Exam 2 Review
Unit 4
Postpartum
Normal Postpartum vital signs
o Heart Rate – Slightly Altered
o Pulse Pressure - elevated for 1st hour aCer birth then returns to normal.
o Respiratory Rate – Normally lowered, returns to non pregnant levels – usually 6-8 weeks
o Blood Pressure – slightly altered
o Temp – Birth temp usually around 100.4 for the 1 st 24 hours then returns to normal aCer 24 hours
o HR/PP returns to nonpregnant levels within a few days
o Platelet should be 150-400 thousand
o White Blood count will be elevated.
o If Temp is less than 100.4 usually sign of dehydraRon and greater then 100.4 indicates infecRon.
Lochia – Can persist for up to 4-8 weeks postpartum
o Rubra – Red, postpartum 1-3 days (3-4 days), made up of blood, decidua and mucus
o Serosa – Pink to brownish, postpartum 3-10 days (22 – 27 days), made up of blood, mucus and invading
leukocytes
o Alba – White in color, postpartum 10-14 days, last 6 weeks, mucus and leukocytes
Postpartum hemorrhage – Elevated Hr/RR lowered temp, Blood pressure down – not an immediate response to
hemorrhage, body will try to compensate 1 st.
o Always check the bladder, if cannot void may need catheterizaRon.
Full bladder displaces uterus making inability to contract.
o Causes maybe subinvoluRon of uterus, lead to pelvic infecRon, then leads to retained placental
fragments.
Endometrial regeneraRon – 16 days postpartum except the placental site, placental site takes 6
weeks aCer birth.
o Uterus is about the size of grapefruit and at the level of umbilicus immediately following birth
Will start at level of umbilicus directly aCer birth and should be down in true pelvis by day 9 aCer
delivery.
o Message fundus – PRIORITY if it is boggy – Always stabilize bo_om of uterus in place (sensiRve pubis) if
you don’t could cause prolapsed uterus due to cervix sRll dilated.
o Water for saturaRng pad every hour of constant trickling of blood.
A pad or 2 every hour is too much.
Check under them for blood.
o Always turn and check for blood under bu_ocks
o Looses about 500ML in normal delivery and about 1000lm in c secRon.
, o InvoluRon
Turning inside out of uterus
PotenRally life threatening
1 in 2500 births
o SubinvoluRon
Late postpartum bleeding
Prolonged lochial discharge and irregular bleeding
o May use drugs to manage postpartum hemorrhage (Table pg-533)
Oxytocin
Misoprostol
Methergine (Known by another name Methylergonovine) – DO NOT GIVE IF BP greater than
140/90
15 Methyl prostaglandin (Contraindicated if pt at asthma – Carboprost
Atony – simply a lack of uterine muscle tone. When placenta peels oe the uterine wall the only thing that
stanches fow of blood is the clamping down of uterine muscle on open vessels. No contracRon means there can
be signigcant blood loss. %75 of all postpartum hemorrhage is caused by atony.
o Uterus will feel boggy – not contracRng as it should
o Most common cause of bleeding
o Occurs right aCer delivery
o May give oxytocin or methergine to cause uterine contracRon
o Also massage uterus to get it to contract.
LaceraRons – If there is steady fow of right red, unclo_ed blood (Trickling) but fundus of uterus remains grm, a
laceraRon is plausible.
o About %20 of early hemorrhage is due to laceraRons Also known as trauma.
Later postpartum hemorrhage - occurs most oCen 1-2 weeks aCer childbirth due to retained placental Rssue.
o (Usually aCer the mom goes home)
o Clues along the way include.
Lochia oCen fails to make normal progression from Rubra to serosa to alba.
If lochia is rubra for longer than 2 weeks is highly suspect.
Other clue is subinvoluRon – Uterus that fails to return to normal size aCer pregnancy.
Make sure to turn client to her side frequently and check the pad underneath. OCen blood can accumulate
under the client. Weigh peri pads to esRmate blood loss if a careful measurement is necessary.
Assess for signs of shock. Remain with the client, if uterus is boggy, massage it gently but grmly.
Diuresis and dehydraRon
o Common aCer delivery
o May have hyperhidrosis (Profuse sweaRng)
o May have fever but SHOULD NOT BE GREATER THAN 100.4f
Fever of 100.4 for greater than 24 hours could indicate infecRon
Unit 4
Postpartum
Normal Postpartum vital signs
o Heart Rate – Slightly Altered
o Pulse Pressure - elevated for 1st hour aCer birth then returns to normal.
o Respiratory Rate – Normally lowered, returns to non pregnant levels – usually 6-8 weeks
o Blood Pressure – slightly altered
o Temp – Birth temp usually around 100.4 for the 1 st 24 hours then returns to normal aCer 24 hours
o HR/PP returns to nonpregnant levels within a few days
o Platelet should be 150-400 thousand
o White Blood count will be elevated.
o If Temp is less than 100.4 usually sign of dehydraRon and greater then 100.4 indicates infecRon.
Lochia – Can persist for up to 4-8 weeks postpartum
o Rubra – Red, postpartum 1-3 days (3-4 days), made up of blood, decidua and mucus
o Serosa – Pink to brownish, postpartum 3-10 days (22 – 27 days), made up of blood, mucus and invading
leukocytes
o Alba – White in color, postpartum 10-14 days, last 6 weeks, mucus and leukocytes
Postpartum hemorrhage – Elevated Hr/RR lowered temp, Blood pressure down – not an immediate response to
hemorrhage, body will try to compensate 1 st.
o Always check the bladder, if cannot void may need catheterizaRon.
Full bladder displaces uterus making inability to contract.
o Causes maybe subinvoluRon of uterus, lead to pelvic infecRon, then leads to retained placental
fragments.
Endometrial regeneraRon – 16 days postpartum except the placental site, placental site takes 6
weeks aCer birth.
o Uterus is about the size of grapefruit and at the level of umbilicus immediately following birth
Will start at level of umbilicus directly aCer birth and should be down in true pelvis by day 9 aCer
delivery.
o Message fundus – PRIORITY if it is boggy – Always stabilize bo_om of uterus in place (sensiRve pubis) if
you don’t could cause prolapsed uterus due to cervix sRll dilated.
o Water for saturaRng pad every hour of constant trickling of blood.
A pad or 2 every hour is too much.
Check under them for blood.
o Always turn and check for blood under bu_ocks
o Looses about 500ML in normal delivery and about 1000lm in c secRon.
, o InvoluRon
Turning inside out of uterus
PotenRally life threatening
1 in 2500 births
o SubinvoluRon
Late postpartum bleeding
Prolonged lochial discharge and irregular bleeding
o May use drugs to manage postpartum hemorrhage (Table pg-533)
Oxytocin
Misoprostol
Methergine (Known by another name Methylergonovine) – DO NOT GIVE IF BP greater than
140/90
15 Methyl prostaglandin (Contraindicated if pt at asthma – Carboprost
Atony – simply a lack of uterine muscle tone. When placenta peels oe the uterine wall the only thing that
stanches fow of blood is the clamping down of uterine muscle on open vessels. No contracRon means there can
be signigcant blood loss. %75 of all postpartum hemorrhage is caused by atony.
o Uterus will feel boggy – not contracRng as it should
o Most common cause of bleeding
o Occurs right aCer delivery
o May give oxytocin or methergine to cause uterine contracRon
o Also massage uterus to get it to contract.
LaceraRons – If there is steady fow of right red, unclo_ed blood (Trickling) but fundus of uterus remains grm, a
laceraRon is plausible.
o About %20 of early hemorrhage is due to laceraRons Also known as trauma.
Later postpartum hemorrhage - occurs most oCen 1-2 weeks aCer childbirth due to retained placental Rssue.
o (Usually aCer the mom goes home)
o Clues along the way include.
Lochia oCen fails to make normal progression from Rubra to serosa to alba.
If lochia is rubra for longer than 2 weeks is highly suspect.
Other clue is subinvoluRon – Uterus that fails to return to normal size aCer pregnancy.
Make sure to turn client to her side frequently and check the pad underneath. OCen blood can accumulate
under the client. Weigh peri pads to esRmate blood loss if a careful measurement is necessary.
Assess for signs of shock. Remain with the client, if uterus is boggy, massage it gently but grmly.
Diuresis and dehydraRon
o Common aCer delivery
o May have hyperhidrosis (Profuse sweaRng)
o May have fever but SHOULD NOT BE GREATER THAN 100.4f
Fever of 100.4 for greater than 24 hours could indicate infecRon
