N4341 - Exam 3 Questions and Answers
Define involution clamping/shrinking of uterus
What is it's opposite? opposite: subvolution (bad! at risk for PPH)
Discuss the progress expected during involution (4) returns to 16w size immediately after delivery
descends 1-2 cm q 24 H
6d = halfway btw symphysis & umbilicus
9d = no longer palpable
During postpartum, when is the fundus no longer 9-10 days after delivery
palpable?
Define FF U-2 fundus firm and 2 fingers below umbilicus
(opposite of fetal station)
Increased risk of subvolution (5) long labor
full bladder
overdistended uterus (multipara OR hydramnios)
Define the different types of lochia and when they are rubra: red & bloody, birth to 4 days
expected serosa: pink/brown, day 4 - day 22
alba: whitish, can last 6 weeks or longer (typical 10-14 days)
Who would you expect to have more bleeding after multi
delivery; multi or primipara?
Normal EBL for c/s vs vag c/s: 1000 mL
vag: 500 mL
, After delivery, the cervix has a permanent appearance of "fish mouth" appearance
what? os closes over 2 weeks
When does os close?
When is vagina expected to return to normal size after normal size: 6-8 weeks
delivery? ↓ mucosa ∵ ↓estrogen from lactation
Discuss vaginal mucosa
What would you expect of estrogen levels after delivery? ↓ estrogen = LOTS of sweating/peeing (lose 5lbs)
progesterone? ↓ progesterone
prolactin? ↑ prolactin
When does ovulation begin in non-breastfeeding moms? ovulation: 27 days
menses: 6-12 weeks
Menses? *can get pregnant before menses*
Ovulation in breastfeeding moms? BF moms: 6 months
Postpartum mom has a heart rate of 51, should you be not necessarily
concerned? HR ↓ after delivery now that blood not being shunted to fetus (tells heart to
slow rate)
What would you expect of H&H in pregnant woman? HIGH! have anemic state but ↓ plasma from diuresis
What is a normal WBC after delivery? can be up to 20-25,000
doesn't mean infection
treat symptoms not lab values
How long does hypercoagulability state last after 2-3 weeks
delivery?
When does true milk come in? 3 days after birth
How should fundal massage be done? support at symphysis and rub in circular motion
stop when hard
What should be assessed prior to palpating the uterus? bowel! assess bowel sounds prior
How soon after delivery/foley should mom void? 6 hours after
How many mL? voids >150mL
Blood present? blood in urine normal
For lochia to be classified as heavy, how quickly is pad less than 1 hour
saturating?
Conditions considered PPH (3) SVB: >500 mL
c/s: >1000 mL
Hct ↓ by 10%
Define involution clamping/shrinking of uterus
What is it's opposite? opposite: subvolution (bad! at risk for PPH)
Discuss the progress expected during involution (4) returns to 16w size immediately after delivery
descends 1-2 cm q 24 H
6d = halfway btw symphysis & umbilicus
9d = no longer palpable
During postpartum, when is the fundus no longer 9-10 days after delivery
palpable?
Define FF U-2 fundus firm and 2 fingers below umbilicus
(opposite of fetal station)
Increased risk of subvolution (5) long labor
full bladder
overdistended uterus (multipara OR hydramnios)
Define the different types of lochia and when they are rubra: red & bloody, birth to 4 days
expected serosa: pink/brown, day 4 - day 22
alba: whitish, can last 6 weeks or longer (typical 10-14 days)
Who would you expect to have more bleeding after multi
delivery; multi or primipara?
Normal EBL for c/s vs vag c/s: 1000 mL
vag: 500 mL
, After delivery, the cervix has a permanent appearance of "fish mouth" appearance
what? os closes over 2 weeks
When does os close?
When is vagina expected to return to normal size after normal size: 6-8 weeks
delivery? ↓ mucosa ∵ ↓estrogen from lactation
Discuss vaginal mucosa
What would you expect of estrogen levels after delivery? ↓ estrogen = LOTS of sweating/peeing (lose 5lbs)
progesterone? ↓ progesterone
prolactin? ↑ prolactin
When does ovulation begin in non-breastfeeding moms? ovulation: 27 days
menses: 6-12 weeks
Menses? *can get pregnant before menses*
Ovulation in breastfeeding moms? BF moms: 6 months
Postpartum mom has a heart rate of 51, should you be not necessarily
concerned? HR ↓ after delivery now that blood not being shunted to fetus (tells heart to
slow rate)
What would you expect of H&H in pregnant woman? HIGH! have anemic state but ↓ plasma from diuresis
What is a normal WBC after delivery? can be up to 20-25,000
doesn't mean infection
treat symptoms not lab values
How long does hypercoagulability state last after 2-3 weeks
delivery?
When does true milk come in? 3 days after birth
How should fundal massage be done? support at symphysis and rub in circular motion
stop when hard
What should be assessed prior to palpating the uterus? bowel! assess bowel sounds prior
How soon after delivery/foley should mom void? 6 hours after
How many mL? voids >150mL
Blood present? blood in urine normal
For lochia to be classified as heavy, how quickly is pad less than 1 hour
saturating?
Conditions considered PPH (3) SVB: >500 mL
c/s: >1000 mL
Hct ↓ by 10%
