POSTPARTUM CARE REVIEWER

(ni opi)
POST-PARTUM PERIOD

• Antepartal / Prenatal Period: Period between conception and the onset of labor.

• Intrapartal Period:

• Extends from the beginning of contractions that cause cervical dilatation

to the first 1 to 4 hours after delivery of the newborn and placenta.

• Postpartal Period:

• Interval between the birth of the Newborn and the return of maternal
reproductive organs to their normal non-pregnant state.

o Puerperium – latin puer “child” and parere “to bring forth”

o Refers to the 6-week period after childbirth

o Post partum; fourth trimester in pregna

Postpartum Warning Signs and Symptoms to Report

• Increased bleeding, clots or passage of tissue

• Bright red vaginal bleeding any time after birth

• Pain greater than expected

• Elevated temperature

• Feeling of full bladder accompanied by inability to void

• Enlarging hematoma

• Feeling restless accompanied by pallor, cool, clammy skin, rapid heart rate,
dizziness and visual disturbance

• Pain, redness, and warmth accompanied by firm area in the calf

• Difficulty breathing rapid heart rate, chest pain, cough, feeling of apprehension,
pale, cold or blue skin color

POSTPARTUM PERIOD BREAKDOWN

• Immediate postpartum period (First 24 hours)

• Early postpartum period (First week)

• Late postpartum period (2nd to 6th week)

The focus of Nursing Care is:
• Woman’s physiologic recovery, psychologic well-being, and her ability to
care for herself and her new baby.
• The nurse supports by strategically planning for the entire family's
adjustment to the new baby.
MATERNAL ADAPTATIONS:
I. PHYSIOLOGIC CHANGES

• Reproductive System

• Involution: Returning to normal size of the uterus, cervix & vagina, to a

non-pregnant state following birth.

• Subinvolution: Failure of the uterus to return to a non-pregnant state due

to retained placental fragments and infection.

UTERUS (contraction and involution)

• Area where the placenta was implanted sealed off to prevent bleeding.

o Contracts inward to seal off the open blood vessels at the former site of the
placenta (7cm wide).

• Uterus reduced to its approximate pregestational size.

o Full term – 11 times its prepregnancy weight.

o After birth – 1000g,
o 1 week after birth – 500g,
o 2 weeks after birth – 350g,
o 6 weeks after birth – 50 to 60g. (involution is complete)

Involution – caused by uterine contraction.

- Assessed by measuring the fundal height.

Few minutes after birth – fundus is firm; midline halfway between the umbilicus &
symphysis pubis

One hour – contracted firmly ; midline at the level of the umbilicus

One day – 1 cm below the umbilicus

9th or 10th day after delivery - the uterus once again lies in the true pelvis

Factors Promoting Contraction & Involution:

• Breastfeeding

• Early ambulation

• Proper nourishment

✓ Normally, Fundus in the midline of the abdomen

✓ Full bladder deviates it from the midline, pushing it upward & to the side
preventing uterine contraction leading to excessive bleeding.
✓ It is vital that the uterus remains firm and well contracted It is vital that the uterus
remains firm and well contracted
✓ UTERINE ATONY - If fundus is boggy (soft or flabby) & relaxed during the 1 st hour
after birth; rapid blood loss. UTERINE ATONY - If fundus is boggy (soft or flabby) &
relaxed during the 1st hour after birth; rapid blood loss.
✓ Oxytocin (Pitocin) is usually administered intramuscularly immediately within 1
minute after birth of the baby.
✓ Mothers are encouraged to breastfeed the baby immediately after birth
because suckling stimulates oxytocin* release.
✓ The uterus of a breastfeeding mother may contract even more quickly, because
oxytocin which is released with BF stimulates uterine contraction. However, BF
alone is not enough to protect against postpartum hemorrhage.
✓ AFTERPAINS – uterine cramping; usually being felt by women with large babies
and multifetal gestation & with breastfeeding. The uterus was greatly distended

Lochia (Post birth Uterine Discharge)

• Lochia rubra

• Blood – dark red and has fleshy odor, 1-3 days, small to moderate
amount, fragments of decidua and mucus.

• Lochia serosa

• 4-10 days, minimal to scanty, brownish to pinkish in color.

• Lochia alba

• After 10 days to 3 weeks, white or pale yellow.

OVARY

• Ovulation can occur as soon as 3 weeks after delivery.

• Menstrual period begins 6-8 weeks in non-breastfeeding mothers.

 • Prolactin levels rise progressively during pregnancy, responsible for initial
lactation.

• Lactation suppresses ovulation until 18 months.

• For Non-lactating women, the prolactin level declines after birth and reach the
prepregnant range in 3-4 weeks.

CERVIX

• Becomes soft and malleable immediately after birth.

• External cervical OS never regains its pre-pregnant appearance; appears as a

jagged slit that is often described as a “fish mouth”

• Internal OS – closes after few days

• External OS – end of 7 days narrowed to about the size of a pencil op

• Complete cervical involution may take 3 to 4 months.

VAGINA

• Vaginal walls are soft with few rugae.

• Small tears will heal without intervention.

• Diameter of the introitus becomes smaller by contraction.

• For breastfeeding mothers- continue to have thin walled or fragile vaginal cells
that cause slight vaginal bleeding during sexual intercourse until 6 weeks

• Kegel’s exercise for rapid increase in strength & tone of the vagina for sexual
enjoyment

PERINEUM

• Develops edema & generalized

o tenderness; may appear bruised.

• Labia minora & majora remain

o atrophic and softened after birth.

INTEGUMENTARY SYSTEM

• Striae gravidarum (stretch marks) on breast, abdomen and thigh may fade but
usually do not disappear.

• Stretch marks on the abdomen still appear reddened after birth

• Chloasma and linea nigra are barely detectable in 6 weeks

• Profuse diaphoresis occurs in the immediate postpartum period.

GASTROINTESTINAL SYSTEM

• Digestion and absorption begin to be active soon after birth.

• Passage of stool may be slow due to the effect of relaxin.

• Hunger and thirst are common after delivery.

• Constipation commonly occurs during early postpartum period due to

decreased intestinal muscle tone, perineal discomfort, and anxiety

• Hemorrhoids (distended rectal vein) are common problem in the early

postpartum period due to pressure on the pelvic floor and straining during labor

HORMONES

• Pregnancy hormones begin to decrease as soon as placenta is no longer

present.

• FSH remains low for about 12 days, then begins to rise as new menstrual cycle is
initiated.

• Estrogen & Progesterone levels drop after expulsion of the placenta.

CIRCULATORY SYSTEM

• Transient bradycardia occurs for 24 to 48 hrs after delivery.

• Blood volume decreases to non-pregnant levels by 4 weeks after delivery.

• Hematocrit rises by the 3rd to 7th postpartum days.

URINARY SYSTEM

• Extensive diuresis immediately after birth due to fluid accumulation during

pregnancy.

• Daily urine output of 1,500 to 3,000 ml during 2nd to 5th day after birth.

BREAST

• Breastfeeding mothers feel a lump or mass at the breast which is a filled milk sac
that consists of a yellowish fluid

• Tenderness may persist for about 48 hours after the start of lactation.

• Colostrum is present for the first few days after childbirth.

• For the non-breastfeeding mother, the breasts generally feel nodular, that is
bilateral.

• Prolactin levels drop rapidly. And reaches the pre-pregnant range in 3-4 wks
 • Palpation of breast on the 2nd and 3rd day, as milk production begins, may
reveal tissue tenderness.

• Colostrum – antibody-rich breast secretion that is the precursor to breast milk

• Colostrum excreted by the breast in the last weeks of pregnancy & continues to
be excreted in the first few postpartum days

• Prolactin – stimulates milk production

• Prolactin rises its level due to continuous suck

BREAST ENGORGEMENT

• The breasts are distended, firm, and warm to touch due to vasocongestion.

• vasocongestion – caused by the temporary congestion of lymphatics

rather than the accumulation of milk

• Engorgement resolves spontaneously within 24 to 36 hours.

VITAL SIGN CHANGES

• Temperature:

o Normal Findings: Slight increase in the first 24 hours due to dehydration.

o Deviation from normal and probable causes: Temp. of 38C after 24hrs
after childbirth or persists for 2 days – postpartal infection

• Pulse:

o Normal Findings: Usually slightly slower than normal during the postpartal
period.

o Deviation from normal and probable causes: A rapid PR or one that is

increasing may have hemorrhage

• Blood Pressure:

o Normal Findings: Altered slightly, orthostatic hypotension may occur.

o Deviation from normal and probable causes: Decrease BP may indicate

bleeding, Elevation above 140/90 may indicate postpartal PIH, Oxytocin
administered for uterine contractions can increase the BP