Exam 3 Study Guide
PP physiology and assessment 6-8 Peripartum = postpartum = puerperium (4th stage of
pregnancy)
PP VS – normal, frequency q15 x 2
... [Show More] hours (temp q4 for the first 8 then at least q8)
HR and BP return to prepregnant state within a few days
RR, PMI, and EKG are normalized once diaphragm descends
Low grade fever 100.4F (or lower) is not uncommon in the first 24 hours- this is a
natural process that is fighting infection
Normal findings:
o Temp can increase to 100.4 secondary to dehydrating effects of labor. 24 hours
s/p delivery; should be afebrile
o Pulse/ stroke volume/ cardiac output remain elevated for 1-2 hours s/p delivery
o Respirations should decrease to within normal range by 6-8 weeks PP
o Blood Pressure is altered only slightly, if all. Orthostatic hypotension can
develop in the first 48 hours
Deviations from normal:
o Temp that is increased to 100.4 and occurs after the first 24 hours after delivery
(sepsis, mastitis, UTI)
o Tachycardia or an increasing HR can be a result of hypovolemia secondary to
hemorrhage
o Hypoventilation can be a result of an unusually high spinal or epidural
o Low BP or decreasing BP can be indicative of hypovolemia secondary to
hemorrhage (usually a late sign). An elevated BP can be a result of
vasopressors, oxytocin or indicative of Preeclampsia
Involution/fundus
Involution: the return of the uterus to a nonpregnant state following birth (progresses
rapidly)
Subinvolution: failure of the uterus to return to a nonpregnant state
o Retained placental fragments
o Infection
Fundus should be firm and midline for first 24 hours at the umbilicus and involutes
(1cm/day); Uterus: should be firm, midline, PP day 1: at umbilicus or slightly below,
descends 1-2cm each PP day (so PP day 3 it should be 3 cm below)
o PP day 6, fundus is between umbilicus & symphysis pubis
o 2 weeks after childbirth the uterus is no longer palpable
o Returns to a nonpregnant state by 6 weeks
o Uterus afterpains resolve after 3-7 days
PP Hemorrhage:
o Early: within 24 hours
o Late: after 24 hours; causes are the same as subinvolution- retained placental
fragments, infection
Oxytocin
Postpartum hemostasis achieved by compression of intramyometrial blood vessels as
uterine muscle contracts, NOT platelet aggregation and clot formation
Hormone oxytocin, released from pituitary gland, strengthens and coordinates uterine
contractions
Contractions are irregular up 1-2 hours postpartum
IV or IM Pitocin
Breast feeding increases natural release of oxytocin body, so when this is released,
they will contract more and help get back to pre-preg state
Uterus will continue to contract; body produces oxytocin naturally (pituitary)
1-time IM (20mili units) of Pitocin or give continuously through IV fluids
Pitocin is not considered a high-risk medication for PP patient (only if baby is in mom
it is high risk)
Contraction right away is how hemorrhage is prevented, you want it contracting as
hard as it can and quickly as possible- WAIT till after placenta is out to administer
Lochia
Placental site: growth of the endometrium causes sloughing of necrotic tissue and
prevents scar formation
Endometrial regeneration is complete by PP day 16 EXCEPT for placental site which
occurs 6 weeks PP
Lochia: post birth uterine discharge, can last up to 4-8 weeks PP
o Lochia rubra: bright red- duration of 3-4 days, “Heavy period”: flow can be
different for every woman, there are no concrete numbers because everyone’s
menstrual cycle is different, therefore it will be a “heavy period” for that
person, Blood and decidual and trophoblastic debris (days 1-3)
o Lochia serosa: pink or brown- old blood, serum, leukocytes, and debris,
average 10-14 days (days 4-10)
o Lochia alba: yellow to white- leukocytes, decidua, epithelial cells, mucus,
serum, and bacteria, continues 4-8 weeks after birth (after day 10 on)
Oxytocic medications or breast-feeding impact amount of lochia, increasing discharge
Less lochia with C-section as uterus is suctioned prior to closure…but these women
WILL have lochia, just less
Lochia flow increases with ambulation and when breast feeding
Lochia pools in vagina while lying down and “gushes” when a woman stands (just like
getting up for the first time in the morning on your period)
Lochia should NOT have a foul odor!!!! It does have a smell of its own, but it should
not smell foul (if it does, uterine infection)
Charting: Scant, light, moderate, heavy
o Scant: 1 inch or so after an hour
o Light: 4 inch after an hour
o Moderate: 6-inch or so, covering about 1/3 of pad
o Heavy: coving majority or all of pad; you need to figure out what might be
going on, ask “do you normally have a heavy period?” this promotes further
investigation
o Soaking more than one pad an hour = A PROBLEM
o Clot bigger than 1cm or bigger than 1 q [Show Less]