Embed Doc
Copy Link
Readcast
Collections

CommentGo Back

The postpartum period covers a critical transitional time for a woman, her newborn, andher family on a physical, emotional and social level. In addition to responding to themother's and baby's special needs, care should include the prevention, detection and earlytreatment of complications and disease and the provision of advice and services on breastfeeding, birth spacing and contraception, immunisation and maternal nutrition.Major causes of maternal death worldwide include postpartum haemorrhage, puerperalinfections and pre-eclampsia / eclampsia. Other common complications include urinarytract problems and infections, perineal pain and infection and psychological problems.

INTRODUCTION

— The postpartum period, also known as the puerperium, beginswith the delivery of the baby and placenta. The end of the postpartum period is lesswell-defined, but is often considered the six to eight weeks after delivery because theeffects of pregnancy on many systems have resolved by this time and these systemshave largely returned to their prepregnancy state. However, all organ systems do notreturn to baseline within this period and the return to baseline is not necessarilylinear over time. In some studies, women are considered postpartum for as long as12 months after delivery.

CHANGES OF THE SKIN DURING PREGNANCY

Alterations in hormonal balance and mechanical stretching are responsible for several changes inthe integumentary system. The following changes occur during pregnancy:a. Linea Nigra. This is a dark line that runs from the umbilicus to the symphysis pubis and mayextend as high as the sternum. It is a hormone- induced pigmentation. After delivery, the linebegins to fade, though it may not ever completely disappear.b. Mask of Pregnancy (Chloasma). This is the brownish hyper pigmentation of the skin over theface and forehead. It gives a bronze look, especially in dark-complexioned women. It beginsabout the 16th week of pregnancy and gradually increases, then it usually fades after delivery.c. Striae Gravidarum (Stretch Marks). This may be due to the action of the adrenocorticosteroids.It reflects a separation within underlying connective tissue of the skin. This occurs over areas of maximal stretch--the abdomen, thighs, and breasts. It will usually fade after delivery although theynever completely disappear.d. Sweat Glands. Activity of the sweat glands throughout the body usually increases whichcauses the woman to perspire more profusely during pregnancy.

5-4. CHANGES OF THE BREASTS

a. In early pregnancy, the breast may feel full or tingle, and increase in size as pregnancyprogresses. The areola of the nipples darken and the diameter increases. The Montgomery'sglands (the sebaceous glands of the areola) enlarge and tend to protrude. The surface vessels of

the breast may become visible due to increased circulation and turns to a bluish tint to thebreasts.b. By the 16th week (2nd trimester) the breasts begin to produce colostrum. This is the precursor of breast milk. It is a thin, watery, yellowish secretion that thickens as pregnancy progresses. It isextremely high in protein.c. Nursing implication: Inform the pregnant patient to wear a good, supporting bra.

Physiologic Changes During Pregnancy

GENERAL

The changes that occur in the pregnant patient's body are caused by severalfactors. Many of these changes are the result of hormonal influence, some arecaused by the growth of the fetus inside the uterus, and some are the result of the patient's physical adaptation to the changes that are occurring. This lesson isclosely related to anatomy and physiology.

5-2. CHANGES OF THE REPRODUCTIVE SYSTEM DURING PREGNANCYFigure 5-1. Appproximate heightof the fundus at various weeksof pregnancy.

Changes in the body during pregnancy are most obvious in the organs of thereproductive system.

Uterus

.(1) Changes in the uterus are phenomenal. By the time the pregnancy hasreached term, the uterus will have increased five times its normal size:(a) In length from 6.5 to 32 cm.(b) In depth from 2.5 to 22 cm.(c) In width from 4 to 24 cm.(d) In weight from 50 to 1000 grams.(e) In thickness of the walls from 1 to 0.5 cm.(2) The capacity of the uterus must expand to normally accommodate a seven-pound fetus and the placenta, the umbilical cord, 500 ml to 1000 ml of amnioticfluid, and the fetal membranes.(3) The abdominal contents are displaced to the sides as the uterus grows insize, which allows for ample space for the uterus within the abdominal cavity.(a) Growth of the uterus occurs at a steady, predictable pace.(b) Measurement of the fundal height during pregnancy is an important factor thatis noted and recorded (see figure 5-1).(c) Growth that occurs too fast or too slow could be an indication of problems.(d) The size of the uterus usually reaches its peak at 38 weeks gestation. Theuterus may drop slightly as the fetal head settles into the pelvis, preparing for delivery. This dropping is referred to as "lightening." This is more noticeable in aprimigravida than a multigravida.

NOTE

: Remember a primigravida is a woman pregnant for the first time. Amultigravida is a woman who has been pregnant more than once.b.

Cervix

.(1) The cervix undergoes a marked softening which is referred to as theGoodell's sign."(2) A mucus plug, which is known as "operculum" is formed in the cervical canal.This is the result of enlarged and active mucus glands of the cervix. It serves toseal the uterus and to protect the fetus and fetal membranes from infection. Themucus plug is expelled at the end of the pregnancy. This may occur at the onset