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Maternity exam 3 (Postpartum & risks)
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Maternity exam 3 (Postpartum & risks) Maternity exam 3 (Postpartum & risks) Maternity exam 3 (Postpartum & risks)
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Maternity exam 3 (Postpartum & risks)Maternal Adaptation During the Postpartum Period - •"4th Trimester of Pregnancy"
•Puerperium -6 to 12 weeks after birth
•Immediate = first 24 hours
•Early postpartum = 1st week
•Late postpartum= 2nd to 12 weeks
•Reproductive system organs gradually return to the nonpregnant size and function in the process of
involution
Maternal Adaptation During the Postpartum Period- uterus - •Contraction and involution: contracts
inward, seals off open blood vessels at the former site of the placenta
•Monitor fundal height, descends approximately one fingerbreadth per day until below pubic bone,
usually day 10 to 14 postpartum
•Clotting cascade also initiated to help control bleeding
•If the uterus DOES NOT contract effectively , it will lead to hemorrhage
Maternal Adaptation During the Postpartum Period- involution - •Involution is the process through
which the uterus, cervix, and vagina return to nonpregnant size and function
•Fundus should be 1cm below umbilicus 1 day after delivery & should descend 1 cm per day until
descended below level of pubic bone and can no longer be palpated; usually by 10th-14th day
Maternal Adaptation During the Postpartum Period—: Promoting involution - •Breastfeeding
simulates oxytocin release from posterior pituitary gland
•Can give Oxytocin via IM or IV route
•Early ambulation
•Adequate diet and fluids
Maternal Adaptation During the Postpartum Period—Inhibiting involution - •Various factors can
inhibit or delay uterine involution
•Grand multiparity = 5 or more pregnancies
•Boggy uterus -
•Check bladder, massage fundus
,•Midline, below umbilicus
•Afterpains: happens because uterus is contacting and relaxing in intervals
•can be quite severe;
•More in multiparity
•may require medication - ibuprofen, Tylenol
•Breastfeeding causes the release of oxytocin and increases the duration and intensity of afterpains
•Primipara: uterus remains contracted and afterpains are less severe
Boggy uterus means??? - a uterus that is NOT contracted; feels soft and spongy rather than firm and
contracted
Maternal Adaptation During the Postpartum Period— Lochia - •Lochia - uterine discharge composed
of blood, mucus, tissue, and WBC
•The uterus MUST shed its lining that was in place during pregnancy
•Lochia may persist for the entire 6 weeks after delivery but usually subsides by the end of the 2nd
and third week
•Lochia should never contain large clots
•Abnormal findings : reversal of pattern ( going from serosa back to rubra)
•Fails to decrease in amount or increases vs gradually decreasing
lochia types - •Lochia rubra -
•days 1 - 4
•Small -moderate amount
•mostly blood, dark red, fleshy odor
•Lochia serosa
•days 4 - 10
•Small amount
•brownish/pink color
•Lochia alba -
•after day 10
•Small amount, white or pale yellow, mostly WBC
•If malodorous or smells rotten, report immediately, indication of infection
, Maternal Adaptation During the Postpartum Period—ovaries - •Ovulation can occur 3 weeks after
delivery
•Menstrual periods may begin within 6 to 8 weeks if not breastfeeding
•Lactating woman may not resume menses for 18 months
•Requires strict adherence to Q 2-3 hr feeding schedule (or breast stimulation/pumping at same
frequency)
•Educate concerning birth control methods
•Ovulation may begin before menstrual bleeding
•Use another form of birth control besides lactation
Maternal Adaptation During the Postpartum Period—cervix - •Cervix goes through trauma during
labor
•After delivery, cervix is still partially open and contains small soft tears
•Appears bruised
•Internal os closes after a few days
•Muscle cells regenerate and cervix recovers by end of 6 week purperium
•External os appears slit-like vs dimple-like ( nulliparous woman)
Maternal Adaptation During the Postpartum Period—Vagina and perineum - •Vagina may have small
tears and be smooth
•Rugae returns after 3 weeks
•Introitus gradually returns to pregravid state
•Encourage Kegel exercises to restore muscle tone
•Labia and perineum may be edematous or bruised
•Episiotomy should be approximated, takes several weeks to heal completely
•Low estrogen levels during breast-feeding leads to vaginal dryness and dyspareunia
•Labia and perineum may be edematous after delivery & appear bruised (especially a difficult
delivery) ; becomes flaccid after childbirth
Maternal Adaptation During the Postpartum Period—Breasts - •Colostrum: antibody-rich breast
secretion precursor to breast milk normally excreted in the first few post-partum days
•Prolactin levels rise when estrogen and progesterone levels fall after delivery of placenta
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