POSTPARTUM: (4th Trimester | Puerperium) From birth to return of reproductive organs to pre-pregnant state 6-12 weeks THE UTERUS Involution: uterus decent into the pelvic cavity 1-2cm Q24 hours ... Returns to 16wk size (grapefruit) immediately after birth Day 6 – halfway b/w symphysis & umbilicus Day 9-10 – not palpable abdominally o Documentation – Firmness & Location (FF U-2) Subinvolution: Uterus does NOT return to pre-pregnancy size over 6 wks Causes: Retained placental fragments | infection| long difficult labor | over distended uterus | full bladder AFTERPAINS Contractions after childbirth that compress uterine muscle fibers to clamp off myometrial blood vessels o Pains are more intense in multiparas and with breastfeeding Putting baby to breast stimulates endogenous oxytocin release or give IV bolus. o prophylactic use of oxytocics reduces PP hemorrhage by half & therapeutic use by 70% PLACENTAL SITE Constriction and thrombosis cause nodularity Endometrium grows over site and causes sloughing of necrotic tissue, allowing normal implantation and placentation in future pregnancies Usually completed by 6 weeks PP LOCHIA Rubra – red and bloody, birth to 2-4 days PP, may have small clots Serosa – pink or brown, begins 3-4 days PP and may last 22-27 days Alba – Primarily leukocytes, may drain 6wks or longer PP. Average 10 – 14 days Multiparas have heavier bleeding | bleeding may be lighter in cesarian CERVIX Shortens and firms within 18 hours Lower segment edematous, thin, and fragile for several days Ectocervix is bruised and has small lacerations OS closes over 2 weeks Has a slit “fish mouth” appearance – new norm VAGINA & PERINEUM Vagina returns to normal size over 6-8 weeks, rugae reappear in 3 weeks, but they are never as prominent again. Reduced estrogen in lactation decreases vaginal mucous Introitus (opening) is erythematous and edematous Hemorrhoids Perineum may be swollen/bruised (ice pack, examine opening) PELVIC MUSCULAR SUPPORT May take 6 months to regain tone May be injured in birth and lead to future gynecologic problems Kegel exercises should be encouraged before and after birth ENDOCRINE SYSTEM Delivery of the placenta leads to reduced human chorionic somatomammotropin, estrogens, cortisol, and the placental enzyme insulinase * Estrogen & Progesterone drop immediately after placenta separates and delivers Lowest level at about 1 wks Helps with lactation, diuresis of excess extracellular fluid (remember fluid volume doubled) – lots of sweating and increased urinary output Ovulation occurs as early as 27 days after birth in non-lactating women; periods may return within 6-12 weeks – remind moms that they don’t have to have a period to get pregnant Ovulation occurs at an average of 6 months in breastfeeding women and can occur before the return of menses (mom has to feed EVERY 3 HOURS) Prolactin levels responsible for breastfeeding - suppresses ovulation [Show More]
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