What is the duration of the postpartum period?
About 6 weeks
Define involution in the context of postpartum.
Return of the uterus to a non-pregnant state after birth
What is subinvolution?
Failure of the uterus to return to the non-pregnant state
Common causes include retained placental parts and infection.
What are the stages of lochia?
- Lochia rubra: Bright red lasting 1-4 days
- Lochia serosa: Pinkish brown lasting 3-10 days
- Lochia alba: Creamy white/light brown lasting 10-14 days (can last 3-6 weeks)
Lochia should have a fleshy smell; an offensive odor may indicate infection.
What are afterpains and how do they differ for first-time and subsequent mothers?
- Mild contractions for first-time moms
- More acute cramping for subsequent pregnancies
- More cramping when uterus has been over distended (multiples or large baby)
Breastfeeding and oxytocin stimulate contractions.
How does the cervix change postpartum?
- Internal os closes by 2 weeks
- external os widens and appears as a jagged slit
The external os never regains its pre-pregnancy appearance.
What happens to the vagina and perineum postpartum?
- Vagina decreases in size and regains tone over several weeks
- Perineum may have trauma, edema, and bruising
- Drop in estrogen causes thinness of vaginal mucosa, dryness = need for water soluble lubrication
Episiotomy or laceration healing may take 4-6 weeks.
What are the cardiovascular changes postpartum?
- Blood volume returns to normal within 4 weeks
- Average blood loss is 300-500mL for vaginal delivery; 500-1000mL for c/s
Cardiac output returns to prepregnant levels by 3 months postpartum.
What is the significance of vital signs in the postpartum period?
- Tachycardia may indicate dehydration, hypovolemia, or hemorrhage
- Decrease in BP may be normal but could suggest hemorrhage or infection
- Temp of 100.4 F in first 24 hours may be due to dehydration
What is the musculoskeletal adaptation postpartum?
Joints stabilize within 6-8 weeks postpartum
Some women may notice a permanent increase in shoe size.
What are the endocrine changes after delivery?
- Rapid clearance of placenta hormones
- Estrogen & progesterone drop quickly
- Prolactin levels increase with lactation
Ovulation can occur before menstruation in breastfeeding women.
What is the role of prolactin in lactation?
Triggers milk production in response to infant suckling
Prolactin levels remain elevated during lactation.
What is the milk ejection reflex?
Oxytocin is responsible for the let-down reflex
Nipple stimulation prompts the posterior pituitary to produce oxytocin.
What are the psychological adaptations during the postpartum period?
- Attachment
- Mood disorders
- Taking in phase
- Taking hold phase
- Letting go phase
Partner and sibling adaptation is also important.
True or false: It is important to discuss sexual activity with the patient and partner before discharge.
TRUE
Patients may resume sexual activity before the first postpartum visit.
What is recommended for pelvic floor muscle training?
Kegel Exercises
What interventions are necessary for perineum care after birth?
- Ice packs
- Witch Hazel
- Dermoplast spray (local anesthetic)
- Peri bottle to clean area (pat dry)
- Sitz bath after 24 hours
Why are mothers at higher risk for blood clots after birth?
- Clotting factors increase in pregnancy and remain elevated in postpartum
- Hypercoagulable state + Vessel damage during birth and immobility place mothers at high risk
What should be discussed at discharge for a postpartum patient?
- Immunizations: Rubella, Tdap, influenza
- Rh status - Rhogam
Education:
- Breastfeeding
- Carseat safety
- Sleep safety
- Self-care
- Peri-care (witch hazel, peri bottle, ice packs, pads, dermoplast, etc.)
When are assessments done on a postpartum patient after delivery?
Vital signs, physical, psychosocial
- 1st hour: every 15 minutes
- 2nd hour: every 30 minutes
- First 24 hours after: every 4 hours
- After 24 hours: every 8 hours
What does a low fever in the first 24 hours indicate?
Dehydration
After 24 hours fever could indicate infection
What heartrate in the postpartum patient requires attention?
> 100 bpm
What does the BUBBLE-EE mnemonic stand for?
B: Breasts
U: Uterus
B: Bladder
B: Bowels
L: Lochia
E: Episotomy/perineum/epidural site
E: Extremeties
E: Emotional status
Maternal postpartum assessments
What should be assessed with the postpartum patient’s breasts?
- How is baby latching on (watch feeding)
- Nipple status - erect, flat, inverted
- Redness, soreness, cracking?
- Engorgement?
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Ch. 13 Pre-Lecture Quiz10
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Ch. 14 Pre-Lecture Quiz10
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Ch. 15 Pre-Lecture Quiz10
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Ch. 16 Pre-Lecture Quiz10
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Ch. 22 Pre-Lecture Quiz10
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Ch. 17 Pre-Lecture Quiz10
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Ch. 18 Pre-Lecture Quiz10
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Intro to Maternity Nursing17
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Fetal Assessment during Labor27
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Group B Strep9
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Cord Prolapse7
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Nursing/Pain Management for the Laboring Client52
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Postpartum Hemorrhage14
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Postpartum Coping11
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Postpartum Nursing Management29
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Newborn Transitioning31
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Care of the Newborn44
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In Class Questions45
