POST PARTUM Lecture 8. Puerperium : “to bring forth” 6 wk > childbirth. “4th trimester” - transition for woman/family (pregnancy ends/parenting role begins) I. Physiological Changes of Post Partum Period A. Reproductive System Changes:
A. Reproductive System Changes:
UTERUS: contx’s begin > birth & delivery of placenta
1. placental site seals
2. Entire uterus contracts & reduces gradually for 8-10 days. “INVOLUTION”. Pt. in danger of hemorrhage uterus until involution is complete.
Oxytocin released > uterine contx’s.
Uterus descends one finger breadth every day.
By day 10, uterus almost back to pre-pregnant size & position in pelvic cavity. [1000 grams→ 50 grams] No longer palpated in abdomen.
effective contraction of uterus not possible. Risk of PP Hemorr.
Delay also with:
After-birth pains = cramping caused by contractions
May prevent episiotomy/laceration.
Teach Kegels - tightening & releasing of perineal muscles. Improves circulation & healing of epis/lac.
pre-pregnant state by 6 wks.
12 days - to begin new menstrual cycle. Menses resumes by 4-5 wks. if not Br. Fdg.
When do you suspect full bladder?
With diuresis & blood loss @ delivery, blood volume
returns to normal in 1-2 wks.
pregnant state = 5250cc.
^ Blood volume: provides adequate exchange of nutrients in placenta & compensates for blood loss during delivery.
Plasma fibrinogen ^^ 50% during pregnancy & remains elevated 6 wks. PP. [^ estrogen levels] WHY?
Can cause ^ thrombus formation.
[striae gravidarum] appear reddened on
abdomen. Fade by 3-6 months;
Pearly white marks may remain in lighter
skinned pts. & darker marks in darker skinned pts.
Temperature: slightly ^ - dehydration during labor 1st 24 hrs. Returns to normal within 24 hrs.
Pulse: HR ^ slightly x 1st hr.
Heart works faster to handle ^ volume. BP remains same.
BP drops slightly d/t lowered peripheral resistance in blood
vessels as placenta expands rapidly. Heart beats faster,
more efficiently d/t ^ blood volume.
Pre-pregnant BP 120/80. Pregnant BP 114/65.
BP back to pre-pregnant value.
[90/60 or less] with dizziness is “Orthostatic hypotension”; could signify hemorrhage.
[140/90 or >] could signify PP pre-eclampsia.
Return of Menses: > delivery FSH levels rise causing ovulation
PSYCHOLOGICAL CHANGES OF POST PARTUM PERIOD: ADJUSTMENTS
Drop in estrogen/progesterone; lasts 1st few days of
PP period. Occurs in 50% of women.
The Post Partum Resource Center of New York, Inc.
MANIFESTATIONS OF POSTPARTUM PSYCHOSIS
Development of Parental Love & Positive Family Relationships:
Advantages to Breast Feeding:
oxytocin from posterior pituitary.
Ways to teach new moms about lactation:
hands on demo
lactation specialist [in clinical settings]
Contraindications to Breast Feeding:
Body prepares for lactation during pregnancy; stores fat
& nutrients; provide energy, vitamins, minerals in breast milk.
Breast milk by 3rd to 4th day in response to:
Colostrum: protein, sugar, fat, water, minerals, vitamins, maternal antibodies.
Foremilk: constantly accumulating.
“Let-down reflex” –lets foremilk be available right away.
Hind milk: forms after let-down reflex. Has most calories;
Feed until breast empty.
Breast Milk: Provides complete nutrition for 1st 6 mos of life.
feeds, more prolactin produced which then produces ^milk.
Assessment: Antepartum Changes
Engorgement : milk enters on 3rd - 4th day; C/S - prior to D/C
desire to breast feed]
Discharge Follow up:
Assessment – minimum of twice daily
Health teaching & discharge planning
Self-breast exam q month; S/S PPD
Ice , Sitz Baths, Topical Anesthetics
Analgesia, Kegels for NSVD; modified sit-ups for
NSVD & C/S, Breast Care
Family Planning options [condoms, depo, OC’s, IUD]
Keep 6 week PP appt.
Maternal Warning Signs to Report
a] Bathing, cord care, circumcision care, diapering
b] Feeding, burping, scheduling feedings [mom can keep chart]
c] Temperature, skin color [dusky], newborn rash, jaundice
d] Stool & voiding [BM’s ; 6 or more voids/day]
e] Back to Sleep [SIDS]
Newborn warning signs:
1. Diarrhea, constipation
2. Colic, repeated vomiting esp. projectile vomiting
3. Fever [temp. 100.0 Rectal or greater]
4. S/S inflammation/ infection @ cord stump [yellow drng.]
5. Bleeding @ circumcision site
6. Rash, jaundice
7. Deviation from normal patterns [long period of sleep >5 hrs.; projectile
vomiting, etc. R/O sepsis; intestinal obstruction]