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Postpartum Period

Terms in this set (38)

Postpartum period
The interval between birth and returm of reproductive organs to their nonpregnant state.
-Fourth stage of Labor
-Lasts 6 weeks, but varies among women
Bubble H
Breat
Uterus
Bladder/ Bowel
Lochia/ Legs
Episiotomy and perineum
Hematoma/ hemorrhage
(emotional status)
Uterus
Involution process is the return of the uterus to a nonpregnant state follwing birth.
-Progresses rapidly
Fundus descends 1-2 cm every 24 hours
2 weeks after childbirth the uterus is no longer palpable
Returns to a nonpregnant state by 6 weeks
-Subinvolution is the failure of the uterus to return to nonpregnant state
Contractions
Postpartum hemostasis acheived by compression of intramyometrial blood vessels as uterine muscle contracts
-Hormone oxytocin, released from pituitary gland, strengthens anc coordiates UC
"After Pain"--Very strong
Lochia
Postibirth uterine discharge
Lochia rubra: blood and decidual and trophoblastic debris
-duration of 3-4 days
Lochia serosa: old blodd, serum, leukocytes, and debris
-duration of 22-27 days
Lochia alba: leukocytes, decidua, epithelial cells, mucus, serum. and bateria
-contnues 2-6 weeks after birth
*Teach women not to use tampons during this time
Cervix
Soft immediately after birth
-Druring the next 12-18 hours the cervix shortens, becomes firm, and regains preoregnant form
-External os regains ite pregnancy appearance
-Cervical os, dilated to 10 cm durig labor, closes gradually
Vagina and perineum
Postpartum estrogen deprivation responsible for thinness of vaginal mucosa and absence of rugae
-Vaginal rugae reappear within 3 weeks
-Thickening of vaginal mucosa occurs with return of ovarian function
-Dryness and coital discomfort, dysparenunia, may persist until return of ovarin function
-Introitus is erythematous and edematous
-Episiotomies heal with in 2-3 weeks
-Hemorrhoids are common and decrease within 6 weeks of childbirth
Pelvic muscular suupport
Supportive tissue of pelvic floor torn or stretched during childbirth
-Require up to 6 months to regain tone
-Kegel exercises encourage healing
Abdomen
-During first 2 weeks abdominal wall remains relaxed
-Woman had still-pregnant appearance
-Return to prepregnancy state take 6 weeks (at this time they should be at their prepregnant weight)
-Depends on previous tone, proper exercise, and amount of adipose tissue
Placenta hormones
Expulsion of the placenta results in dramatic decrease of placental-produced hormones
-Decreases in hCS, estrogen, cortisol, and placental enzyme insulinase reverse effects of pregnancy
-Estrogen and progesterone levels drop markedly
Pituitary hormones and ovarian function
Lacating and nonlactating woman differ in timing of first ovulation and menstruation
-70% of nonbreastfeeding mothers menstruate within first 12 weeks
-In breastfeeding women, return of ovulation depends on breastfeeding pattern
-In nonlactating women, ovulation occurs as early as 27 days after birth
Urinary system
Witin 12 hours women being to diurese
-Profuse diaphoresis often occirs at night for first 2 to 3 days
Urethra and bladder: excessive bleeding can occur because of displacement of the uterus if bladder is full
-Because of hormone fluctuation the body holds into fluids during labor in case of hemorrhage
GI
Appetite: most new mother are very hungry after recovery from analgesia, anesthesia, and fatigue.
Bowel evacuation: spontaneous bowel evacuation may not occur for 2 to 3 days after childbirth (because of lacerations, give stimulant laxatives)
Breasts
Breastfeeding mothers: before lactation a yellowish fluid, colostrum, can be expressed from nipples. Breasts become fuller and heavier, estimate whem milk comes in (72-96 hours after birth)
Nonbreastfeeding mothers: engorgement resolves spontaneously, and discomfort decreased within 24-36 hours (cabbage leaves)
Blood Volume
Changes in blood volume depend on several factors:
-blood loss during childbirth
-amount of extravascular water mobilized and excreted
-pregnancy-induced hypervolemia allow most women to tolerate blood loss during childbirth
*Continue taking prenatal Vits. in postpartum period
**Varicosities=hereditary
Cardiac Output
Remains increased for 48 hours after birth
-Increased stroke volume is caused by the return of blood to the maternal systemic circulation
-Stroke volume, end-diastolic volume, and systemic vascular resistance remain elevated for 12 weeks after delivery
Neurologic System
Postpartum headaches may be caused by gestational hypertension, stess, and leakage of CSF into extrdural space during placement of spinal anesthesia
Musculoskeletal System
Joints are completely stabilized by 6-8 weeks after birth
-New mothers may notice permanent increase in shoe size
Integumentary System
-Chloasma usually disappears
-Hyperpigmentation of areolae and linea nigra may not regress completely after childbirth
-Stretch marks on breasts, abdomen, and thighs may fade but not disappear
-Vascular abnormalities, spider angiomas, palmar erythema, and epulis regress with rapid decline in estrogen
-Spider nevi persist indefinitely for some (broken blood vessels)
-Hair growth slow during the postpartum period
Immune System
Rebound of the immune system can cause "flare ups" of some conditions such as Lupus or MS
To provide optimum care for the postpartum woman, the nurse understands that the most commone cause of subinvolution are:
Retained placental fragments and infecton or urinary retention
Newborns' and Mothers' Health Protection Act of 1996
Allows for a minimum of 48 hours stay after a vaginal birth and 96 hours after C-section
Planning for Future Pregancies
Rubella Vaccine: if woman is not immune, vaccination is recommended
Varicella Vaccine
T-dap
Rh Isoimmunization: Rh immune globulin should be give within 72 hours for R-negative women who deliver an Rh-positive infant
Parenting
A process of role transition
-Requires cognitvie, affective, and motor skill
-Infant's well-being and development depends on these components
Parent-Infant Contact
-May facilitate attachement process
-Skin to skin immediately after birth
Extended contact
-Optimizes family-centered care
-Acheived through couplet care
-Family is encouraged to participate
Postpartum Blues
Emotionally labile and often cry for no apparent reason. This liability seems to peak arounf the 5th day and subside by the 10th day.
Other symptoms: depression, a let-down feeling, restlessness, fatigue, headache, anxiety, sadness, and anger.
These are normal and usually short lived.
Postpartum Hemorrhage
Leading cause of maternal death worldwide
-Traditionally defined as loss of more than:
500 ml of blood after vaginal birth
1000 ml after C-section
-Life threatening with little warning
Often unrecognized until profound symptoms
Etiology and risk factor of PPH
Uterine atony (#1 cause- retained placenta)
-marked hypotonia of uterus
Laceration of genital tract
Hematomas
Retained placenta: nonadherent retained placenta/ adherent retained placenta
Inversion of Uterus
Very rare, turning inside out of uterus
Potentially life threatening
1 in 3000 births
Subinvolution of Uterus
Last postpartum bleeding
Retained placental fragment and pelvic infection
Medical Management of PPH
Early recognition is critical
First step is evaluation of contractility of uterus
Firm massage of fundus (first thing you would do as the nurse)
Management is directed toward increasing contractility and mnimizing blood loss
If you can't get bleeding to stop= DIC or hysterectomy
Hemorrhagic (Hypovolemic) Shock
Fluid or blood replacement therapy
Legal tip: standard of care for bleeding emergencies allows for provisions to be made for nurses to initiate actions immediately
Coagulopathies
Idiopathic thrombocytopenic purpura (ITP): drop in platelet count
von Willebrand disease: type of hemophilia
DIC: consumptive coagulopathy, consumes large amounts of clotting factors, widespread external bleeding, internal bleeding, or both
Thromboembolic Disease
Results from blood clots caused by inflammation or partial obstruction of vessel: superficial venous thrombosis, deep venous thrombosis
Postpartum Infections
Puerperal sepsis: any infection of genital tract within 28 days after miscarriage, induced abortion, or birth
Most common infecting agents are numerous streptoccocal organisms
-endometritis, wound infections, UTI, Mastitis
Mastitis
An infection of the tissue of the breast that occurs most frequently during the time of breastfeeding. This infection causes pain, swelling, redness, and increased temperature of the breast. It can occur when bacteria, often from the baby's mouth, enter a milk duct through a crack in the nipple. This causes an infection and painful inflammation of the breast.
Sequelae of Childbirth Trauma
Disorders of uterus and vagina related to pelvic relaxation and urinary incontinence ; are often result of childbearing
Uterine displacement displacement and prolapse: posterior displacement, or retroversion, retroflexion and anteflexion, uterine prolapse a more serious displacement
Genital fistuals (perforations)
May result from anomaly, gynecologic surgery, obstretic trauma, cnacer, radiation therapy, gynecologic trauma, or infection
-Vesicovaginal: btw bladder and gential tract
-Urethrovaginal: btw urethra and vagina
-Rectovaginal: btw rectum or sigmoid colon and vagina
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