OBYGYN NURSING EXAM #3 STUDY GUIDE
Postpartum Care (Chapters 20, 21, 22)
Physiologic Changes (by body system, including labs)
Uterus
• Involution
The uterus returns to its nonpregnant size due to declining estrogen and progesterone. This
process begins immediately after placental delivery as uterine muscle fibers contract.
o Fundus descends approximately 1–2 cm daily
o Not palpable abdominally by 2 weeks
o Returns to normal size by 6 weeks
o Size progression:
▪ 24 hours: similar to 20-week gestation size
▪ 1 week: ~500 g
▪ 2 weeks: ~300 g
▪ 4 weeks: ~100 g (nonpregnant size)
o Reduction occurs through autolysis, where excess hypertrophied cells self-destruct
• Subinvolution
Delayed return to normal size, often caused by retained placental fragments or infection
• Postpartum contractions
Uterine contractions compress blood vessels to control bleeding (primary mechanism of
hemostasis—not clotting)
• Oxytocin
o Enhances strength and coordination of contractions
o More discomfort in multiparous women
o Endogenous: released from posterior pituitary; stimulated by breastfeeding
o Exogenous: given IV/IM (e.g., Pitocin) for hemorrhage prevention
• Afterpains
o Common with subsequent births
o Last 3–7 days
o Increased with breastfeeding and oxytocin use
• Placental site healing
o Involves vasoconstriction, thrombosis, and shedding of necrotic tissue
o No scar formation, allowing future implantation
o Healed by ~6 weeks
• Endometrium
o Fully restored by 3 weeks postpartum
• Lochia (postpartum discharge)
o Reflects uterine healing
o Initially similar to heavy menses, then decreases
o Less after cesarean birth
o Increases with activity and breastfeeding
o Pools in vagina when lying down → gush upon standing (normal)
o Foul odor suggests infection
Types:
o Lochia rubra (Days 1–3): bright red; blood, decidua, mucus
▪ Persistent rubra → possible retained tissue
o Lochia serosa (Days 4–10): pink-brown; blood, mucus, leukocytes
▪ Persistent beyond 3–4 weeks → possible endometritis
o Lochia alba (after Day 10): yellow-white; mucus, leukocytes
,Cervix
• Soft, edematous, possibly bruised immediately after birth
• Returns to form within 2–3 days
• Dilated ~1 cm at 1 week
• External os becomes slit-like after vaginal birth (permanent change)
• Lactation may reduce cervical mucus → vaginal dryness
Pelvic Muscles
• May take up to 6 months to regain tone
• Kegel exercises promote strength and healing
• Risk of long-term pelvic relaxation increases with age
Ovaries
• Nonlactating women
o Ovulation may occur as early as 27 days
o Average: 7–9 weeks
o Menses usually resume by 12 weeks
• Lactating women
o Ovulation suppressed due to prolactin
o May be delayed ~6 months
o Unpredictable → contraception education is essential
• First menstrual cycle is often heavier; normalizes within 3–4 cycles
Vagina
• Estrogen deficiency leads to dryness, thinning, and decreased elasticity
• Rugae return by 3 weeks but may remain flattened
• Full healing of lacerations: 4–6 months (initial healing in 2–3 weeks)
• Dyspareunia may persist until hormones normalize
• Hemorrhoids common
Breasts
• Hormonal drop triggers lactation
• Colostrum: early milk, rich in antibodies and nutrients
• Foremilk: low fat, hydrates infant
• Hindmilk: high fat, supports growth
• Mature milk appears by 3–4 days
• Engorgement: occurs at 72–96 hours; temporary (24–48 hrs)
• Nonbreastfeeding women: lactation stops within ~1 week
Cardiovascular
• Blood volume increased 40–45% during pregnancy
• Diuresis reduces volume postpartum
• Cardiac output rises 60–80% immediately after birth
• Returns to baseline by 6–8 weeks
Assessment findings:
• Bradycardia (50–60 bpm) common
• Increasing pulse → possible hemorrhage
• Temporary BP increase; hypotension may indicate blood loss
• Respirations normalize quickly
• Mild fever first 24 hours is normal; persistent fever suggests infection
• WBC up to 30,000 (normal postpartum)
• Increased clotting factors → higher VTE risk
Endocrine
• Estrogen and progesterone drop after placenta delivery
• Prolactin increases → milk production
• Oxytocin → milk ejection (not production)
, • hCG present up to 3–4 weeks
• Thyroid normalizes by 3 months
• Insulin needs decrease postpartum
Urinary
• Diuresis: up to 3 L/day for 2–3 days
• Ureters return to normal by ~6 weeks
• Risk for UTI remains elevated
• Decreased urge to void due to trauma/anesthesia
• Full bladder → uterine atony and bleeding risk
• Bladder tone returns in 5–7 days
Gastrointestinal
• Increased appetite (especially if breastfeeding)
• Bowel movement typically within 2–3 days
• Delays due to decreased motility, dehydration, opioids
• Severe perineal lacerations → risk of incontinence
Skin
• Melasma may persist temporarily
• Linea nigra and areola darkening may remain
• Striae fade but do not disappear
• Hair shedding common first 3 months
Musculoskeletal
• Abdominal tone returns by ~6 weeks
• Diastasis recti resolves gradually
• Joint stability returns by 6–8 weeks
• Back pain improves within weeks
• Foot size increase may be permanent
Neurologic/Immune
• Headaches common (rule out serious causes)
• Carpal tunnel improves with fluid loss
• Autoimmune conditions may flare postpartum
NURSING ASSESSMENT (POSTPARTUM)
• Focus on recovery, complication prevention, education, and bonding
• Family-centered care (rooming-in model)
• Early discharge common (1–2 days vaginal birth)
Key assessments:
• Breasts, fundus, lochia, perineum, bladder, bowel, extremities
Postpartum Hemorrhage Prevention
• Most common cause: uterine atony
• Key interventions:
o Assess fundal tone
o Monitor lochia
o Prevent bladder distention
• Warning signs:
o Saturated pad in ≤15 minutes
o Pooling blood
Vital Signs
• Temp: <100.4°F (after 24 hrs → infection concern)
• Pulse: 50–90 bpm
• RR: 16–20
• BP: slight increase normal
Postpartum Care (Chapters 20, 21, 22)
Physiologic Changes (by body system, including labs)
Uterus
• Involution
The uterus returns to its nonpregnant size due to declining estrogen and progesterone. This
process begins immediately after placental delivery as uterine muscle fibers contract.
o Fundus descends approximately 1–2 cm daily
o Not palpable abdominally by 2 weeks
o Returns to normal size by 6 weeks
o Size progression:
▪ 24 hours: similar to 20-week gestation size
▪ 1 week: ~500 g
▪ 2 weeks: ~300 g
▪ 4 weeks: ~100 g (nonpregnant size)
o Reduction occurs through autolysis, where excess hypertrophied cells self-destruct
• Subinvolution
Delayed return to normal size, often caused by retained placental fragments or infection
• Postpartum contractions
Uterine contractions compress blood vessels to control bleeding (primary mechanism of
hemostasis—not clotting)
• Oxytocin
o Enhances strength and coordination of contractions
o More discomfort in multiparous women
o Endogenous: released from posterior pituitary; stimulated by breastfeeding
o Exogenous: given IV/IM (e.g., Pitocin) for hemorrhage prevention
• Afterpains
o Common with subsequent births
o Last 3–7 days
o Increased with breastfeeding and oxytocin use
• Placental site healing
o Involves vasoconstriction, thrombosis, and shedding of necrotic tissue
o No scar formation, allowing future implantation
o Healed by ~6 weeks
• Endometrium
o Fully restored by 3 weeks postpartum
• Lochia (postpartum discharge)
o Reflects uterine healing
o Initially similar to heavy menses, then decreases
o Less after cesarean birth
o Increases with activity and breastfeeding
o Pools in vagina when lying down → gush upon standing (normal)
o Foul odor suggests infection
Types:
o Lochia rubra (Days 1–3): bright red; blood, decidua, mucus
▪ Persistent rubra → possible retained tissue
o Lochia serosa (Days 4–10): pink-brown; blood, mucus, leukocytes
▪ Persistent beyond 3–4 weeks → possible endometritis
o Lochia alba (after Day 10): yellow-white; mucus, leukocytes
,Cervix
• Soft, edematous, possibly bruised immediately after birth
• Returns to form within 2–3 days
• Dilated ~1 cm at 1 week
• External os becomes slit-like after vaginal birth (permanent change)
• Lactation may reduce cervical mucus → vaginal dryness
Pelvic Muscles
• May take up to 6 months to regain tone
• Kegel exercises promote strength and healing
• Risk of long-term pelvic relaxation increases with age
Ovaries
• Nonlactating women
o Ovulation may occur as early as 27 days
o Average: 7–9 weeks
o Menses usually resume by 12 weeks
• Lactating women
o Ovulation suppressed due to prolactin
o May be delayed ~6 months
o Unpredictable → contraception education is essential
• First menstrual cycle is often heavier; normalizes within 3–4 cycles
Vagina
• Estrogen deficiency leads to dryness, thinning, and decreased elasticity
• Rugae return by 3 weeks but may remain flattened
• Full healing of lacerations: 4–6 months (initial healing in 2–3 weeks)
• Dyspareunia may persist until hormones normalize
• Hemorrhoids common
Breasts
• Hormonal drop triggers lactation
• Colostrum: early milk, rich in antibodies and nutrients
• Foremilk: low fat, hydrates infant
• Hindmilk: high fat, supports growth
• Mature milk appears by 3–4 days
• Engorgement: occurs at 72–96 hours; temporary (24–48 hrs)
• Nonbreastfeeding women: lactation stops within ~1 week
Cardiovascular
• Blood volume increased 40–45% during pregnancy
• Diuresis reduces volume postpartum
• Cardiac output rises 60–80% immediately after birth
• Returns to baseline by 6–8 weeks
Assessment findings:
• Bradycardia (50–60 bpm) common
• Increasing pulse → possible hemorrhage
• Temporary BP increase; hypotension may indicate blood loss
• Respirations normalize quickly
• Mild fever first 24 hours is normal; persistent fever suggests infection
• WBC up to 30,000 (normal postpartum)
• Increased clotting factors → higher VTE risk
Endocrine
• Estrogen and progesterone drop after placenta delivery
• Prolactin increases → milk production
• Oxytocin → milk ejection (not production)
, • hCG present up to 3–4 weeks
• Thyroid normalizes by 3 months
• Insulin needs decrease postpartum
Urinary
• Diuresis: up to 3 L/day for 2–3 days
• Ureters return to normal by ~6 weeks
• Risk for UTI remains elevated
• Decreased urge to void due to trauma/anesthesia
• Full bladder → uterine atony and bleeding risk
• Bladder tone returns in 5–7 days
Gastrointestinal
• Increased appetite (especially if breastfeeding)
• Bowel movement typically within 2–3 days
• Delays due to decreased motility, dehydration, opioids
• Severe perineal lacerations → risk of incontinence
Skin
• Melasma may persist temporarily
• Linea nigra and areola darkening may remain
• Striae fade but do not disappear
• Hair shedding common first 3 months
Musculoskeletal
• Abdominal tone returns by ~6 weeks
• Diastasis recti resolves gradually
• Joint stability returns by 6–8 weeks
• Back pain improves within weeks
• Foot size increase may be permanent
Neurologic/Immune
• Headaches common (rule out serious causes)
• Carpal tunnel improves with fluid loss
• Autoimmune conditions may flare postpartum
NURSING ASSESSMENT (POSTPARTUM)
• Focus on recovery, complication prevention, education, and bonding
• Family-centered care (rooming-in model)
• Early discharge common (1–2 days vaginal birth)
Key assessments:
• Breasts, fundus, lochia, perineum, bladder, bowel, extremities
Postpartum Hemorrhage Prevention
• Most common cause: uterine atony
• Key interventions:
o Assess fundal tone
o Monitor lochia
o Prevent bladder distention
• Warning signs:
o Saturated pad in ≤15 minutes
o Pooling blood
Vital Signs
• Temp: <100.4°F (after 24 hrs → infection concern)
• Pulse: 50–90 bpm
• RR: 16–20
• BP: slight increase normal
