Postpartum Complications(All correctly answered)
Postpartum Period correct answers - birth to return of reproductive organs to non-pregnant state
- 4th stage of labor is 1-2 hrs postpartum
- decrease in hormones following delivery of placenta prompts postpartum changes (less
estrogen and progesterone)
- lasts after birth to 6 weeks when they go back to non-pregnant state
Uterine Contractions correct answers - contractions of uterine muscle
- contractions do not end w/birth
- contractions compress myometrial vessels
- controls bleeding from placental site
- decreases size of uterus
- oxytocin strengthens contractions: exogenous (IV/IM), endogenous (occurs w/breastfeeding)
Uterine Involution correct answers - involution: uterus shrinking to original size
- height of the uterine fundus decreases by approx. 1 cm/day
- fundus is no longer palpable by 14 days
- ex: 3 days postpartum fundus would be approx. 3 cm below umbilicus
Fundal Assessment correct answers - assess fundal height: document in relation to umbilicus (1
cm, U/U)
- consistency (firm - hard, boggy - soft, atony - completely flaccid)
- position (midline, displaced)
- displaced uterus often d/t distended bladder
- support lower segment of uterus w/bottom hand while palpating fundus
- sometimes say finger breath instead of cm
- u/u means uterus at umbilicus (trying to move away from this and be more objective)
- after birth women have decreased urge to void or epidural (bladder fills w/o women being
aware)
Subinvolution correct answers - subinvolution: failure of uterus to return to non-pregnant state
- often d/t retained placenta or infection (fragments of placenta left in uterus)
- subinvolution can cause postpartum hemorrhage
- late postpartum hemorrhage usually
- prevent by provider examining placenta after to ensure nothing was left inside
Lochia correct answers changes in color
- lochia rubra: days 1-3
- lochia serosa: days 3-10
- lochia alba: after day 10
- like heavy menstrual period initially
, - flow may increase w/ambulation or breastfeeding
- constant trickle or oozing indicates excessive bleeding and requires immediate attention
- foul odor suggests infection
- blood, amniotic fluid, vernix, debris of pregnancy
- best way to measure is to weigh pads, can measure in cm/in
Lochia x2 correct answers - scant: <2.5 cm (1 in) stain
- light: 2.5-10 cm (1-4 in) stain
- moderate: 10-15 cm (4-6 in) stain
- heavy: saturated in 1 hr
Afterpains correct answers - more acute for multiparous women (uterus has to work harder the
second time)
- more severe w/overdistention of uterus (multi gestation fetus)
- intensity increases w/breastfeeding and oxytocin
- analgesics may be helpful prior to breastfeeding (ibuprofen - can take while breast feeding, not
really narcotics)
Postpartum Changes correct answers GI
- increased appetite and thirst
- constipation and gas
- nursing: encourage bowels, stool softeners, fiber, fluids
integumentary
- melasma, linea nigra (slowly fade)
- striae gravidarum (fade but don't go away)
Cardiovascular Changes correct answers - increased BV during pregnancy helps prevent possible
hypovolemic shock
- body rids itself of excess fluid
- decrease in plasma volume (ie: diuresis, diaphoresis - urine and sweat) results in a rise in Hct
and Hgb levels in several days
- leukocytosis common for 10-12 days after (WBC, even up to 30,000 w/o it being an infection)
- clotting factors elevated (body trying to compensate and stop bleeding, can cause clots)
Report and Chart Review correct answers - review prenatal record (allergies, gravida and para)
- report from labor nurse (vaginal, C-section, anesthesia)
- review L/D experience (how long it was)
- review labs (blood type (Rh factor), hep B, rubella, group B status)
- determine risk factors for complications
Postpartum Assessment correct answers - VS: q15 min 1st hr
- fundus: location and firmness
- lochia: amt. and color
- perineum: episiotomy, lacerations, hematoma
Postpartum Period correct answers - birth to return of reproductive organs to non-pregnant state
- 4th stage of labor is 1-2 hrs postpartum
- decrease in hormones following delivery of placenta prompts postpartum changes (less
estrogen and progesterone)
- lasts after birth to 6 weeks when they go back to non-pregnant state
Uterine Contractions correct answers - contractions of uterine muscle
- contractions do not end w/birth
- contractions compress myometrial vessels
- controls bleeding from placental site
- decreases size of uterus
- oxytocin strengthens contractions: exogenous (IV/IM), endogenous (occurs w/breastfeeding)
Uterine Involution correct answers - involution: uterus shrinking to original size
- height of the uterine fundus decreases by approx. 1 cm/day
- fundus is no longer palpable by 14 days
- ex: 3 days postpartum fundus would be approx. 3 cm below umbilicus
Fundal Assessment correct answers - assess fundal height: document in relation to umbilicus (1
cm, U/U)
- consistency (firm - hard, boggy - soft, atony - completely flaccid)
- position (midline, displaced)
- displaced uterus often d/t distended bladder
- support lower segment of uterus w/bottom hand while palpating fundus
- sometimes say finger breath instead of cm
- u/u means uterus at umbilicus (trying to move away from this and be more objective)
- after birth women have decreased urge to void or epidural (bladder fills w/o women being
aware)
Subinvolution correct answers - subinvolution: failure of uterus to return to non-pregnant state
- often d/t retained placenta or infection (fragments of placenta left in uterus)
- subinvolution can cause postpartum hemorrhage
- late postpartum hemorrhage usually
- prevent by provider examining placenta after to ensure nothing was left inside
Lochia correct answers changes in color
- lochia rubra: days 1-3
- lochia serosa: days 3-10
- lochia alba: after day 10
- like heavy menstrual period initially
, - flow may increase w/ambulation or breastfeeding
- constant trickle or oozing indicates excessive bleeding and requires immediate attention
- foul odor suggests infection
- blood, amniotic fluid, vernix, debris of pregnancy
- best way to measure is to weigh pads, can measure in cm/in
Lochia x2 correct answers - scant: <2.5 cm (1 in) stain
- light: 2.5-10 cm (1-4 in) stain
- moderate: 10-15 cm (4-6 in) stain
- heavy: saturated in 1 hr
Afterpains correct answers - more acute for multiparous women (uterus has to work harder the
second time)
- more severe w/overdistention of uterus (multi gestation fetus)
- intensity increases w/breastfeeding and oxytocin
- analgesics may be helpful prior to breastfeeding (ibuprofen - can take while breast feeding, not
really narcotics)
Postpartum Changes correct answers GI
- increased appetite and thirst
- constipation and gas
- nursing: encourage bowels, stool softeners, fiber, fluids
integumentary
- melasma, linea nigra (slowly fade)
- striae gravidarum (fade but don't go away)
Cardiovascular Changes correct answers - increased BV during pregnancy helps prevent possible
hypovolemic shock
- body rids itself of excess fluid
- decrease in plasma volume (ie: diuresis, diaphoresis - urine and sweat) results in a rise in Hct
and Hgb levels in several days
- leukocytosis common for 10-12 days after (WBC, even up to 30,000 w/o it being an infection)
- clotting factors elevated (body trying to compensate and stop bleeding, can cause clots)
Report and Chart Review correct answers - review prenatal record (allergies, gravida and para)
- report from labor nurse (vaginal, C-section, anesthesia)
- review L/D experience (how long it was)
- review labs (blood type (Rh factor), hep B, rubella, group B status)
- determine risk factors for complications
Postpartum Assessment correct answers - VS: q15 min 1st hr
- fundus: location and firmness
- lochia: amt. and color
- perineum: episiotomy, lacerations, hematoma
