how often should the uterus be assessed postpartum
- 1hr: q15mins
- 2 hrs: q30 mins
- next 22hrs: q4hrs
what should be done before assessing the fundus
instruct the pt to void first
how should the lower uterine segment be supported during fundal assessment
place one hand just above the pubic symphysis to prevent uterine inversion
what is uterine involution
return of the uterus to its nonpregnant state after birth
how long does uterine involution take
around 6-8 wks
what are afterpains, and who experiences it more
- mod to severe cramps caused by UCs
- more common in multiparous women
why do afterpains occur
uterus contracts to remain firm and prevent hemorrhage
what interventions help relieve afterpains
- encourage frequent voiding
- warm compress
- ibuprofen/acetaminophen
where is the uterien fundus immediately after birth
midway between the umbilicus and pubic symphysis
where should the fundus be within 12 hrs postpartum
level of umbilicus or 1cm above
how much does the uterus descend each day postpartum
~ 1cm each day
when is the uterus no longer palpable
by day 14, as it descends into the pelvis
when does the cervix regain its prepregnancy form
after 2-3 days, but doesn’t return to its original shape, appears like a jagged slit “fish mouth”
how does lactation affect the cervix
hormonal changes leads to thinner vaginal mucosa and reduces lubrication
what is the purpose of lochia
- expel remaining tissue, bacteria
- shedding prevents scarring
- indicates stage of healing
what are the 3 types of lochia and their timeframes
- lochia rubra (1-3D): red, small clots
- lochia serosa (4-10D): pink/brown, serosanguineous
- lochia alba (11-21D): creamy yellow
what are abnormal findings with lochia
- foul odor
- heavy bleeding
- large clots
what does REEDA stand for in perineal assessment
R: redness
E: edema
E: ecchymosis
D: discharge
A: approximation of edges
how long do perineal lacerations/episiotomies take to heal
~ 6 wks
interventions for perineal pain & healing
- first 2 days: ice packs, cold sitz baths
- after 1st day: warm sitz baths
- lie on side to reduce pressure
- wear peripads snugly to prevent rubbing
- topical anesthetics
how can postpartum mothers prevent perineal infections
- use peri-bottle with warm water after elimination
- change peripads frequently
- wash hands when doing pericare
when do vaginal folds (rugae) begin to reappear postpartum
~ 3 wks but are less prominent
how does estrogen deprivation effect the vagina postpartum
- thinner vaginal mucosa
- temporary loss of rugae
leading to vaginal dryness and discomfort (dysparenunia)
when does vaginal lubrication improve postpartum
once ovarian function returns (menstruation), the vaginal mucosa will thicken
