Chapter 12: Postpartum Notes Physiological Changes That Occur After Birth Reproductive System o Uterus returns to pre-pregnant size, shape, and location Uterus descend 1 cm/day; by day 14 Fundus descended into the pelvis and not palpable o Afterpains – moderate to severe cramp-like pains r/t uterus working to remain contracted and/or to increase of oxytocin released in response to infant suckling Endometrium: o Undergoes exfoliation and regeneration after placental birth through necrosis of superficial layer of the decidua and regeneration of decidua basalis into endometrial tissue o Lochia- bloody discharge from the uterus containing sloughed necrosis tissue Undergoes healing process of the uterine placental site Lochia rubra – Day 1 – 3 Normal findings: o Bloody with small clots o Moderate to scant amount o Increased flow on standing or breastfeeding o Fleshy odor Abnormal findings o Large clots o Heavy amount; saturates pad within 15 minutes o Foul odor o Placental fragments Lochia serosa – Day 4 – 10 Normal findings o Pink or brown coloration o Scant amount o Increased flow during physical activity o Fleshy odor Unexpected findings o Continuation of rubra stage after 4 o Heavy amount o Heavy amount; saturates pad within 15 minutes o Foul odor Lochia alba – Day 10 Normal findings: o Yellow to white in color o Scant amount o Fleshy odor Anomalies: o Bright red bleeding
Chapter 12: Postpartum Notes o Foul odor Vagina and Perineum: o Primary complication = infection o Experience changes r/t birthing; tears, stretching, episiotomies Breasts: o Primary engorgement (subsides 24 - 48 hrs) Occurs 2 to 3 days after birth Increase in vascular and lymphatic system of breasts Preceded the initiation of milk production o Larger, firmer, warm, tender o May feel throbbing pain o Breastfeeding women: Subsequent engorgement r/t distention of milk glands that is relieved by feeding the baby or pumping o Primary complication is mastitis o Colostrum clear, yellowish fluid preceding milk production High in protein Low in carbohydrates Contain IgG and IgA Cardiovascular: o Avg blood loss 200-500mL o WBC may increase to 25,000/mm Return to normal within 7 days o CO returns to normal within 48 hours o
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- Spring '14
- Obstetrics, Postpartum hemorrhage, Postpartum Notes