lOMoARc PSD|1209 6575
OB Final SG - Postpartum Mom
Concepts Of Maternal-Child Nursing And Families (Nova South-eastern University)
lOMoARc PSD|12 096575
,Postpartum Adaption and Nursing Assessment - KNOW!
- During the puerperium, or postpartum period, the woman readjusts, physically and
psychologically, from pregnancy and birth. The period begins immediately after birth
and continues for approx. 6 weeks, or until the body has returned to a near pre-
pregnant state.
- It is divided into three phases:
o Immediate Postpartum: the 24-hour
period immediately following
delivery. Most important a lot of
complications can happen. Watch for
hemorrhage and uterine atony.
o Early Postpartum or puerperium:
up to 7 days.
o Remote postpartum or puerperium:
up to 6 weeks.
Postpartum Physical
Adaptations Reproductive
System
Involution of the Uterus
- The term involution is used to describe the rapid reduction in size and the return of
the uterus to a non-pregnant state. AT: Uterus should be midline and firm and go to the
back of the pubic bone. Use of Pitocin to keep the uterus contracting (close vessels back up
from the detachment of the placenta). If the uterus is boggy – MASSAGE IT for a couple
of mins! Can lead to hemorrhage. The uterus can feel boggy due a to a full bladder
because it pushes on the uterus and relaxes it. Figure out why it’s boggy? Is it that the
bladder is full? Bedpan or catheterize. Other reasons can be clots that have been pooling
inside while woman is lying down.
o First 6-12 hrs. midline and firm at the umbilicus
o Every 24 hrs. it shrinks a little and it should be 1 cm below. Ex. Delivered at 6 am by
10
am it’s going to be by the umbilicus. At 6 am the next day it should be 1 cm
below. o By the 10th day you cant feel it because its behind the bone
- Following separation of the placenta, the decidua of the uterus is irregular, jagged, and
varied in thickness.
lOMoARc PSD|12 096575
, - The spongy layer of the decidua is cast off as lochia, and the basal layer of the decidua
remains in the uterus to become differentiated into two layers. This occurs within the first
48 to 72 hours after birth. The outermost layer becomes necrotic and is sloughed off in the
lochia.
- Exfoliation is an important aspect of involution; if healing of the placental site leaves a
fibrous scar, the area available for future implantation is limited, as is the number of
possible pregnancies.
- With the dramatic decrease in the levels of circulating estrogen and progesterone
following placental separation, the uterine cells atrophy, and the hyperplasia of
pregnancy begins to reverse.
- Factors that enhance involution include: (takes 5-6 weeks)
o An uncomplicated labor and birth, complete expulsion of the placenta or membranes,
breast-feeding, manual removal of the placenta during C-section, and early
ambulation
- Factors that retard uterine involution include:
o Prolonged labor, anesthesia (makes it boggy), difficult birth, grand multi-parity, full
bladder, incomplete expulsion of placenta or membranes, infection, over distention
of uterus
- Time frame for an immediate uterine involution process is lengthened =
subinvolution (slowing of descent)
Changes in Fundal Position: Know where it should be
- The Fundus (top portion of the uterus) is midline midway between the symphysis pubis and
the umbilicus. Immediately following the birth of the placenta, the uterus contracts to the
size a large grape fruit.
- Within 6 to 12 hours’ after birth, the fundus of the uterus rises to the level of the
umbilicus because of blood and clots that remain within the uterus and changes in support
of the uterus by the ligaments.
o Afterbirth the top of the fundus remains at the level of the umbilicus for about
half a day.
o On the first postpartum day, the top of the fundus is located about 1 cm below
the umbilicus.
o The top of the fundus drops approximately one finger range, or 1 cm, per
day until it descends into the pelvis on about the 10th day
- A fundus that is above the umbilicus and boggy (feels soft and spongy rather than firm and
well contracted) is associated with excessive uterine bleeding. As blood collects and forms
, clots
2
lOMoARcPSD|12 096 575
within the uterus, the fundus rises; firm contractions of the uterus are interrupted causing a
boggy uterus = uterine atony
o Fundal massage performed until fundus contracts, fundal massage is painful.
Maintain therapeutic communication while massaging. If bleeding persists, HCP
may order IV oxytocin. IV fluids may be required as well as blood transfusions and
they all depend on the H&H and coagulation studies. Surgical interventions may be
required if bleeding does not stop. Manual compressions (Putting pressure on the
uterus internally). Uterine balloon tamponade is a successful technique to stop
bleeding.
- When the fundus is higher than expected on palpation and is not in the midline
(usually deviated to the right), distension of the bladder should be
suspected KNOW! The bladder should be emptied immediately and
the uterus re-measured. If the woman is unable to avoid, in and out
catheterization of the bladder may be required.
- If the mother is breastfeeding, the release of endogenous oxytocin
from the posterior pituitary in response to suckling hastens involutionof the uterus. Barring
complications, such as infection or retained placental fragments, the uterus approaches its
pre-pregnant size and location by 5 to 6 weeks. In women who has an oversized uterus
(because of hydramnios, birth of a LGA, or multiple gestation) process is lengthened. If
intrauterine infection is present, in addition to foul smelling lochia or vaginal discharge, the
uterine fundus descends more slowly. Any slowing in descend is called subinvolution
(failure of the uterus to return to a non-pregnant state. Common causes-retained placental
fragments and infection). Uterus is relaxed and not contracting properly. Over 10 days
there’s still bleeding.
Lochia
- The uterus rids itself of the debris remaining afterbirth through a discharged called
lochia (Discharge of RBCs, WBCs)
- It’s classified according to its appearance
and contents.
o Lochia RUBRA is dark red. It occurs for
the first 2 to 3 days and contains
OB Final SG - Postpartum Mom
Concepts Of Maternal-Child Nursing And Families (Nova South-eastern University)
lOMoARc PSD|12 096575
,Postpartum Adaption and Nursing Assessment - KNOW!
- During the puerperium, or postpartum period, the woman readjusts, physically and
psychologically, from pregnancy and birth. The period begins immediately after birth
and continues for approx. 6 weeks, or until the body has returned to a near pre-
pregnant state.
- It is divided into three phases:
o Immediate Postpartum: the 24-hour
period immediately following
delivery. Most important a lot of
complications can happen. Watch for
hemorrhage and uterine atony.
o Early Postpartum or puerperium:
up to 7 days.
o Remote postpartum or puerperium:
up to 6 weeks.
Postpartum Physical
Adaptations Reproductive
System
Involution of the Uterus
- The term involution is used to describe the rapid reduction in size and the return of
the uterus to a non-pregnant state. AT: Uterus should be midline and firm and go to the
back of the pubic bone. Use of Pitocin to keep the uterus contracting (close vessels back up
from the detachment of the placenta). If the uterus is boggy – MASSAGE IT for a couple
of mins! Can lead to hemorrhage. The uterus can feel boggy due a to a full bladder
because it pushes on the uterus and relaxes it. Figure out why it’s boggy? Is it that the
bladder is full? Bedpan or catheterize. Other reasons can be clots that have been pooling
inside while woman is lying down.
o First 6-12 hrs. midline and firm at the umbilicus
o Every 24 hrs. it shrinks a little and it should be 1 cm below. Ex. Delivered at 6 am by
10
am it’s going to be by the umbilicus. At 6 am the next day it should be 1 cm
below. o By the 10th day you cant feel it because its behind the bone
- Following separation of the placenta, the decidua of the uterus is irregular, jagged, and
varied in thickness.
lOMoARc PSD|12 096575
, - The spongy layer of the decidua is cast off as lochia, and the basal layer of the decidua
remains in the uterus to become differentiated into two layers. This occurs within the first
48 to 72 hours after birth. The outermost layer becomes necrotic and is sloughed off in the
lochia.
- Exfoliation is an important aspect of involution; if healing of the placental site leaves a
fibrous scar, the area available for future implantation is limited, as is the number of
possible pregnancies.
- With the dramatic decrease in the levels of circulating estrogen and progesterone
following placental separation, the uterine cells atrophy, and the hyperplasia of
pregnancy begins to reverse.
- Factors that enhance involution include: (takes 5-6 weeks)
o An uncomplicated labor and birth, complete expulsion of the placenta or membranes,
breast-feeding, manual removal of the placenta during C-section, and early
ambulation
- Factors that retard uterine involution include:
o Prolonged labor, anesthesia (makes it boggy), difficult birth, grand multi-parity, full
bladder, incomplete expulsion of placenta or membranes, infection, over distention
of uterus
- Time frame for an immediate uterine involution process is lengthened =
subinvolution (slowing of descent)
Changes in Fundal Position: Know where it should be
- The Fundus (top portion of the uterus) is midline midway between the symphysis pubis and
the umbilicus. Immediately following the birth of the placenta, the uterus contracts to the
size a large grape fruit.
- Within 6 to 12 hours’ after birth, the fundus of the uterus rises to the level of the
umbilicus because of blood and clots that remain within the uterus and changes in support
of the uterus by the ligaments.
o Afterbirth the top of the fundus remains at the level of the umbilicus for about
half a day.
o On the first postpartum day, the top of the fundus is located about 1 cm below
the umbilicus.
o The top of the fundus drops approximately one finger range, or 1 cm, per
day until it descends into the pelvis on about the 10th day
- A fundus that is above the umbilicus and boggy (feels soft and spongy rather than firm and
well contracted) is associated with excessive uterine bleeding. As blood collects and forms
, clots
2
lOMoARcPSD|12 096 575
within the uterus, the fundus rises; firm contractions of the uterus are interrupted causing a
boggy uterus = uterine atony
o Fundal massage performed until fundus contracts, fundal massage is painful.
Maintain therapeutic communication while massaging. If bleeding persists, HCP
may order IV oxytocin. IV fluids may be required as well as blood transfusions and
they all depend on the H&H and coagulation studies. Surgical interventions may be
required if bleeding does not stop. Manual compressions (Putting pressure on the
uterus internally). Uterine balloon tamponade is a successful technique to stop
bleeding.
- When the fundus is higher than expected on palpation and is not in the midline
(usually deviated to the right), distension of the bladder should be
suspected KNOW! The bladder should be emptied immediately and
the uterus re-measured. If the woman is unable to avoid, in and out
catheterization of the bladder may be required.
- If the mother is breastfeeding, the release of endogenous oxytocin
from the posterior pituitary in response to suckling hastens involutionof the uterus. Barring
complications, such as infection or retained placental fragments, the uterus approaches its
pre-pregnant size and location by 5 to 6 weeks. In women who has an oversized uterus
(because of hydramnios, birth of a LGA, or multiple gestation) process is lengthened. If
intrauterine infection is present, in addition to foul smelling lochia or vaginal discharge, the
uterine fundus descends more slowly. Any slowing in descend is called subinvolution
(failure of the uterus to return to a non-pregnant state. Common causes-retained placental
fragments and infection). Uterus is relaxed and not contracting properly. Over 10 days
there’s still bleeding.
Lochia
- The uterus rids itself of the debris remaining afterbirth through a discharged called
lochia (Discharge of RBCs, WBCs)
- It’s classified according to its appearance
and contents.
o Lochia RUBRA is dark red. It occurs for
the first 2 to 3 days and contains
