OB exam 3
Chapter 15
- Uterine involution
o Process of uterus returning to its normal size
Starts close in, folds on itself
Allows clamping down and constriction of blood vessels to stop bleeding
o After birth uterus weighs 1000g – one week half its size- back to norm in 6 weeks
o Contractions of smooth uterine muscles start to help it involute on itself (clamp down)
Related to decrease in estrogen and progesterone
oxytocin- released by pituitary during breast feeding
Pitocin- give in hospital
o After pains (below)
- Subinvolution
o Caused by: full bladder
Uterus is up and deviated to the right
o Retained placental fragments
o Atony (stretching of the uterus)
Multiple births, macrosomia, hydramnios
- Fundal checks
o Fundus goes down one finger breadth each day of postpartum
o U/U after birth- at umbilicus at 24 hrs
o Typically descends from level of umbilicus at a rate of 1 cm per day
1/U- one above umbilicus
u/1- one below umbilicus
o
- after pains
o part of involution
o contractions- occur to constrict blood vessels in uterine muscles
oxytocin contributes to this (natural)
secreted from pituitary gland
breastfeeding can contribute to oxytocin release
o stimulated uterine contractions which in turn help the uterus fold
on itself
mild analgesic may be administered due to pain of contractions- Tylenol,
motrin
standing order: Pitocin directly after birth
- lochia
o sloughing off of endometrial tissue- due to low progesterone
o amount: scant, small, moderate, large
o should have: fleshy smell
o should not have: foul smell (infection), bright red (laceration: not sutured enough)
rubra- dark red, 3-4 days
deep-red mix of mucus, tissue, debris, and blood
serosa- dark brown/ pink- 10 days
, leukocytes, decidual tissue, RBC, and serous fluid
alba- white, 2-6 weeks
consists of leukocytes, decidual tissue, and reduced fluid content
- cervix
o external: os never goes back to pre-pregnancy state
before kids: circular
after kids- slit-like, never fully closes
o interna:
return to normal after 2 weeks
- vagina
o returns to normal at end of postpartum (6 weeks)
o normal mucus production and thickening of mucosa return with ovulation
lactation amenorrhea- no period r/t breastfeeding, not a good contraceptive
o dyspareunia (painful sex) may occur until menstruation returns
use water soluble lubricants
- perineum
o assess for hemorrhoids, episiotomy, laceration, bruised, and edematous
o ice pack- first 24 hours (vasoconstriction)
o sitz bath- warm water (vasodilation)
hazal pads, anesthetic spray, peri bottle
o episiotomy- pain, strain, BM, tear sutures
fl, walking, fiber, colace
o episiotomy or laceration may take 4-6 months to heal in the absence of complications
(hematoma and infection)
o KEGALS- improve pelvic floor tone
- Cardiovascular system
o Blood volume
Vaginal- 500 ml blood loss
C-section- 1000 ml blood loss
More than that = hemorrhage risk
o Pulse
Slower = may be bradycardic
It can run from 40-60 bpm
It will then return to baseline
Worry about tachycardia
First sign of hemorrhage
Dehydration can occur
o Blood pressure
Should return to pre-pregnancy level
Can be slightly lower the first two days PP
Preeclampsia
May take longer to return to normal
Decreased bp
May suggest an infection or a uterine hemorrhage
o Coagulation
Pooling and stasis of blood in the lower limbs
, Place women at risk for blood clots
2-3 weeks PP stay elevated- still hypercoaguable
Blood clots
SCD’s, walk, fluid, s/s to watch for, DVT, PE, chest pain, SOB, dyspnea
Greater risk with history of smoking, obesity, immobility (c-section)
- Urinary system
o Increased bladder capacity, swelling, bruising
o Your body retains extra fluids during pregnancy, so large volumes of urine is one way it
rids itself of excess fluid
o Urine stasis- increased risk for UTI
o Epidural- decreases urine output
May not feel full bladder- straight cath
o Puerperal diuresis- excessive fluid excretion after childbirth
Causes: large amounts of IV fluids, d/c Pitocin, buildup/retention of fluid during
pregnancy
Pitocin- antidiuretic property (causes mom to hold onto fluid), wont diuresis as
much until Pitocin d/c
Sweating a lot (while they shower- change sheets and gown)
- GI system
o NPO after labor
o Bowels sluggish following birth
Regardless of vaginal or cesarean
o GI usually returns to normal quickly
o Bowel sounds can be hypo when listening at first
Decreased peristalsis due to analgesic, surgery, diminished intra-abdominal
pressure, low- fiber diet, insufficient fluid intake, diminished muscle tone
o Constipation is common
Encourage fluid, food, fiber, walking
Stool softener can be ordered
- Musculoskeletal
o Joints return to prepregnant state except for feet (can be ½ size larger)
o Fatigue and activity intolerance may occur
o NANDA nursing diagnosis: distorted body image
Women feel better now that they are no longer pregnant, but they have the
appearance of pregnancy- support
Remind them it took 9 months to get there so its going to take time to get back to
normal
o Good body mechanics and correct positioning are important during this time
Prevent low back pain and injury to joints
After birth, muscle tone is diminished and the abdominal muscles are
soft and flabby
- Integumentary system
o Pigmentation fades (linea nigra, chloasma)
Due to estrogen/progesterone levels going back to normal
o Stretch marks fade to silvery lines
Typically on abdomen and breasts
Chapter 15
- Uterine involution
o Process of uterus returning to its normal size
Starts close in, folds on itself
Allows clamping down and constriction of blood vessels to stop bleeding
o After birth uterus weighs 1000g – one week half its size- back to norm in 6 weeks
o Contractions of smooth uterine muscles start to help it involute on itself (clamp down)
Related to decrease in estrogen and progesterone
oxytocin- released by pituitary during breast feeding
Pitocin- give in hospital
o After pains (below)
- Subinvolution
o Caused by: full bladder
Uterus is up and deviated to the right
o Retained placental fragments
o Atony (stretching of the uterus)
Multiple births, macrosomia, hydramnios
- Fundal checks
o Fundus goes down one finger breadth each day of postpartum
o U/U after birth- at umbilicus at 24 hrs
o Typically descends from level of umbilicus at a rate of 1 cm per day
1/U- one above umbilicus
u/1- one below umbilicus
o
- after pains
o part of involution
o contractions- occur to constrict blood vessels in uterine muscles
oxytocin contributes to this (natural)
secreted from pituitary gland
breastfeeding can contribute to oxytocin release
o stimulated uterine contractions which in turn help the uterus fold
on itself
mild analgesic may be administered due to pain of contractions- Tylenol,
motrin
standing order: Pitocin directly after birth
- lochia
o sloughing off of endometrial tissue- due to low progesterone
o amount: scant, small, moderate, large
o should have: fleshy smell
o should not have: foul smell (infection), bright red (laceration: not sutured enough)
rubra- dark red, 3-4 days
deep-red mix of mucus, tissue, debris, and blood
serosa- dark brown/ pink- 10 days
, leukocytes, decidual tissue, RBC, and serous fluid
alba- white, 2-6 weeks
consists of leukocytes, decidual tissue, and reduced fluid content
- cervix
o external: os never goes back to pre-pregnancy state
before kids: circular
after kids- slit-like, never fully closes
o interna:
return to normal after 2 weeks
- vagina
o returns to normal at end of postpartum (6 weeks)
o normal mucus production and thickening of mucosa return with ovulation
lactation amenorrhea- no period r/t breastfeeding, not a good contraceptive
o dyspareunia (painful sex) may occur until menstruation returns
use water soluble lubricants
- perineum
o assess for hemorrhoids, episiotomy, laceration, bruised, and edematous
o ice pack- first 24 hours (vasoconstriction)
o sitz bath- warm water (vasodilation)
hazal pads, anesthetic spray, peri bottle
o episiotomy- pain, strain, BM, tear sutures
fl, walking, fiber, colace
o episiotomy or laceration may take 4-6 months to heal in the absence of complications
(hematoma and infection)
o KEGALS- improve pelvic floor tone
- Cardiovascular system
o Blood volume
Vaginal- 500 ml blood loss
C-section- 1000 ml blood loss
More than that = hemorrhage risk
o Pulse
Slower = may be bradycardic
It can run from 40-60 bpm
It will then return to baseline
Worry about tachycardia
First sign of hemorrhage
Dehydration can occur
o Blood pressure
Should return to pre-pregnancy level
Can be slightly lower the first two days PP
Preeclampsia
May take longer to return to normal
Decreased bp
May suggest an infection or a uterine hemorrhage
o Coagulation
Pooling and stasis of blood in the lower limbs
, Place women at risk for blood clots
2-3 weeks PP stay elevated- still hypercoaguable
Blood clots
SCD’s, walk, fluid, s/s to watch for, DVT, PE, chest pain, SOB, dyspnea
Greater risk with history of smoking, obesity, immobility (c-section)
- Urinary system
o Increased bladder capacity, swelling, bruising
o Your body retains extra fluids during pregnancy, so large volumes of urine is one way it
rids itself of excess fluid
o Urine stasis- increased risk for UTI
o Epidural- decreases urine output
May not feel full bladder- straight cath
o Puerperal diuresis- excessive fluid excretion after childbirth
Causes: large amounts of IV fluids, d/c Pitocin, buildup/retention of fluid during
pregnancy
Pitocin- antidiuretic property (causes mom to hold onto fluid), wont diuresis as
much until Pitocin d/c
Sweating a lot (while they shower- change sheets and gown)
- GI system
o NPO after labor
o Bowels sluggish following birth
Regardless of vaginal or cesarean
o GI usually returns to normal quickly
o Bowel sounds can be hypo when listening at first
Decreased peristalsis due to analgesic, surgery, diminished intra-abdominal
pressure, low- fiber diet, insufficient fluid intake, diminished muscle tone
o Constipation is common
Encourage fluid, food, fiber, walking
Stool softener can be ordered
- Musculoskeletal
o Joints return to prepregnant state except for feet (can be ½ size larger)
o Fatigue and activity intolerance may occur
o NANDA nursing diagnosis: distorted body image
Women feel better now that they are no longer pregnant, but they have the
appearance of pregnancy- support
Remind them it took 9 months to get there so its going to take time to get back to
normal
o Good body mechanics and correct positioning are important during this time
Prevent low back pain and injury to joints
After birth, muscle tone is diminished and the abdominal muscles are
soft and flabby
- Integumentary system
o Pigmentation fades (linea nigra, chloasma)
Due to estrogen/progesterone levels going back to normal
o Stretch marks fade to silvery lines
Typically on abdomen and breasts
