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ALBAMCBPostpartum
Postpartum
| Question | Answer |
|---|---|
| Hormonal changes occur secondary to what in the PP period | Delivery of the placenta (and hormones) Change in prolactin secretion |
| Prolactin | ant. pituitary, suppressed by estrogen in pregnancy Increases immediately after delivery - peaks at 3 hours PP Stimulated by suckling - stimulates alveolar cells to produce milk. In non-lactating women - falls to non-pregnant levels at 7-14 days |
| Oxytocin | Produced in hypothalamus, stored and secreted by posterior pituitary Causes myoepithelial cell contraction leading to milk ejection Responsible for contraction and involution of the uterus |
| Oxytocin release is inhibited by: | Fear, anxiety, embarrassment |
| Oxytocin release is enhanced by: | Relaxation, orgasm, baby cry, breast stimulation |
| Estrogen | Decreases rapidly PP with removal of placenta estradiol reaches <2% preg val by 24 h aiding in initiation of lactation |
| Progesterone | 24-48 h: level similar to luteal phase 3-7 d: level = fallicular phase decrease aids in lactation |
| HPO axis | Suppressed in pregnancy Estrogen and progesterone slowly increase and pituitary function resume at 4-6 weeks pp. |
| Hemoglobin and HCT are affected PP by: | Hydration, fluids retained in labor and reduction in blood volume |
| 9 predisposing factors for thromboembolic disease in the PP woman | Venous stasis from dilation of vein and compression of uterus Prolonged bed rest Lack of activity or ambulation Hypercoagulation disorders Instrument assisted and cesarean birth Hemorrhage Sepsis Multiparity Advanced maternal age |
| Blood loss: - 1 pt drop in HCT = - 1 pt drop in HGB = | HCT - 250 ml HGB - 500 ml |
| Renal pelves and ureters return to normal by: | 4th PP week |
| Bladder is edematous and hypotonic immediately PP resulting in: | Over distention and incomplete emptying - encourage periodic voicing |
| What % of women have non-pathologic proteinuria up to 2nd day PP? | 40% |
| Diuresis begins______ _______ _______ and lasts up to the ___ PP day? | Shortly after delivery 5th |
| Urine output may equal _______mL/D PP | 3000 mL |
| Urinary incontinence may persist up to _____ postpartum | 6 months |
| What are the 3 processes to uterine regeneration? What speeds up the process? | Contractions, autolysis, and placental site regeneration Breastfeeding |
| Immediately following delivery uterus is at?________ at 1-2 hours uterus is at?________ Uterus descends __ finger breadth/d? At 2 weeks uterus is approximately __ week size. Uterus is at the non-pregnant size at ____ to ____ weeks PP? | 2/3 btw pubis and umbilicus umbilicus or 1 fb below 1 12 week 4-6 weeks |
| Endometrium takes ___ weeks to regenerate? Placental site takes ___ weeks to regenerate? | 3 weeks 6 weeks |
| Lochia arises from the? | Superficial layer of the uterine decidua |
| Lochia rubra lasts___ days Color? Contains mostly? | 4 days Bright red Blood |
| Lochia Serosa lasts __ days Color? Composed of? | 22 days pink serous fluid, decidual tissue, leukocytes and erythrocytes |
| Lochia Alba lasts ___ days Color Contains: | 7 days Whitish erythrocytes and decidua |
| Mean duration of lochia is __ days but can last up to __ days | 33 days 60 days |
| Engorgement may occur btw the __ and ___ PP day and resolves in _______ hours | 2nd and 4th 24-48 |
| Resumption of ovulation is associated with a rise in? | Plasma progesterone |
| Initial menses following delivery is anovulatory in | 75% of women |
| Breastfeeding - prolactin Secreted by: Influence in PP State | Anterior pituitary Stimulated alveolar cells to produce milk; initiates lactation with suckling; inverse relationship btw catecholamines and PRL |
| Breastfeeding - Prolactin inhibiting factor Secreted by: Influence PP: | Hypothalamus Suppresses release of prolactin |
| Breastfeeding - Oxytocin Secreted by: Influence in PP | Posterior pituitary "Milk ejection" reflex |
| Breastfeeding - Estrogen Secreted by: Influence PP: | Ovary and placenta Blood levels decrease and initiation of lactation associated |
| Breastfeeding - Progesterone Secreted by: Influence PP: | Ovary and placenta Blood levels decrease and initiation of lactation associated |
| Breastfeeding - ACTH Secreted by: Influence PP | Anterior pituitary High level believed necessary for maintaining lactation (milk synthesis and release) |
| Breastfeeding - HPL Secreted by: Influence on PP | Placenta Not applicable to PP but stimulated mammary growth of alveoli in non pregnant/pregnant state |
| Breastfeeding - Thyroxine Secreted by: Influence on PP | Thyroid Important in maintaining lactation by control of metabolism; direct effect on mammary glands |
| Breastfeeding - thyroid releasing hormone Secreted by: Influence on PP | Hypothalamus Stimulates release of PRL; can be used to maintain lactation |
| Breastfeeding - Growth hormone Secreted by: Influence on PP | Anterior Pituitary may act with prl in initiation of lactation May act with thyroxine to potentate milk yield; most important in maintaining lactation |
| PP PE Breasts | Observe presence of engorgement, lumps, red streaks Observe integrity of nipples Check presence of colostrum or milk BF women will have glandular hypertrophy Hyperpigmentation may be permanent |
| PP PE Uterus | Assess position of uterus in relation to pp day If enlarged or displaced, reevaluate after void Assess tenderness, and fundus for firmness |
| PP PE Perineum | Lie on side for visualization Inspect laceration/epis, integrity of sutures,hemorrhoids/hematoma Perineum edematous and bruise at dx - returns to nl at 2 weeks pp - may remain tender to palpation suture visible at 6 weeks Encourage perineal hygiene. |
| REEDA is | Redness, Edema, Ecchymosis, DIscharge, approximation |
| PP PE Lochia | Assess amt, color and odor Signs of possible problem: lochia malodorous, becomes heavier and bright red; associated with abdominal pain or fever Bleeding may increase temp. with activity |
| PP PE Bladder | Assess UO, dysuria, ability to void and edema r/t lacerations birth related trauma usually resolves within 24 hours Cath may be necessary for distention, increased bleeding or edema interfering with voiding |
| PP PE Extremities (exam of legs) | Place foot flat and knees slightly bent Palpate both sides of legs for varicosities, calf tenderness and heat Inspect for edema, redness Homan's sign |
| PP PE Vital Signs | BP and Pulse Q 15 min X 2 hours after delivery Temp: slight increase; normal w/i 24 h Pulse - Normal (>100 indicates infection or hemorrhage) Resp: Normal 12-20/min BP: transient rise but should resolve to pre-preg over a few days |
| Rubella immunization | If prenatal titer <1:10 (non immune) 0.5 mL subcutaneously |
| RhoGAM administered to: | Rh negative mom if: Infant Rh positive Mother not sensitized to Hr D antibodies Infant has a negative direct autoagglutination test -Administer within 72 hours |
| Perineal pain management | Ice packs prn x 24-48 h Topical anesthetic prn Witch hazel Stiz bath, cold or hot Analgesia (Ibuprofen, acetaminophen, tylenol 3 or percocet) |
| Constipation managment | Common after extended labor and NPO or fear d/t extensive laceration Docusate sodium 50-100 mg oral qd or bid increase fluids and fiber |
| Afterbirth pain management and cause | Cause: continuing contraction and relaxation of uterus More common with increased parity Triggered by oxytocin Keep bladder empty Ibuprofen (anti-inflammatory) |
| Non-lactating breast care: | Pharmacologic agents not recommended by FDA Moderate to severe pain Tight fitting bra or ace wrap Ice Avoid nipple stimulation Discourage expression of milk Mild analgesics Cabbage leaves |
| Sore nipples Presentation and management | Pink, burning nipples related to nipple stretching, peaks at 3-4 d pp. Air dry, correct positioning/breaking of suction, apply EBM/colostrum, treat thrush, least sore side first, ice for engorgement/pain relief, apap 30 min before feeding. |
| Cracked nipples Presentation and management | Blistered, scabbed, cracked d/t trauma Air dry, correct position/breaking of suction, apply ebm/colostrum, treat thrush, least sore side 1st, Ice, apap 30 min prior to feed. |
| Engorgement Presentation and management | Usually temporary, tight, red, shiny skin; occasional fever up to 101, usually pp day 3-5, pain. Use good bra, facilitate drainage, anti-inflammatory, heat before bf, cold after bf, feed q2h, cool cabbage leaves pump to reduce milk buildup. |
| Low milk supply Presentation and management | infant wt loss >7%, infant with concentrated urine, dry hard stools, lethargy, dry MM extra feeds/pumps/pump after feed, skin to skin during pump, stop smoking, evaluate mom for endocrine abnormalities, reglan protocol, acupuncture, fenugreek. |
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