Flashcards in Postpartum Anatomy & Physiology Deck (38):
uterus position immediately PP
at level of umbilicus
uterus 1-2h PP
b/w umbilicus and symphysis pubis
uterus 12h PP
1cm above umbilicus
uterus 24h PP
1cm below umbilicus
uterus 3 days PP
3cm below umbilicus
uterus 7 days PP
uterus 14 days PP
How does involution occur?
myometrial cell autolysis - decrease in size, not number
What occurs to the endometrium PP?
Days 2-3: decidua basalis divides into 2 layers
1) superficial: protects from infection; later sloughs
2) basal: stays together to create new endometrium
Week 1: new epithelium
Weeks 2-3: regrows like pre-pregnancy
Week 6: vessels that were part of placenta exfoliated and sloughed --> endometrium remodeling
Describe lochia PP
rubra: ~3 days
serosa: ~ 7-10 days
eschar bleeding: ~7-14 days PP for a few hours
alba: up to 4wks
Describe vaginal changes PP
3-4w: vaginal rugae returns
6-10w: vaginal epithelium healed
labia minora no longer hide introitus
+/- decreased vaginal tone
What are the 3 phases of [perineal] healing?
1) hemostasis and inflammation
2) granulation and proliferation
Why are pts w/ HTN, PEC, or CVD at increased risk of pulmonary edema/cardiac failure in the first 24-48h PP?
- immediate auto-transfusion of blood volume
- shifting of extracellular fluid into intravascular system
- stroke volume and cardiac output increase by 80%
What occurs to cardiac output PP?
INCREASES d/t increased blood flow from:
- loss of uteroplacental circulation
- decreased pressure from pregnant uterus
- mobilization of extracellular fluid
How much does cardiac out put change PP?
- increases during first 48h PP
- slowly returns to normal by 6-12w
When does plasma volume return to pre-pregnancy values?
When does blood volume normalize?
What is transient anemia?
decreased H/H from hemodilution and blood loss in birth immediately PP and for 1w after
When does transient anemia resolve?
When should pts expect to have their first BM PP?
2-3 days PP; normal GI function and bowel patters return 1-2w PP
What is diastasis recti?
separation of rectus abdominus muscles
- resolves in weeks
- can vary in severity
Why is there decreased peristalsis in early puerperium?
- decreased progesterone --> increased motility BUT takes time
- decreased bowel and abdominal wall tone
Why may pts be constipated PP?
- perineal pain
- narcotics in labor
- restriction of fluids/food during labor
- iron supps
- decreased activity
Why is SOB/chest pain significant PP?
dyspnea should resolve almost immediately - SOB may indicate thromboembolic event
What are 3 reasons for urine retention PP?
1) decreased bladder tone
2) decreased bladder sensation
3) increase in diuresis
How are oxytocin and water related?
oxytocin promotes water reabsorption - decrease in oxytocin --> diuresis
When do oxytocin levels decrease?
not breastfeeding: 7-14 days
What is the effect of estrogen on the thyroid?
decreased estrogen PP --> decreased thyroid-binding globulin --> decreased T3, T4 --> return to pre-pregnancy levels
*at risk for:
- Grave's disease
- PP thyroiditis
- thyroid storm
When do FSH and LH levels return?
4-6w in nonlactating people
Describe lactogenesis I
end 1st tri to 2nd half of pregnancy
- milk duct system growing
- secretion initiation
- may see leaking at 16-18w GA
Describe lactogenesis II
- secretory activation
- plasma progesterone drops suddenly w/ expulsion of placenta
- lactocytes secrete lactose --> increase in milk production
- milk synthesis PLUS milk ejection
What does suckling stimulate?
1) prolactin secreted from anterior pituitary --> milk secretion
2) oxytocin secreted from posterior pituitary --> milk ejection
Describe lactogenesis III
galactopoiesis = established lactation; continued milk production
What are the functions of breastmilk components?
- stimulates infant GI
- cell-mediated immunity for infant
Describe lactogenesis IV
cessation of breastfeeding and involution of mammary glands
Which hormones does lactation effect?
1) GnRH (suppressed by prolactin -->)
2) suppressed LH --> suppressed ovulation
When does menstruation return?