ANATOMY AND PHYSIOLOGY

PARTS AND FUNCTION OF FEMALE REPRODUCTIVE SYSTEM

EXTERNAL GENITALIA
The external female genitalia structures are referred to collectively as the vulva a latin word for
“covering”. It serves as a protection to the woman/s sexual organs, urinary opening, vestibule and
vagina.

MONS PUBIS
The mons pubis is a rounded mound of fatty tissue that covers the pubic bone. During puberty, it
becomes covered with hair. The mons pubis contains oil-secreting (sebaceous) glands that release
substances that are involved in sexual attraction (pheromones).

LABIA MAJORA
The labia majora (literally, large lips) are relatively large, fleshy folds of tissue that enclose and protect
the other external genital organs. They are comparable to the scrotum in males. The labia majora
contain sweat and sebaceous glands, which produce lubricating secretions. During puberty, hair appears
on the labia majora.

LABIA MINORA
These are the folds of tissue that is fused anteriorly and separated posteriorly positioned lateral to the
labia minora. It’s internal surface is made up of mucous membranes and the external surface is covered
with skin, it is also composed of fine layer of pubic hair and serves as a protection of external genitalia
and acts as a shield to urethra and vaginal opening.
CLITORIS
It is a small rounded organ of erectile tissue at the anterior junction of labia minora. It is usually 1 to 2
cm in size and is the center of sexual arousal and orgasm in woman.

URETHARAL OPENING
Female urethral opening: The external opening of the transport tube that leads from the bladder to
discharge urine outside the body in a female.

HYMEN
A tough elastic semicircle tissue that covers the opening of the vagina during childhood. It is often
torn during the time of the first sexual intercourse. However, hymen can’t be utilized as a sign of
“virginity”

VAGINAL ENTRANCE
The opening is where menstrual blood leaves the body. It's also used to birth a baby and for sexual
intercourse.

SKENE AND BARTHOLIN GLANDS

Skene glands (paraurethral glands) are two glands that is located on each side of the urethra
while Bartholin glands (vulvovaginal glands) are located on each side of the vaginal opening. Both
of these glands produce secretions that lubricate the external genitalia during sexual intercourse.
The alkaline pH of those secretions also increases the survivability rate of the sperm in the vagina.

FOURCHETTE
Is the ridge of tissue formed by the posterior joining the labia minora and the labia majora. This is the
structure that sometimes tears (laceration) or is to cut (episiotomy) during childbirth to enlarge the
vaginal opening.
 INTERNAL GENITALIA OF FEMALE

OVARY
The ovaries are approximately 3 cm long by 2 cm in diameter and 1.5 cm thick, or the size and shape of
almonds. They are located on both sides of the uterus in the lower abdomen. The function of the two
ovaries is to produce, mature and discharge ova (egg cells). In the process of producing ova, the ovaries
also produces estrogen and progesterone with the help of FSH (Follicle Stimulating Hormone) and LH
(Luteinizing Hormone) produced by the pituitary gland. Ovaries are not covered by a layer of
peritoneum so that the ova can readily escape and enter the uterus by the fallopian tubes.

UTERINE TUBE
The primary function of the uterine tubes is to transport sperm toward the egg, which is released by the
ovary, and to then allow passage of the fertilized egg back to the uterus for implantation.

URINARY BLADDER
Bladder. This triangle-shaped, hollow organ is located in the lower abdomen. It is held in place by
ligaments that are attached to other organs and the pelvic bones. The bladder's walls relax and expand
to store urine, and contract and flatten to empty urine through the urethra.

FALLOPIAN TUBE
These are narrow tubes that are attached to the upper part of the uterus and serve as pathways for the
ova (egg cells) to travel from the ovaries to the uterus. Fertilization of an egg by a sperm normally occurs
in the fallopian tubes. The fertilized egg then moves to the uterus, where it implants to the uterine
lining.

UTERUS
Uterus, also called womb, an inverted pear-shaped muscular organ of the female reproductive system,
located between the bladder and the rectum. It functions to nourish and house a fertilized egg until the
fetus, or offspring, is ready to be delivered.

A uterus is about 5 to 7 cm long, 5 cm wide, and 2.5 cm deep. Ina non pregnant state it weighs about 60
g. The function of the uterus is to receive the ovum from the fallopian tube, provide a place for
implantation and nourishment, serve as a protection to the growing fetus and at the maturity of the
fetus expel it from the body. After pregnancy, uterus never returns to the nonpregnant size but remains
approximately 9 cm long, 6 cm wide, 3 cm thick, and 80 g in weight. . The fundus (uppermost portion of
the uterus) can be palpated abdominally to determine the amount of uterine growth during pregnancy,
to measure the force of uterine contractions during labor, and to assess that the uterus is returning to
its nonpregnant state after childbirth.

VAGINA
The vagina is a muscular, ridged sheath connecting the external genitals to the uterus, where the
embryo grows into a fetus during pregnancy. In the reproductive process, the vagina functions as a two-
way street, accepting the penis and sperm during intercourse and roughly nine months later, serving as
the avenue of birth through which the new baby enters the world. The vagina ends at the cervix, the
lower portion or neck of the uterus. Like the vagina, the cervix has dual reproductive functions.
PHYSIOLOGY OF CONCEPTION
Conception is the initial stage in humans that allow for the establishment of pregnancy. Coitus is the
word we use to refer to sexual intercourse resulting in the deposition of sperm in the vagina at the level
of the cervix. After sperm has been deposited at the cervix it is transported to the uterus where it
fertilises the ovum and implants in the uterine stroma.

Transport of Sperm
Following coitus, a small percentage of the millions of sperm deposited at the cervix will reach the site of
fertilisation. In order for conception to occur these sperm must travel to the ampulla in the fallopian
tube and undergo a series of steps that will allow it to then penetrate the cell layer surrounding the
oocyte and so fertilise it.

Oxytocin stimulates uterine contraction which, along with the sperms’ own propulsive activity, aids in
transporting the sperm and helping it travel. In order for sperm to penetrate the oocyte it undergoes
capacitation. Capacitation reorganises the sperm cell membrane and results in the tail movement
changing from a beat-like action to a thrashing whip-like action to help propel the sperm forward.

The changes that occur in capacitation induced by the removal of the protein coat of sperm exposes
acrosome enzymes. Therefore, capacitation is vital to allowing the acrosome reaction to occur – which
will allow penetration of the zona pellucida.

The Zona Pellucida

The zona pellucida specific cell surface glycoproteins (ZP3 proteins) interact with the capacitated sperm
and allow calcium to enter the spermatozoa, which results in an increase in intracellular cAMP. The
acrosome then swells and its outer membrane fuses with the sperm plasma membrane. This leads to
the release of enzymes from the acrosome into the space surrounding the head of the sperm.

The inner cell membrane of the acrosome is then exposed and another glycoprotein (ZP2) holds the
sperm near the egg. The proteolytic enzymes released from the acrosome then allow for penetration of
the zona pellucida by the whip-lashing sperm.

Changes Following Penetration of the Zona Pellucida

Penetration of the zona pellucida allows the sperm and oocyte cell membranes to fuse almost
immediately. Calcium enters the oocyte and the sperm cell stop moving. The rise in intracellular calcium
results in 3 changes in the oocyte:

The egg cell membrane depolarises in order to prevent polyspermy – this is the primary block.
The cortical reaction occurs, which is where cortical granules that lie just beneath the egg cell
membrane fuse with the membrane and release their contents into the zona pellucida. This is a
secondary block to polyspermy as it hardens the zona.
The egg will complete the final meiotic division – this forms a polar body that is subsequently released.
Following fertilisation the zygote undergoes several changes which will result in the implantation within
the wall of the uterus in a successful pregnancy.

https://teachmephysiology.com/reproductive-system/pregnancy/conception/

HYPHOTALAMUS
The release of GnRH also called luteinizing hormone-releasing hormone in the hypothalamus
initiates the menstrual cycle. GnRH then stimulates the pituitary gland to send the
gonadotrophic hormone to the ovaries to produce estrogen.

PITUARY GLAND
Under the influence of GnRH, the anterior lobe of the pituitary gland produces two hormones,
the
FSH (Follicle Stimulating Hormone) and the LH (Luteinizing Hormone). The FSH is responsible
for the maturation of the ovum and the LH is responsible for the release of the mature egg cell
from the ovary.

OVARIES
FSH and LH are called gonadotrophic hormones because they cause growth in the ovaries.
Every month during the fertile period of a woman’s life one of the ovary’s oocytes is activated
by FSH to begin to grow and mature. As the oocyte grows, its cells produce a clear fluid that
contains a high degree estrogen and progesterone. If conception occurs as the ovum proceeds
down a fallopian tube and the fertilized ovum implants on the endometrium of the uterus, the
corpus luteum remains throughout the major portion of pregnancy. If conception does not
occur the unfertilized ovum atrophies after 4 to 5 days.

UTERUS
Uterine changes occur monthly as a result of stimulation from the estrogen and progesterone
produced by the ovaries preparing the endometrium for a possible implantation.

ANTEPARTUM PRENATAL

A. Fertilization: A Sperm and an Egg Form a Zygote

 - During sexual intercourse, some sperm ejaculated from the male penis swim up through
the female vagina and uterus toward an oocyte (egg cell) floating in one of the uterine
tubes. The sperm and the egg are gametes. They each contain half the genetic
information necessary for reproduction. When a sperm cell penetrates and fertilizes an
egg, that genetic information combines. The 23 chromosomes from the sperm pair with
23 chromosomes in the egg, forming a 46-chromosome cell called a zygote. The zygote
starts to divide and multiply. As it travels toward the uterus it divides to become a
blastocyst, which will burrow into the uterine wall.

B. The Zygote Becomes an Embryo: Development Prior to and During

Implantation

- A fertilized egg, or zygote, takes about five days to reach the uterus from the uterine
tube. As it moves, the zygote divides and develops into a blastocyst, with an inner mass
of cells and a protective outer ring. The blastocyst attaches to the wall of the uterus and
gradually implants itself into the uterine lining. During implantation, its cells
differentiate further. At day 15 after conception, the cells that will form the embryo
become an embryonic disc. Other cells begin to form support structures. The yolk sac,
on one side of the disc, will become part of the digestive tract. On the other side, the
amnion fills with fluid and will surround the embryo as it develops. Other cell groups
initiate the placenta and umbilical cord, which will bring in nutrients and eliminate
waste.

C. In Eight Weeks, the Embryo Develops; By the End of Week

10 It Becomes a Fetus

- Fifteen days after conception marks the beginning of the embryonic period. The embryo
contains a flat embryonic disc that now differentiates into three layers: the endoderm,
the mesoderm, and the ectoderm. All organs of the human body derive from these
three tissues. They begin to curve and fold and to form an oblong body. By week 4, the
embryo has a distinct head and tail and a beating heart. Over the next six weeks, limbs,
eyes, brain regions, and vertebrae form. Primitive versions of all body systems appear.
By the end of week 10, the embryo is a fetus. (Note: Pregnancy is often measured in
terms of gestational age—age of the fetus starting with the first day of a woman’s last
menstrual period—and embryonic or fetal age—actual age of the growing fetus. We are
referring to the gestational age of the fetus.)
https://www.visiblebody.com/learn/reproductive/reproductive-process?
__cf_chl_managed_tk__=MAWgIc22OIG1ypRtNUMg3XTOoQ0VT6_08F8RVC31B7I-
1643553414-0-gaNycGzNCZE

SIGNS OF PREGNANCY
PRESUMPTIVE PROBABLE POSITIVE

Nausea – with or Increased Fetal heart sounds

without vomiting frequency of
urination

Breast Braxton hicks Ultrasound

enlargement contractions scanning of the
fetus

Fatigue Abdominal Palpation of fetus

enlargement
 Poor sleep Goodell`s sign Fetal movements

Constipation Chadwick sign

Within 24 hours after fertilization, the egg that will become your baby rapidly divides into many
cells. By the eighth week of pregnancy, the embryo develops into a fetus. There are about 40
weeks to a typical pregnancy. These weeks are divided into three trimesters.

Pre-embryonic - First 2 weeks, beginning with fertilization

Embryonic – weeks 3 through 8

Fetal – from week 8 through birth

Fertilization – also referred to as conception or impregnation. It is the union of

spermatozoon
and ovum (zygote)
Implantation – once fertilization is complete, a zygote migrates over the next 3
to 4 days toward
the body of the uterus. Aided by the muscular contractions of the fallopian tubes.
During this time,
mitotic cell division or cleavage begins. Over the next 3 – 4 days large cells tend to
connect at the
periphery of the ball leaving a fluid space surrounding an inner cell mass. At this
stage, the
structure is termed as the blastocyst. The cells in the outer ring are called
trophoblast cells these
are the structure that will later form the placenta and membranes

EMBRYONIC STAGE AND FETAL STRUCTURE

DECIDUA
- After fertilization, the corpus luteum in the ovary continues to function rather than
atrophying under the influence of human chorionic gonadotrophin hCG secreted by the
trophoblast cells. The endometrium is now typically termed as the decidua (latin word for
falling off) because it will be discarded after birth.

CHORIONIC VILLI
- As early as 11th or 12th day after fertilization, chorionic villi reach out from the
trophoblast cells into the uterine endometrium to begin formation of the placenta

PLACENTA
- Latin for “pancake” grows from few identifiable trophoblastic cells at the beginning of
pregnancy to an organ 15 to 20 cm in diameter covering about the half the surface area of the
internal uterus at term. As early as the 12th day of pregnancy, maternal blood begins to collect
in the intervillous spaces of the uterine endometrium surrounding the chorionic villi. By the
third week, oxygen and other nutrients such as glucose, amino acids, fatty acids, minerals,
vitamins and water osmose from the maternal blood through the cell layers of the chorionic
villi. From there, nutrients are transported to the developing embryo.

AMNIOTIC MEMBRANES
- The chorionic villi on the medial surface of the trophoblast gradually thin until they
become chorionic membrane the outermost fetal membrane. The amniotic membrane forms
beneath the chorion. It is a dual walled sac with the chorion as the outmost and the amnion as
the innermost part. They have no nerve supply, so when they spontaneously rupture at term
the pregnant woman doesn’t feel any pain.

AMNIOTIC FLUID
- This fluid never becomes stagnant because it is constantly being newly formed and
absorbed by direct contact with the fetal surface of the placenta. At term, the amount of
amniotic fluid has grown so much it ranges from 800 – 1,200 ml. If for any reason the fetus is
unable to swallow excessive fluid may occur or hydramnios may occur (fluid more than 2000
ml). As soon as the fetal kidneys become active, fetal urine adds to the quantity of the amniotic
fluid any disturbance may cause oligohydramnios or reduced amount of amniotic fluid. The
most important purpose of the amniotic fluid is to shield the fetus against pressure or a blow to
a mother’s abdomen, protects the fetus in changes of temperature and it allows muscular
development on the fetus.

PHYSIOLOGICAL CHANGES IN PREGNANCY

RESPIRATORY CHANGES

- There is a significant increase in oxygen demand during normal pregnancy. This is due to a 15%
increase in the metabolic rate and a 20% increased consumption of oxygen. There is a 40–50%
increase in minute ventilation, mostly due to an increase in tidal volume, rather than in the
respiratory rate.

PITUARY GLAND

- The pituitary gland enlarges in pregnancy and this is mainly due to proliferation of prolactin-
producing cells in the anterior lobe. Serum prolactin levels increase in the first trimester and are
10 times higher at term.

INTEGUMENTARY CHANGES

- As the uterus increases in size, the abdominal wall must stretch to accommodate it. This
stretching can cause rupture and atrophy of the segment os connective lare of the skin leading
to streaks of lines or “stretch marks” on the sides of the abdominal wall called the Striae
gravidarum. After birth these lines lighten to a silvery color and became barely noticeable. Extra
pigmentation generally appears on the abdominal wall because of the melanocytestimulating
hormone from the pituitary. A narrow brown line called the linea nigra shows from the
umbilicus to the symphysis pubis. Darkened and reddened areas may appear on the face as well,
particularly on the nose and cheeks known as melasma or the “mask of pregnancy”.

BREAST CHANGES

- Typical changes in breasts often show at about 6 weeks of pregnancy. These changes are a
feeling of fullness, tingling, or tenderness that occurs because of the increased stimulation of
breast tissues by the high estrogen level in the body. The areola of the nipple darkens and
increases in diameter from about 3.5 cm to 7.5 cm. This changes also happens because the
breasts begin readying themselves for secretion of milk.
RESPIRATORY CHANGES

- As the uterus enlarges so much during pregnancy, the diaphragm and the lungs receive an
increasing amount of pressure. This can actually displace the diaphragm by as much as 4 cm
upward. Two major changes do occur with pregnancy: a more rapid than usual breathing rate
918 to 20 breaths per min) and a chronic feeling of shortness of breath.

ABDOMINAL CHANGES

- Besides of noticeable changes on the abdomen of the pregnant women during 9 months of
gestation such as an expanding belly, enlargement of the uterus and weight gain, a pregnant
woman also experiences some nausea and vomiting. It is also known as morning sickness; it
begins to be noticed at the same time levels of hCG and progesterone begin to rise.

URINARY CHANGES

- Like other systems, the urinary system undergoes physiologic changes during pregnancy. These
includes alteration in fluid retention and renal, ureter, and bladder function which results from
the effects of high estrogen and progesterone levels, compression of the bladder due to the
growing fetus, increased blood volume that increases urine production by the kidney and
postural influences.

VAGINAL CHANGES
- Pregnancy hormones can cause an increase in vaginal discharge, but this should be clear,
mucous, non-irritant and non-smelly. Not long after delivery, the woman will have a vaginal
secretion made generally of blood and what is left of the uterine coating from pregnancy. This is
called lochia and can keep going for half a month. Changes in vaginal discharge can begin as
early as one to two weeks after conception. As the pregnancy progresses, this discharge usually
becomes more noticeable, and it's heaviest at the end of pregnancy. The vaginal area can feel
painful or sore in the immediate period after childbirth. This usually improves within 6 to 12
weeks after the birth

SKIN CHANGES

- A temporary shift in immunologic, metabolic, and hormonal factors during pregnancy leads to
physiological dermatologic manifestations including hyperpigmentation, hair and nail changes,
vascular changes, and shifts in apocrine and eccrine gland activity.
 PHYSIOLOGY OF LABOR

Labor is the physiologic process through which the fetus is released from the uterus and
delivered into the outside world.. It involves the sequential integrated changes in the
uterine decidua and myometrium. Labor usually starts two weeks before or after the
estimated date of delivery. The muscles of your uterus contract and then relax during
contractions. Contractions aid in the expulsion of your baby from your uterus.

First Stage of dilation

It begins with the initiation of true labor contraction and ends when the cervix is fully dilated.
There are 3 different Phases at this stage: latent, active and transition phase.

Latent Phase
Begins at the onset of regularly perceived uterine contraction and end ends when slow cervical dilation
begins. The contraction are mild and short, it last for 10- 30 seconds and the cervix dilates from 0 to
3cm. The contraction cause only a minimal discomfort and can be managed by controlled breathing.

Active Phase
The cervical dilation occurs rapidly and contraction are moderate, it grow stronger and lasting 30-45 sec
and 3-5 minutes apart. It shows increased vaginal secretion, this phase can be difficult because of
continues grow of pain and begins to experience true discomfort.

Transition Phase
the maximum cervical dilation is 8-10 cm and contraction reach peak of intensity which is very regular and strong.
Show is occur as the last mucus plug from the cervix is released.

Second Stage
With or without maternal pushing, the fetus falls into the vaginal canal once cervical dilatation is
complete. Fetus begins descent descent and as the fetal head touches the internal perineum to begin
rotation, the perineum begins to bulge and appear tense. The fetus passes through the birth canal via 7
movements known as the cardinal movements.
Stage 3
Begins with the birth of the infant and ends with the delivery of the placenta. The third stage of labor
commences when the fetus is delivered and concludes with the delivery of the placenta. Separation of
the placenta from the uterine interface is hallmarked by three cardinal signs, including a gush of blood
at the vagina, lengthening of the umbilical cord, and a globular shaped uterine fundus on palpation.
Placental separation is delivered using one hand on umbilical cord with gentle downward traction. The
other hand is on the abdomen supporting the uterine fundus. As the placenta separates, its edges
tends to fold on itself like an umbrella and presents at the vaginal opening with fetus surface
evident.

Stage 4
Placental expansion refers to the time when the delivery of the placenta, once the separation occurred
the placenta delivers either by the natural bearing-down. the placenta needs to be inspected after
delivery to certain it is intact and part of it was not retained.
 7 CARDINAL MOVEMENT OF LABOR

Engagement

fetal presenting part as its widest diameter reaches the level of the ischial spine of the pelvis

Descent
movement of the bi-parietal diameter of the fetal head downwards until it reaches the pelvic
inlet.

Flexion
Fetal head reaches the pelvic floor; head bends forward onto chest, presenting the smallest
anteroposterior diameter.

Internal Rotation
fetus enters pelvic inlet to the maternal pelvis, allows longest fetal head to match the longest
maternal pelvic diameter.

Extension
Internal rotation is complete, fetal head passes beneath the symphysis pubis while in flexion.

External Rotation
as the head is delivered, it rotates back to its original position prior to internal rotation. The
release of the Passive forces on the fetal head allows it to return to appropriate position.
Expulsion
delivery of the fetus, occurs first as the anterior, then the posterior shoulder passes under the
symphysis pubis.

Signs of Labor : True vs False Labor

SIGNS OF LABOR
 Your baby drops or moves lower into your pelvis. This is called lightening. It means
that your baby is getting ready to move into position for birth. It can happen a few weeks
or even just a few hours before your labor begins.
 You have an increase in vaginal discharge that’s clear, pink or slightly
bloody. This is called show or bloody show. It can happen a few days before labor starts
or at the beginning of labor. 
 At a prenatal checkup, your health care provider tells you that your cervix has
begun to efface (thin) and dilate (open). Before labor, your cervix is about 3.5 to 4
centimeters long. When it’s fully dilated (open) for labor, it’s 10 centimeters. Once labor
starts, contractions help open your cervix. 
 You have the nesting instinct. This is when you want to get things organized in your
home to get ready for your baby. You may want to do things like cook meals or get the
baby’s clothes and room ready. Doing these things is fine as long as you’re careful not to
overdo it. You need your energy for labor and birth.

TRUE AND FALSE LABOR (CONTRACTIONS)

The timing of the contractions is a big component for recognizing the differences between true
and false labor. Other differences you might notice include the contractions changing when you
change positions, like stopping with movement or rest. The strength of contractions is also
different, and the pain is felt in different places.

True labor False labor (Braxton-Hicks contractions)

 Contractions come and get closer
together over time, lasting about 30-70
seconds each
 They continue regardless of movement or
resting
 They progressively get stronger
 Usually they start in the back and move to
 Contractions don’t come regularly and
they don’t get closer together
 They stop with walking or resting or with
changes in position
 They are usually weak and don’t get
stronger, or start strong and get weaker
 Usually the pain is only felt in the front
 the front
 contractions come at regular intervals and
get closer together as time goes on.
(Contractions last about 30 to 70
seconds.).
 contractions continue, despite moving or
changing positions.
 contractions are often irregular and do not
get closer together.
 contractions might stop when you walk or
rest, or might even stop when you change
position.
 PHYSIOLOGY OF POST-PARTUM

A. POST-PARTUM ASSESSMENT AND PHYSIOLOGICAL CHANGES

ASSESSMENT

An assessment on any patient is always considered to be from head to toe. In the

postpartum patient, the assessment EXPANDS to also include the following (starting from top to
bottom):

BREASTS
Palpate each breast for firmness, fullness, tenderness, shininess, and contour. Does the
mom complain of sore nipples, are the nipples red, cracked or bleeding? Is she wearing a support bra?
Encourage all moms to wear a support bra whether nursing or non-nursing.

UTERUS
It is firm or is it boggy? The fundus should be firm; if not, gently massage to obtain firmness
and note if excess bleeding or clots are expelled during the massage. What is the fundal height? It
should decrease in height by one fingerbreadth below the umbilicus each day post delivery. Nursing
mothers may involute a little more quickly due to the release of oxytocin while nursing. It is best to have
the mother void and then have her lie flat in bed before checking fundal height. If the fundus is above
the
uterus or displaced to the right or left, the mom may have a full bladder or retained placenta fragments.

C-SECTION
If the patient had a C-Section, inspect the dressing or incision at this time noting site,
redness, discharge, and approximation of the incision if uncovered. Don't forget to check for bowel
sounds.

LOCHIA
When examining the fundus, check the lochia for color, amount, odor, and the number of pads
used. The first two to three days, lochia is bright red, similar to menses and is known as RUBRA. The
next few days lochia becomes serous and more watery and is known as SEROSA. By 10 to 14 days the
lochia is thin and colorless and is known as ALBA. If the lochia has a foul odor, then be suspicious of an
infection. The doctor should be notified of any unusual odor, excessive bleeding, or clotting.

EPISIOTOMY

Inspect the incision for REEDA. (If you do not know what this is, look it up in your
textbook before giving care) Also check for a hematoma. The patient may need to be medicated for
discomfort. Also check the rectum at this time for hemorrhoids and initiate appropriate measures if
uncomfortable to the patient.

ELIMINATION: BLADDER
Is mom voiding, is so, how often and how much. Is bladder distended?
Does she or did she have a catheter? If the catheter has been discontinued, what time was it? All
postpartum patients should void by six hours after delivery or Foley removal. All postpartum moms
should have their urine measured the first three voiding’s to ensure adequate emptying of the bladder.
These voiding’s should be at least 150 cc's. Remember, the mom's blood volume increased during the
second and third trimester, and diuresis takes place to return to pre-pregnancy status.
Frequent, small voiding’s may be indicative of retention or infection. This is a good time to find out if the
mom is performing peri care with each use of the bathroom. If she is not, then by all means teach her
according to the process of your hospital uses. BOWEL: Daily ask the patient if she has had a bowel
movement. If no bowel movement by the second day, she may need a stool softener or a laxative.
Encourage increase in fluid and juices along with increasing intake of fruits and vegetables. Ambulation
helps too.

LEGS
Check Homan's sign, and chart with cardiovascular status.
TEACHING: Talk with your mom during the assessment, and teach her the things about her care
as you go along. EXAMPLE: Peri care when checking the perineum, rationale for sitz bath and
peri light, use of local analgesics, hemorrhoid treatment, rationale for ambulation especially if a
Csection, etc.

PSYCHOSOCIAL
Note mother/father infant bonding and chart. Is mom stroking the infant,
talking to the infant, calling the infant affectionate names, or just looking affectionately at the
infant. A lack of bonding may be noted by bottle feeding the infant in the crib, or spending time
on the phone when the infant is in the room. Evaluate the mom's emotional status, explain the
hormonal changes that are occurring, and that her emotions may change from high to low quickly.
She may cry easily, but these changes are normal. Informing the family members of these
changes helps too.

POSTURAL HYPOTENSION
Caution the mom to move slowly upon sitting or getting out of
bed. Assist her the first few times she is up. Stay in the bathroom or close by the first time she
showers or when taking a sitz bath. Remind her NOT TO LOCK the bathroom or shower doors.
Be CERTAIN your mom can reach and has been instructed in the use of the call bell in the
bathroom or shower as well as her bed.

http://eccdl.dcccd.edu/ADNClin_Handbook/1461/Obstetrics%20unit/POSTPARTUM
%20ASSESSMENT.pdf