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Maternity Exam 2

Terms in this set (49)

Involution - the process of the uterus moving back in to the true pelvis
the process of the uterus moving back in to the true pelvis
Uterus
may rise above the umbilicus by 1cm within the first 12 hours
With in _________should be at umbilicus (the level of a 20 week gestation)
24 hrs
Uterine involution should occur at a rate of
1-2 cm per day and at 2 weeks postpartum should not be felt externally
Gradual closing of
cervical os
Ovulation within
1 to 6 months
Healing of perineum within
4 to 6 months
Contractions
YES- THEY CONTINUE-UGH!
After delivery patients are given _____________ to help the uterus contract
Pitocin
These contractions help to constrict
the maternal vessels at the placental site to help control bleeding
Breastfeeding
stimulates release of oxytocin to contract uterus
Primips
have less pain with this as the uterus has only been stretched once
Multips
will have more pain -WHY??
Pain control with
Ibuprofen
Placental site healing begins
as soon as expulsion of the placenta
Vasoconstriction and thromboses will
reduce placental size to small elevated nodular areas
By postpartum day 16
endometrial regeneration except for the placental site is complete and ready for another implantation
Education very, very important
Must teach mom:
1. How to use peri-bottle
2. How to use Tucks
3. How to use Dermaplast spray
4. Stress importance of all of the above.
Infected lacerations are extremely painful
The muscles that supports the uterus and the bladder may
be injured during delivery.
May take 6 months to heal completely
May require 6 weeks to
return to pre-pregnant state
Separation of the recti abdominis is
normal, requirement of surgical repair is very rare but sometimes necessary
Vast hormonal changes occur after delivery
1. Estrogen, cortisol, placental enzyme insulinase reverse the diabetogenic effects of pregnancy which means mom will need less insulin (If type I diabetic)
2. Estrogen and progesterone
levels drop markedly and reach rock bottom at 1 week PP which is the main cause of breast engorgement (HESI!)
3.Diuresis -
release extracellular water that is accumulated during pregnancy
Prolactin blood levels
rise progressively throughout pregnancy - In those patients who decide to breast feed they remain high
First ovulation after delivery varies:
1. Ovulation can occur as early as day 27 PP.
2. Non lactating women have a mean time of about 10 weeks,
3. Breastfeeding women have a mean time of about 6 months.

This is NOT A FORM OF BIRTH CONTROL
You must educate your moms that breastfeeding
is not a form of birth control and if she does not want to get pregnant right away then she needs to choose a method of birth control. The 6 month marker is an estimate every woman is different and they have different starts times with ovulation.
Within 12 hours of delivery women begin to lose excess tissue fluid.
Caused by
decreased estrogen levels and removal of increased venous pressure in the lower extremities
Blood loss with normal delivery
also aids in removal of extra fluid
Due to anesthesia and birth trauma to the urethra the woman may experience
a decreased need to void - so encouraging her to urinate often is important.
A full bladder will tend to cause
more bleeding by displacing the uterus and pushing it up blocking blood flow, the bladder will need to be kept empty
Bowel evacuation may not occur for 2 - 3 days PP due to many reasons:
1. decreased muscle tone in intestines during labor
2. pre labor diarrhea
3. lack of food
4. dehydration
5. fear of pain
C-section moms really must be watched due to the increased risk of
illeus
Rectal sphincter tear
-may experience some incontinence
Colostrum is a clear/yellow fluid.
Milk comes in at around
72 - 96 hours
If engorgement occurs
encourage frequent breast feeding-or pump.
Mastitis-
inflammation of duct/ducts, continue to breast feed.
Mastitis
Infection of the breast
Almost always unilateral
Develops well after milk flow has been established
Painful, localized tenderness
Encourage breastfeeding
Breastfeeding will be painful
Non-breastfeeding mothers
Prolactin levels drop rapidly
Colostrum will be present for the first few days
Breast tenderness may be present
Engorgement may occur on day 3 or 4 PP-congeston of vasculature of breast.
S/S of engorgement
tenderness, warm, firm, swollen.
Avoid ANY nipple stimulation
Treatment for Engorgement
mild pain relievers, breast binders, supportive bra, ice packs, frozen cabbage leaves
Engorgement is caused by
congestion in the vasculature of the breast tissue.
To treat engorgement
ibuprofen/Tylenol can be given be sure to use breast binders and supportive bras, ice packs - frozen peas work well for this task and frozen cabbage leaves are great there is a chemical in the cabbage leaf that decreases swelling therefore reducing pain.
Avoid any nipple stimulation
- this activates the release of prolactin and causes milk production patients should be urged to stand in the shower with their back to the water and not allow the hot water to run in the front of them.
Lactation will ceases within a few days to a week
Cardiac output -
remains increased- related to the movement of extra vascular fluid that backs into systemic circulation and the loss of uteroplacental circulation after delivery (HESI!)
Maternal VS return to pre-pregnant state
2 days PP
Respiratory function will return to pre-pregnant function in
6 - 8 weeks
Blood volume decreases
based on the amount of blood loss during delivery
The 1000 - 1500cc fluid gain during pregnancy is eliminated
in the first 2 weeks PP
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