POSTPARTUM


Vanneza Trixzy V. Tamparong
 Normal Postpartum

 It is a period following labor during which the
maternal body in general, and the genital organs, in
particular return to the pre-pregnant condition
 Duration is 40 days or 6-8 weeks.
 Another 4 to 6 weeks is needed for complete
involution.
 The puerperal period is much shorter after abortion
 The first ten days are called EARLY POSTPARTUM,
and the days after called the LATE POSTPARTUM.
GENERAL PHYSIOLOGICAL
CHANGES

 Immediately following labor, the general condition
of the mother is on physical fatigue.
 Vital signs:
• Temperature:
Is slightly elevated: 0.5 degree for the first 24 hours and
up to 38 degrees is known. This is due to absorption of
waste products of muscular contractions of labor.
GENERAL PHYSIOLOGICAL
CHANGES

 Vital signs:
• Temperature:
Transient rise in temperature later on is due to:
 Milk engorgement
 Constipation
 Nervous excitation
 Pulse:
Physiological bradycardia (for 24-48 hrs after labor) due to:
 Rest period after labor
 Increase in circulating blood volume after elimination of
placental pool.
GENERAL PHYSIOLOGICAL
CHANGES

 Vital signs:
• Respiration:
Is in usual relation with pulse and temperature.
Is more abdominal in character.
• Blood pressure:
No change is counted, but if hypotension is present,
postpartum hemorrhage is suspected.
If hypertension is present, postpartum toxemia may be
suspected.
GENERAL PHYSIOLOGICAL
CHANGES

 Skin:
-Excessive sweating, particularly in patients who were
subjected to edema in late pregnancy.
This gradually ceases within 1st week and the skin
reacts as usual.
Skin pigmentation gradually disappears.
GENERAL PHYSIOLOGICAL
CHANGES

 Kidneys and urinary output:
Physiological diuresis.
Painful, difficult micturition dues to tears,
lacerations, or episitomy.
Traces of albumin may be present as a result of
muscle involution
Lactosuria is common with milk engorgement on the
4th day at the start of lactation.
GENERAL PHYSIOLOGICAL
CHANGES

 Kidneys and urinary output:
The woman may experience retention of urine in first
few days after labor due to:
Laxity of the abdominal muscles
Inability to micturate in recumbent position
Reflex inhibition due to stiched perineum or bruised
urethra
Atony of the bladder
Compression of the urethra by edema or hematoma
GENERAL PHYSIOLOGICAL
CHANGES

 Bowel function and intestinal elimination:
Thirst is present due to the marked fluid loss through sweat
and urine.
Tendency to atony gastrointestinal tract, with flatulence and
constipation.
CONSTIPATION MAY BE PRESENT DUE TO:
• Intestinal atony
• Anorexia after labor
• Loss of body fluids
• Laxity of abdominal wall
• Hemorrhoids, reflex inhibition, enema in labor.
GENERAL PHYSIOLOGICAL
CHANGES

 Blood picture:
With proper intranatal care, the amount of blood loss
during 3rd stage of labor doesn’t cause anemia.
A moderate increase in leucocytic count.
RBCs count and blood constitutes usually return to
the non-pregnant level in 4-6 weeks.
GENERAL PHYSIOLOGICAL
CHANGES

 Body weight:
-Loss of weight is observed during the 1st 10 days
especially in non-lactating women.
-There is about 4-5kg (sometimes 8kg) due to
evacuation of uterine contents and diuresis.
GENERAL PHYSIOLOGICAL
CHANGES

 After pains:
It is spasmodic cloickly pain in the lower abdomen
during early postpartum days.
It is more common and more sever in multiparas (due to
weak muscle tone), multiple pregnancy,
polyhydraminos, and large sized infants.
Can be precipitated by the presence of blood clots, a
piece of membrane, or placental tissue.
It increases during breast feeding as a result of oxcytocin
secretion stimulation by suckling reflex of infant.
GENERAL PHYSIOLOGICAL
CHANGES

 Return of menstruation:
Non-lactating women begin to menstruate again 6-8
weeks.
In lactating women, usually reappears in 4-5 months,
and in sometimes as late as 24 months
The first period is usually prolonged and profuse.
It should be mentioned that ovulation can commence
in the absence of menstruation, and another
pregnancy can occur.
GENERAL PHYSIOLOGICAL
CHANGES

 Uterus:
Involution of uterus is the return of uterus to its non-pregnant
condition.
 Skin:
Immediately after labor, the fundal level is at the level of
umbilicus.
At the end of first week, the fundus on midway between
umbilicus and symphysis pubis.
By the end of 2nd week, the fundus is just behind the symphysis
pubis, and therafter it becomes a pelvis organ.
 Weight:
By the end of postpartum it weighs 50gms instead of 1000gms
during pregnancy.
GENERAL PHYSIOLOGICAL
CHANGES

 Mechanisms through which involution of uterus
occurs:
- Autolysis
Ischemia (decreased blood supply)
GENERAL PHYSIOLOGICAL
CHANGES

 In the endometrum:
 Separation of placenta and membranes occur in the deeper portion of the
spongy layer of decidua.
 All based layer is shed off in the lochia
 If the involution process is slow or delayed, known as
SUBINVOLUTION.
 If the involution process is rapid, known as HYPERINVOLUTION.
 Lochia:
 It is the uterine discharge coming through the vagina during the first 3-4
weeks postpartum.
 It is alkaline with fleshy odor, and contains blood, leucocytes, dead
decidual tissues, vaginal epithilial cells, cholesterol, and non-pathogenic
bacteria.
GENERAL PHYSIOLOGICAL
CHANGES

 Types of lochia:
• LOCHIA RUBRA: the discharge is red in color, and
lasts from 1st postpartum day, to 4th day (and
sometimes 7th day)
• LOCHIA SEROSA: a pink yellow discharge containing
less blood and more serum, and extends for another 3
to 4 days.
• LOCHIA ALBA: a creamy or white colored discharge
containing leucocytes and mucus.
- It remains for the 10th day postpartum.
 CHARACTERISTICS OF LOCHIA

 Should not be excessive in amount
 Should nor have an offensive odor
 Should not contain large pieces of tissue or blood
clots
 Should not be absent during the first 3 weeks
 Should proceed from rubra - serosa - alba
GENERAL PHYSIOLOGICAL
CHANGES

 Clinical significance of abnormal lochia:
Fetid lochia denotes the presence of infection and/or
stagnation.
Sudden suppression may be due to sever infection.
Prolongation or recurrence of lochia rubra may
suggest retained parts of placenta, membranes,
subinvolution, tumors.
GENERAL PHYSIOLOGICAL
CHANGES

 Vagina:
 The vagina diminishes in size, but not as pregravid stae
 Rugae reappear in third week
 The anterior and posterior walls may be sagging
immediately after labor.
 Vulva:
 Edema, minute or frank lacerations may be seen
immediately after labor.
 The vulva tends to gap for some time after delivery.
GENERAL PHYSIOLOGICAL
CHANGES

 The abdominal wall:
The muscles were over-stretched during pregnancy
and strained during labor, are slow to regain their
normal tone and elasticity.
The recti muscles may separate widely so that the
uterus may be felt between them.
Diastasis recti.
GENERAL PHYSIOLOGICAL
CHANGES

 Breasts:
 Anatomy
 Shape
 Situation
 Structure:
• Axillary tail
• Montogomery’s glands
• Nipples
• Areola
• 15-20 lobes: Alveoli, myoepithelial cells, lactiferous tubules,
lactifeorus ducts, sinuses.
PHYSIOLOGY OF LACTATION

Psychological changes during
postpartum

 PHASES OF MATERNAL ROLE:
- Taking- in phase
Taking- hold phase
Letting- go phase
 Psychological changes
during postpartum

 Taking – in phase:
It takes 2-3 days, during which time the mother’s
first concern is with her own needs (sleep and food)
The woman reacts passively, mostly dependent on
others to meet her needs
She is quite talkative during this phase about every
detail of the labor and delivery experience.
 Psychological changes
during postpartum

 Taking – Hold phase:
It starts 3rd day postpartum
The emphasis is placed on the present
She progresses from the passive individual to the
one who is in command of the situation
This phase lasts about 10 days
Acceptance her role as a mother
 Psychological changes
during postpartum

 Letting – Go phase:
This generally occurs when the mother returns home
Must realize and accept physical separation from the
infant
Must relinquish her former role as a childless person
and accept the enormous implications and
responsibilities of her new situation.
 Development of parenteral love
and Positive family relationship

 Face position- eye to eye contact
 Explore with finger tips
 Hand and palmar contact
 Whole arms- enfolds whole baby close to body
 POSTPARTUM BLUES

 Is the gap between the ideal and reality: the new
mother’s self – expectation may exceed her
capabilities, resulting in cyclic feelings of depression.
 Let-down feelings, irritability, and tears
 Usually is temporary, may be related to hormonal
changes and role transition
 POSTPARTUM BLUES

 Predisposing factors:
The first pregnancy
A pregnancy in late child bearing years
Ambivalence toward the woman’s own mother
Social isolation
Long and hard labor
Anxiety regarding finances
Marital disharmony
Crisis in the extended family
 SUBSEQUENT GENERAL
DAILY CARE

 Check vital signs twice daily (morning and evening)
 A temperature of 38 C, or above for two consequitive days
after first 24 hours is considered an early signs of puerperal
infection.
 Bradycardia is a normal physiological
 Palpate the uterus to assess firmness, level of fundus, and rate
of involution.
 Check lochia for color, amount, odor, consistency, and clots.
 Observe perinum and suture line of redness, ecchymosis,
edema or gapping
 Provide sufficient periods of rest and sleep.
 SUBSEQUENT GENERAL
DAILY CARE

 During the first 8 hours, the mother is encouraged to sleep in
any comfortable position. After that, the prone position or
lateral should be encouraged to facilitate involution and help
drainage of lochia.
 Also, sitting position is recommended to promote contractions
of abdominal muscles and drain lochia
 Supine and semi-sitting should be avoided
 Prevent infection
 Provide diet high in protein and calories to restore tissues
 Roughage and green vegetables to prevent constipation
 Increase in fluid intake
 SUBSEQUENT GENERAL
DAILY CARE

 Voiding should be encouraged within 6-8 hours after labor. If
failed within 12 hours, catheterization is performed
 Encourage early ambulation, and avoid heavy activities
 Encourage postpartum exercise
 Provide treatment for after pains
 Monitor laboratory reports for Hb, HCT, and WBC
 Observe for postpartal blues.
 If Rh negative mother, assess need for administration of anit D
(RhO GAM)
 Discuss resumption of sexual relations
 Discuss community resources that provide maternal services
 SUBSEQUENT GENERAL
DAILY CARE

 BREAST CARE:
 Encourage initiation of breastfeeding
 Breast should be soft, until milk comes in
 Daily cleansing in shower
 Regular examination of breast for complications such as
engorged breast, cracked nipples, mastitis, and breast abscess
 PERINUIM CARE:
 Inspect and observe presence of episiotomy
 Keep area clean and dry
 Teach the mother principles of self-care
 References:

 https://www.google.com/amp/s/slideplayer/amp
/7532063/
 https://www.slideshare.net/mobile/msmaybelle/p
ostpartum-17077732