Maternal Exam 3
Unit 7
Chapter 11: Postpartum Woman and Family, pg. 370-399, 402-403
Post Partum Part 1
• Recovery
o Vital Signs:
§ Normal:
o Fundal Assessment:
§ Boggy, firm, midline, etc.
o Lochia Assessment:
§ COACH
o Perineum Assessment:
§ Stitches, Tear Degree, REEDA
• Postpartum Hemorrhage (PPH)
o Leading cause of maternal death
• Early Hemorrhage:
o Signs: Tachycardia, 15% drop in B/P, Decreased O2 <95%
o Most practitioners do not accurately estimate blood loss
o Occurs within 24 hours post-delivery
o Most common cause: uterine atony
o 4 T’s
§ Tone, Trauma, Tissue, Thrombin:
o Unrepaired lacerations of the perineum or vaginal canal
§ Causes a continuous trickle of bright red blood
o Hematomas:
§ Unrelieved pain/pressure
§ Sometimes visible, sometimes not
§ Common cause: forceps delivery
o Medications:
§ Oxytocin (Pitocin)
• 20 U in 1000 mL of LR or NS
§ Methylergonovine Maleate (Methergine)
• Dose: 0.2 mg/q4/x6 IM
• PO 0.2 mg q 4
o Check BP: contraindicated in HPTN
§ Prostaglandins:
§ Cytotec:
• Rectal, sublingual, PO x1
• Carboprost (Hemobate): IM, Intrauterine q15-90 minutes up to 8 doses
• Side effects: Nausea, vomiting, diarrhea
• Late Postpartum Hemorrhage
• More than 24 hrs but less than a week post-delivery
o Common cause: TISSUE, retained placenta
, § After the first postpartum day, the most common cause of uterine atony is retained
placental fragments. The nurse must check for fragments in the lochia tissue.
o Bubble-E assessment
§ Breasts
• Nipple Inspection: Flat, Everted, Inverted
• Breast Tissue: Soft, Filling, Firm
• Temperature
• Color
o Colostrum
o Milk comes in on day 3
o Day 4: engorgement
§ Uterus
• Normal Involution
• Location: Midline vs Deviated
• Tone: Firm, Firm with massage, or boggy
• Afterpains
§ Bladder and Bowel
• COLA assessment:
o Color, Odor, Last void/BM, Amount
• Bladder distention (can cause uterine atony)
• Flatus, auscultate bowel sounds
§ Lochia
• Color
o Rubra, Serosa, Alba
• Amount
o Scant, Light, Moderate, Heavy
• Presence of Clots
Unit 7
Chapter 11: Postpartum Woman and Family, pg. 370-399, 402-403
Post Partum Part 1
• Recovery
o Vital Signs:
§ Normal:
o Fundal Assessment:
§ Boggy, firm, midline, etc.
o Lochia Assessment:
§ COACH
o Perineum Assessment:
§ Stitches, Tear Degree, REEDA
• Postpartum Hemorrhage (PPH)
o Leading cause of maternal death
• Early Hemorrhage:
o Signs: Tachycardia, 15% drop in B/P, Decreased O2 <95%
o Most practitioners do not accurately estimate blood loss
o Occurs within 24 hours post-delivery
o Most common cause: uterine atony
o 4 T’s
§ Tone, Trauma, Tissue, Thrombin:
o Unrepaired lacerations of the perineum or vaginal canal
§ Causes a continuous trickle of bright red blood
o Hematomas:
§ Unrelieved pain/pressure
§ Sometimes visible, sometimes not
§ Common cause: forceps delivery
o Medications:
§ Oxytocin (Pitocin)
• 20 U in 1000 mL of LR or NS
§ Methylergonovine Maleate (Methergine)
• Dose: 0.2 mg/q4/x6 IM
• PO 0.2 mg q 4
o Check BP: contraindicated in HPTN
§ Prostaglandins:
§ Cytotec:
• Rectal, sublingual, PO x1
• Carboprost (Hemobate): IM, Intrauterine q15-90 minutes up to 8 doses
• Side effects: Nausea, vomiting, diarrhea
• Late Postpartum Hemorrhage
• More than 24 hrs but less than a week post-delivery
o Common cause: TISSUE, retained placenta
, § After the first postpartum day, the most common cause of uterine atony is retained
placental fragments. The nurse must check for fragments in the lochia tissue.
o Bubble-E assessment
§ Breasts
• Nipple Inspection: Flat, Everted, Inverted
• Breast Tissue: Soft, Filling, Firm
• Temperature
• Color
o Colostrum
o Milk comes in on day 3
o Day 4: engorgement
§ Uterus
• Normal Involution
• Location: Midline vs Deviated
• Tone: Firm, Firm with massage, or boggy
• Afterpains
§ Bladder and Bowel
• COLA assessment:
o Color, Odor, Last void/BM, Amount
• Bladder distention (can cause uterine atony)
• Flatus, auscultate bowel sounds
§ Lochia
• Color
o Rubra, Serosa, Alba
• Amount
o Scant, Light, Moderate, Heavy
• Presence of Clots
