Postpartum Anatomy & Physiology Flashcards Preview

NURS787 Exam 3 > Postpartum Anatomy & Physiology > Flashcards

Flashcards in Postpartum Anatomy & Physiology Deck (38):
1

uterus position immediately PP

at level of umbilicus

2

uterus 1-2h PP

b/w umbilicus and symphysis pubis

3

uterus 12h PP

1cm above umbilicus

4

uterus 24h PP

1cm below umbilicus

5

uterus 3 days PP

3cm below umbilicus

6

uterus 7 days PP

at symphysis

7

uterus 14 days PP

non-palpable

8

How does involution occur?

myometrial cell autolysis - decrease in size, not number

9

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

10

Describe lochia PP

rubra: ~3 days

serosa: ~ 7-10 days

eschar bleeding: ~7-14 days PP for a few hours

alba: up to 4wks

11

Describe vaginal changes PP

3-4w: vaginal rugae returns

6-10w: vaginal epithelium healed

labia minora no longer hide introitus

+/- decreased vaginal tone

12

What are the 3 phases of [perineal] healing?

1) hemostasis and inflammation
2) granulation and proliferation
3) remodeling

13

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%

14

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

15

How much does cardiac out put change PP?

- increases during first 48h PP
- slowly returns to normal by 6-12w

16

When does plasma volume return to pre-pregnancy values?

2w

17

When does blood volume normalize?

2w

18

What is transient anemia?

decreased H/H from hemodilution and blood loss in birth immediately PP and for 1w after

19

When does transient anemia resolve?

4-6w PP

20

When should pts expect to have their first BM PP?

2-3 days PP; normal GI function and bowel patters return 1-2w PP

21

What is diastasis recti?

separation of rectus abdominus muscles
- resolves in weeks
- can vary in severity

22

Why is there decreased peristalsis in early puerperium?

- decreased progesterone --> increased motility BUT takes time
- decreased bowel and abdominal wall tone

23

Why may pts be constipated PP?

- fear
- perineal pain
- narcotics in labor
- c/s
- dehydrationj
- restriction of fluids/food during labor
- iron supps
- decreased activity

24

Why is SOB/chest pain significant PP?

dyspnea should resolve almost immediately - SOB may indicate thromboembolic event

25

What are 3 reasons for urine retention PP?

1) decreased bladder tone
2) decreased bladder sensation
3) increase in diuresis

26

How are oxytocin and water related?

oxytocin promotes water reabsorption - decrease in oxytocin --> diuresis

27

When do oxytocin levels decrease?

not breastfeeding: 7-14 days

28

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

29

When do FSH and LH levels return?

4-6w in nonlactating people

30

Describe lactogenesis I

end 1st tri to 2nd half of pregnancy

- milk duct system growing
- secretion initiation
- may see leaking at 16-18w GA

31

Describe lactogenesis II

30-72h PP

- secretory activation
- plasma progesterone drops suddenly w/ expulsion of placenta
- lactocytes secrete lactose --> increase in milk production
- milk synthesis PLUS milk ejection

32

What does suckling stimulate?

1) prolactin secreted from anterior pituitary --> milk secretion
2) oxytocin secreted from posterior pituitary --> milk ejection

33

Describe lactogenesis III

galactopoiesis = established lactation; continued milk production

34

What are the functions of breastmilk components?

- bacteriostatic
- anti-inflammatory
- immune-modulation
- stimulates infant GI
- pinocytosis
- chemotaxis
- cell-mediated immunity for infant

35

Describe lactogenesis IV

cessation of breastfeeding and involution of mammary glands

36

Which hormones does lactation effect?

1) GnRH (suppressed by prolactin -->)
2) suppressed LH --> suppressed ovulation
3) FSH

37

When does menstruation return?

non-lactating: 12w

lactating: ~38mo

38

What is lactational amennorhea?

"nonfertile" ovulation