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Summary OB 101 - Final Exam Study Guide.
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OB 101 - Final Exam Study Guide/OB 101 - Final Exam Study Guide.
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Postpartum Adaptions, Needs and CarePostpartum
The postpartum or the puerperium period is the period of time
following the delivery of the child and placenta during which the body
tissues, especially the reproductive system reverts back to the pre-
pregnant state, both anatomically and physiologically
o Time after woman has baby
o Body reverts back to prepregnancy state
o Takes about 6 weeks*****
Puerperium
The puerperium or the postpartum period lasts for 6 weeks.
o Assessment needed:
Fundal height, lochia, history of woman to look at
complications that may arise
Frequent vital signs because even though there were no
complications during pregnancy and her labor she could
have complications during this period
Immediately do frequent VS
It is divided into three phases:
o Immediate Postpartum: the 24-hour period immediately
following delivery.
o Early Postpartum or puerperium: up to 7 days.
Education is key
o Remote postpartum or puerperium: up to 6 weeks.
Postpartal Physical Adaptions
Reproductive System
o Involution of the uterus-rapid reduction in size of the uterus to a
nonpregnant state following birth.
Occurs within 48 to 72 hours after birth*****
, See that it is contract
Know it is contract if it is hard that is the only thing that
will tell us it is contracted
If it does not contact it feels boggy
It should contract in a hard mass
It should start going down; should be hard and midline
o Following delivery of the placenta the uterus contracts into a
hard mass; the size of a grapefruit
Uterus
o At delivery fundus (top portion of the uterus) is at the umbilicus;
as large as a grapefruit
o Once the woman delivers it goes down and rises up after
o 1-2 hours: midway between umbilicus and symphysis pubis
o 12 hours: 1 cm above or at umbilicus
36-37 weeks Fundus under breast once baby born fundus
goes down rises above umbilicus and then it starts going
down
At 24 hrs fundus at umbilicus *****
Checking to see if fundus midline firm and it is not
deviated to right to left
If it deviated to right or left thinking bladder
If bladder is full deviate to right or left
o After that the height of the uterine fundus decreases (involutes)
by approximately 1 cm per day. (one fingerbreadth a day)
On first day postpartum day the top of the fundus is
located about 1 cm below the umbilicus
o Should remain firm at all times
o Boggy-soft;
A fundus above the umbilicus and boggy is associated with
excessive uterine bleeding
Want to massage fundus to make it firm
If its not contracting then next intervene is Pitocin
, Assess amount of bleeding; assess lochia because if she is
not contract that means she is bleeding
IF she is bleeding she might be lightheaded dizzy and BP
low
Go to pt room in the morning she says she’s dizzy then it
might alert that something is wrong; BP if low next check
her baseline
Still need to assess the uterus and pad
o Blood and clots formation
o Failure of uterus to contract
o If off to the side; suspect full bladder
Fundus higher than expected on palpation
Bladder should be emptied immediately and the uterus
remeasured
If woman unable to void may catherize
o Subinvolution is the failure of the uterus to return to a
nonpregnant state
o Common causes- retained placental fragments and infection
o If woman deliver today at 10 it is delivery day until tomorrow at
10 and then at 10 it will be first postpartum day
o If woman fundus is firm and she is contracted and she is
bleeding it could lacerations; she will have a spurt of continuous
bleeding
Should not be HUGE bleeding; woman is going to have
lochia (assess amount of lochia)
o Intrauterine infection present with foul-smelling lochia or vag
discharge, tachycardia, fever
Lochia
o Assess amount and color
o Uterine debris after birth
o Rubra- 1-3 days – dark red, bloody, fleshy, musty, stale non-
offensive odor; clots
, SHOULD NOT CONTAIN LARGE CLOTS
o Serosa- 4-10 days – pinkish, watery, odorless
o Alba-11-21 days; yellow to white, possible stale odor
o Average volume of lochia 225 ml
o Educate pt and more than likely in the rubra when she is home
serosa and then alba
o Can her lochia if there is complication revert back to rubra yes it
can
o She can go home in her 4-10 and having rubra lochia again see
HCP because that is a problem
o A huge amount hemorrhage
o How would we determine if woman hemorrhaging or not?
Pads saturated within that hour; weigh a dry pad first and
weigh saturated and subtract
Some woman bleed on the bed and on the chuck if MD
need exact amount in mililiters
IF she wants to know how many sat in an hour assess that
Any woman that is bleeding heavy they can be dizzy and
fall
Go to room at 8 o’clock woman pad is saturated; ask her
when was the last time she changed her pad
Been in bed since midnight and is 8
Can’t say hemorrhaging because its been 8 hrs since she
changed her pad; clean her document it and need to start
from scratch and see what she is to compare
Cervical changes
o Cervical changes: soft, irregular, edematous
o Bruised-looking with multiple small lacerations
o Closes to 2 -3 cm after few days
o Admits fingertip after one week
o Permanent change to os after 1st delivery to slit-like
Vaginal changes
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