Transcript Postpartum Physiology RNSG 2308

Postpartum Physiology
RNSG 2308
Learning Objectives
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Describe the anatomic and physiologic
changes that occur during the postpartum
period.
Discuss the characteristics of uterine
involution and lochial flow, and describe ways
to measure them.
List expected values for vital signs and blood
pressure, deviations from normal findings, and
probable causes of the deviations
Postpartum Physiology
Postpartum period
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Interval between the
birth of the newborn and
the return of the
reproductive organs to
their nonpregnant state.
Fourth trimester of
pregnancy
Also referred to as the
puerperium
Last on an average of
about 6 weeks
Postpartum Physiology
Reproductive System and
Associated Structures
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Uterus
 Involution- the return of
the uterus to a
nonpregnant state after
birth
 Fundus descends 1 to 2 cm
every 24 hours
Subinvolution- is the failure
of the uterus to return to a
nonpregnant state
 Most common causes
are retained placenta
fragments and
infection
Postpartum Physiology
Contractions
 Oxytocin- strengthens
and coordinates uterine
contractions, which
compress the blood
vessels and thereby
promotes hemostasis
 Postpartum hemostasisis achieved primarily by
compression of
intramyometrial blood
vessels as the uterine
muscle contracts, rather
than platelet aggregation
and clot formation
Postpartum Physiology
Afterpains
 Intermittent uterine contractions
 Maybe intense at times
 More common in multiparas
 Frequently occurs with
breastfeeding
 Suckling results in release of
oxytocin
 Oxytocin causes contractions
of the lateral ducts in the
breast which cause
contractions of the uterine
muscles
A postpartum client asks the nurse about the occurrence of
afterpains. The nurse informs the mother that afterpains will
be especially noticeable:
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1.When ambulating
2.While taking sitz baths
3.During breast-feeding
4.Once the client arrives home and activities
are increased
Postpartum Physiology
Lochia
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Rubra
Last 3 to 4 days
Consists of blood, mucus,
particles of decidua and
trophoblastic debris
Bright red
Serosa
After 3 to 4 days
Alba
Consists of leukocytes,
decidua, epithelial cells,
mucus, serum, and bacteria
After 10 days-up to 6 weeks
Yellow to white
A nurse is assessing the lochia discharge on a 1-day postpartum woman.
The nurse notes that the lochia is red and has a fleshy odor. The nurse
determines that this assessment finding indicates:
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1.A normal finding
2.The presence of infection
3.The need for increasing oral fluids
4.The need for increasing ambulating
A nurse is providing information about lochia flow to a woman who just
delivered a newborn. The nurse tells the woman that the amount of lochia
flow:
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1.Increases during ambulation
2.Increases during sleep
3.Is scant immediately following delivery
4.Increases in amount on the third postpartum
day
Postpartum Physiology
Cervix
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Remains edematous, thin,
and fragile for several days
after birth
Ectocervix- portion of the
cervix that protrudes into
the vagina
 May appear bruised
 May have some small
lacerations
 Constitutes an optimal
condition for
development of an
infection
Postpartum Physiology
Vagina and Perineum
 Vagina returns to its
prepregnancy size by 6 to 10
weeks after childbirth
 Rugae reappears within in 3
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Normal estrogen levels and
lubrication return by 6 to 10
weeks
 Episiotomies heal within 2 to
3 weeks
 Hemorrhoids usually decrease
in size within 6 weeks
Postpartum Physiology
Endocrine System
 Placental hormones
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Human placental lactogen
(hPL) decreases to
undetectable levels in 24
hours
Hcg decreases after birth and
remains low until after
ovulation
Estrogen and progesterone
levels decrease markedly after
expulsion of the placenta
Lowest levels 1 week into the
postpartum period
Endocrine System
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Pituitary Hormones and Ovarian
Function
Elevated serum prolactin levels in
breastfeeding women appears to
be responsible for suppressing
ovulation
Ovulation occurs as early as 27
days after birth in nonlactating
women
Menstruation usually resumes by
12 weeks after birth
Mean time of about 70 to 75 days
Mean time to ovulation in women
who breastfeed is about 6 months
Postpartum Physiology
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Abdomen
During the first days after
birth, woman’s abdominal
muscles protrude and give
her a still-pregnant look
6 weeks for the abdominal
wall to return almost to it
prepregnancy state
Return of muscle tone
depends on previous tone,
proper exercise, and the
amount of adipose tissue
Abdomen
Postpartum Physiology
Urinary System
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Diuresis occurs within
12 hours after delivery
Profuse diaphoresis that
often occurs, especially
at night, for the first 2 to
3 days after childbirth
Fluid loss through
perspiration and the
increased urinary output
accounts for weight loss
In the immediate postpartum period, the nurse monitors the
new mother for which risk related to the urinary system?
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1.Diuresis
2.Stress incontinence
3.Urge incontinence
4.Retention
Postpartum Physiology
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Urethra and Bladder
Trauma to the urethra and bladder
may occur during the birth
process
Decreased voiding, along with
postpartum diuresis, may result in
bladder distention
Immediately after birth, excessive
bleeding can occur if the bladder
becomes distended
Adequate emptying of the
bladder, bladder tone is usually
restored 5 to 7 days after
childbirth
Postpartum Physiology
Gastrointestinal System
 Spontaneous bowel
evacuation maybe delayed
until 2 to 3 days after
childbirth
 Discomfort may be
anticipated due to lacerations,
episiotomies, or hemorrhoids
and may cause a delay in
evacuation
 Operational vaginal birth and
sphincter lacerations may
cause postpartum
incontinence
 May resolve in 6 months
A postpartum nurse is providing home care instructions to a woman
following delivery of a healthy newborn. The nurse tells the mother that
she should expect normal bowel elimination to return:
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1.1 day postpartum
2.3 days postpartum
3.7 days postpartum
4.Within 2 weeks postpartum
Postpartum Physiology
Breasts
Breastfeeding Mothers
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Colostrum-before lactation
begins and is yellowish in
color
Breast milk (true)- after
lactation begins and is bluish
white in color
Breast may feel warm and
firm
Tenderness may persist for
about 48 hours after the start
of lactation.
Nipples are assessed for signs
of irritation such as; cracks,
blisters, or reddening
A nurse is performing a breast assessment on a client who is preparing to
breast-feed her newborn. Which breast finding would the nurse
determine to be the most effective for breast-feeding?
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1.Erectile nipples
2.Inverted nipples
3.Flat nipples
4.Nipples that are level with the skin surface
Postpartum Physiology
Nonbreastfeeding Mothers
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Prolactin levels decrease rapidly
Colostrum is excreted for the first
few days after childbirth
On the 3rd or 4th postpartum day,
engorgement may occur and the
breast become swollen, firm,
tender, and warm to touch
Engorgement resolves itself
spontaneously, and discomfort
usually decreases by 24 to 36
hours
Breast binder or tight bra, ice
packs, and analgesics may be
used as comfort measures
Postpartum Physiology
Blood Volume
 Blood volume that increases
during pregnancy is
eliminated within the first 2
weeks after birth
 Blood volume returns to
nonpregnant values within 6
months
 Normal blood loss for vaginal
delivery is 300 to 500 ml
 Normal blood loss for a
C/Section is 500 to 1000 ml
Postpartum Physiology
Blood Components
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Hgb and Hct levels drop
moderately for 3 to 4 days
WBC increase to 20,000 to
25,000
Increased neutrophils and
eosinophils and decreased
lymphocytes ( shifts to the left)
Clotting factors l,ll, V111, lX,
decrease to nonpregnant level
within a few days
Fibrinogen and thromboplastin
remain elevated during the first
few days after childbirth
Postpartum Physiology
Neuromuscular System
 Numbness of thighs, fingers, or hands disappear in several
days
 Back pain usually resolves in a few weeks or months
following birth
 Postpartum headaches may be caused by various
conditions, including; postpartum onset preeclampsia,
stress, and the leakage of cerebrospinal fluid into the
extradural space during an insertion of an epidural
 Headaches last from 1 to 3 days to several weeks depend
on cause and effectiveness of treatment
Varicosities
Postpartum Physiology
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Musculoskeletal System
Relaxation of the joints and
the changes in the mother’s
center of gravity in response
to the enlarging uterus
Joints are completely
stabilized by 6 to 8 weeks
after birth
Mother may notice a
permanent increase in her
shoe size
Postpartum Physiology
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Integumentary System
Chloasma of pregnancy
usually disappears at the end
of pregnancy
Hyperpigmentation of the
areolae, and linea nigra may
not regress completely after
childbirth
Spider angiomas (nevi),
palmar erythema, and epulis
generally regress
Profuse diaphoresis
Key Points
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The rapid decrease in estrogen and
progesterone levels after expulsion of the
placenta is responsible for triggering many of
the anatomic and physiologic changes in the
puerperium.
Within 6 weeks after birth, the physiologic
changes induced by pregnancy have reverted
to their normal state.
Assessing lochia and fundal height is essential
to monitor the progress of normal involution
and to identify potential problems.
Key Points (Cont.)
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The uterus involutes rapidly after birth and
returns to the true pelvis within 2 weeks.
The return of ovulation and menses is
determined in part by whether the woman
breastfeeds her infant.
Few alterations in vital signs are seen after
birth under normal circumstances
Key Points (Cont.)
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Hypercoagulability, vessel damage, and
immobility predispose the woman to venous
thromboembolism.
Marked diuresis, decreased bladder sensitivity,
and overdistention of the bladder can lead to
problems with urinary elimination.
Pregnancy-induced hypervolemia, combined
with several postpartum physiologic changes,
allows the woman to tolerate considerable
blood loss at birth.
Question
1. Which vital sign deviates from the normal
reading as a result of puerperal sepsis?
a.
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d.
Temperature
Respirations
Blood pressure (BP)
Pulse