NURS 4341 OB Exam 3 Study Guide _POSTPARTUM: (4th Trimester | Puerperium) From birth to return of reproductive organs to pre-pregnant state > 6-12 weeks

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POSTPARTUM: (4th Trimester | Puerperium) From birth to return of reproductive organs to pre-pregnant state  6-12 weeks THE UTERUS Involution: uterus decent into the pelvic cavity 1-2cm Q24 hours ...  Returns to 16wk size (grapefruit) immediately after birth  Day 6 – halfway b/w symphysis & umbilicus  Day 9-10 – not palpable abdominally o Documentation – Firmness & Location (FF U-2) Subinvolution: Uterus does NOT return to pre-pregnancy size over 6 wks  Causes: Retained placental fragments | infection| long difficult labor | over distended uterus | full bladder AFTERPAINS  Contractions after childbirth that compress uterine muscle fibers to clamp off myometrial blood vessels o Pains are more intense in multiparas and with breastfeeding  Putting baby to breast stimulates endogenous oxytocin release or give IV bolus. o prophylactic use of oxytocics reduces PP hemorrhage by half & therapeutic use by 70% PLACENTAL SITE  Constriction and thrombosis cause nodularity  Endometrium grows over site and causes sloughing of necrotic tissue, allowing normal implantation and placentation in future pregnancies  Usually completed by 6 weeks PP LOCHIA  Rubra – red and bloody, birth to 2-4 days PP, may have small clots  Serosa – pink or brown, begins 3-4 days PP and may last 22-27 days  Alba – Primarily leukocytes, may drain 6wks or longer PP. Average 10 – 14 days  Multiparas have heavier bleeding | bleeding may be lighter in cesarian CERVIX  Shortens and firms within 18 hours  Lower segment edematous, thin, and fragile for several days  Ectocervix is bruised and has small lacerations  OS closes over 2 weeks  Has a slit “fish mouth” appearance – new norm VAGINA & PERINEUM  Vagina returns to normal size over 6-8 weeks, rugae reappear in 3 weeks, but they are never as prominent again.  Reduced estrogen in lactation decreases vaginal mucous  Introitus (opening) is erythematous and edematous  Hemorrhoids  Perineum may be swollen/bruised (ice pack, examine opening) PELVIC MUSCULAR SUPPORT  May take 6 months to regain tone  May be injured in birth and lead to future gynecologic problems  Kegel exercises should be encouraged before and after birth ENDOCRINE SYSTEM  Delivery of the placenta leads to reduced human chorionic somatomammotropin, estrogens, cortisol, and the placental enzyme insulinase *  Estrogen & Progesterone drop immediately after placenta separates and delivers  Lowest level at about 1 wks  Helps with lactation, diuresis of excess extracellular fluid (remember fluid volume doubled) – lots of sweating and increased urinary output  Ovulation occurs as early as 27 days after birth in non-lactating women; periods may return within 6-12 weeks – remind moms that they don’t have to have a period to get pregnant  Ovulation occurs at an average of 6 months in breastfeeding women and can occur before the return of menses (mom has to feed EVERY 3 HOURS)  Prolactin levels responsible for breastfeeding - suppresses ovulation [Show More]

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