PP-NORMAL Flashcards
Postpartum
Postpartum period, also called the puerperium, last from delivery to placenta until - weeks
6-12 weeks
What pregnancy changes remain present for months to years?
Pelvic musculature and cardiac remodeling
The pregnant uterus at term–excluding stuff inside–weighs about 1000g, 10-20x heavier than the nonpregnant uterus. Involution back into the pelvis usually occurs around week __ and usually back to it’s size by week ___
Week 2: back into pelvis
Week 6: normal size
By day __, the endometrium is fully restored via regeneration
16 (2.5wks)
How is hemostasis accomplished right after birth?
Arterial smooth muscle contraction and compression of vessels by the involuting uterus.
A sudden but transient increase in bleeding occurs between day _ and _
& should be evaluated if lasts longer than _ and __ hours
7-14 days
1-2 hours.
Describe phases of lochia
Lochia rubra–flow of blood last several hours, then rapidly diminishes to a reddish brown d/c through day 3-4.
Lochia serosa: mucopurulent, somewhat malodorous d/c that lasts on avg 22-27days (with bleeding from healing placenta location occurring around day 7-14.)
Lochia alba: yellow-white d/c occurs afterward.
T or F: Breastfeeding and use of COCs affect lochia
False;
BF may just help decrease amount of bleeding immediately PP
Mgmt plan for abnormal uterine bleeding in the PP period
ultrasound; uterine evacuation and curettage
Meds: Pit, Cytotec, Methergine, Hemabate, Dinoprostone, TXA
Labs: CBC w/diff, coags
Give: extra IV fluids, O2, 2nd IV line for possible transfusion
Cont. to monitor VS
Determine cause: 4 T’s- Tone, Tissue, Trauma, Thrombin
Mean-time to ovulation in the breastfeeding and nonlactating mothers?
Lactating: 6 mons
Nonlactating: Day 70-75 (week 9), earliest being 27 d after delivery
Thyroid panel should be drawn at week _, month__, and month __ in women who have thyroid disease
6 wks
3 months
6 months
TSH should be 0.4-5mU/L
Hyperthyroidism is best treated with…
1st: beta blockers
2nd: Methimazole and propylthiouracil, which are SAFE during BF
Hypothyroidism is best treated with…
thyroid supplementation: synthroid
Plasma volume decreases by about _____cc after delivery secondary to blood loss, and by the third day PP, is replenished by fluid shift.
1000cc
By __ weeks, red cell mass has rebounded and hematocrit is usually normal
8wks
Due to cardiac remodeling, this remains higher than prepregnancy values 1 year after delivery
Cardiac output
When are PP women most likely to clot?
Greatest level of coagulability: immediately after delivery, up to 48 hours after
up to 6 wks PP
By week __, dilation and tone of ureters and renal pelvis decrease back to prepregnancy state
6
What is telogen effluvium
Period of diffused, rapid hair turnover, up to 3 mons, returns to normal within a few months
When does bone loss usually resolve by?
& what can you do to prevent it?
12-18 mons PP
aerobic exercises in the PP period
Management/tx for constipation & to prevent straining?
Stool softeners (colace), high fiber diet, fluid intake, laxatives, suppositories (avoid if 3rd/4th degree lac), limit opioid use if possible.
Treatment for hemorrhoids
Witch hazel compresses, hydrocortisone suppository, corticosteroids, stool softeners, cold/warm sitz baths or compresses, anesthetics
When does BP return to baseline after delivery
Usually within 24 hrs-4 days
T or F: A low-grade fever is not normal in the PP period
False, can have low-grade fever 1-3 days PP
