable by ___

Answer 32

End of first wk, 24 hours

Question 33

Estrogen levels ___ | Prolactin levels ___

Answer 33

Drop | Rise

Question 34

What is the acronym to remember for a postpartum assessment?

Answer 34

``` BUBBLES breasts Uterus Bowel Bladder Lochia Epis/lac pSychosicial ```

Question 35

Baby blues usually lasts about ___ wks

Answer 35

3

Question 36

What is endometritis/what are the symptoms?

Answer 36

Infection of uterus | Fever, inc abd pain, malaise, uterine tenderness, malodorous lochia

Question 37

What is normal blood loss with a vaginal delivery? Csection?

Answer 37

500 | 1000

Question 38

Early pp hemorrhage is one that happens in first ___ hours and can be caused by_______

Answer 38

First 24 hours ``` Atony Lacerations Retained products Accretas Rupture Inversion Coagulopathy ```

Question 39

Late pp hemorrhage happens ____ and can be caused by _______

Answer 39

Between 24hrs-6wks pp Infection Retained products Subinvolution Coagulopathy

Question 40

What are surgical interventions for a pp hemorrhage?

Answer 40

Uterine artery embolization Uterine artery ligation Uterine compression sutures Hysterectomy

Question 41

Most changes that occurred during pregnancy resolve by ___ wks. This postpartum period is also called ___

Answer 41

6-8 Puerperium

Question 42

What are the three phases of maternal role attachment?

Answer 42

Taking in: first 48 hrs, dependent, relive birth experience, separates self from newborn Taking hold: day 3-several weeks, active, desire to do infant care without help Letting go: reconnects with others, inc confidence

Question 43

What hormones are responsible for milk production and delivery?

Answer 43

Pituitary hormones: Galactopoietic hormone- prolactin Galactokinesis hormone- oxytocin

Question 44

What is colostrum?

Answer 44

More protein and lactose Less fat Immunoglobulins and antibodies There before milk comes in on day 2-5

Question 45

How does lactation keep ovulation at bay?

Answer 45

Prolactin levels suppress lutinizing hormone

Question 46

What is recommended for engorgement?

Answer 46

Mild analgesic Ice pack Frequent breastfeeding

Question 47

What is mastitis?

Answer 47

Infection of breast Usually unilateral Fever, chills, malaise, tender, hard, red, swollen Continue to nurse Antibiotics

Question 48

What are maternal warning signs ?

Answer 48

``` Temp >100 Severe cramps with abd pain, chills/fever Heavy bleeding/large clots Foul discharge Inc tenderness, redness, drainage, separation of stitches Pain, burning, difficulty urinating Red streaks/pain in calves ```

Question 49

What are newborn warning signs?

Answer 49

``` Fever >100.4 60 Jaundice Bleeding from circ Foul discharge from umbilical cord Feeding problems ```