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Postpartum:

When to contact your Healthcare Provider?

With your help, all efforts


will be made in the
postpartum unit to ensure
that your uterus is
contracting at a steady rate
to prevent excessive
bleeding. After you are
discharged from the
postpartum unit and return
home, be sure to contact
your healthcare provider if
you experience a marked
increase in vaginal bleeding
(lochia), accompanied by
lightheadedness and/or
headache- which may be
due to excessive blood loss from inadequate uterine contractions.
Most women do not experience excessive bleeding, infection, and
shock, especially after discharge because thorough measures are
taken in the hospital after birth to assess, prevent and treat these
conditions.
Congratulations on your birth!

Kapiolani Community College:


Associates Degree in Nursing
Program

Uterine Involution

What is Uterine Involution?

What is a retained placenta?

Involution is the contractions of the uterine smooth muscle, causing


afterpains in order to return the uterus to its pre-pregnant state. The fundus is
the top portion of the uterus that may be palpated after birth. Immediately after
birth, the fundus should be firm and midline with the umbilicus.
The uterus rapidly decreases in size from about 2.2 lbs to < 2 oz. over a
period of 6 weeks, while the fundal height gradually descends into the pelvis at
about 1 cm (1 fingerbreadth) a day. By day 10, the uterus will lie in the true pelvis
and should not be palpable.

A retained placenta is when the placenta fails to be delivered within minutes


after the child is born. The physician will administer medication IV to relax,
instead of contract the uterus, to manually or surgically remove the placenta. If
the placenta is implanted within the uterine muscle, the surgical removal of the
entire uterus is warranted in an emergency because excessive blood loss is fatal.
Blood transfusions may also be ordered to replace lost blood.

What if the postpartum womans fundus is not midline with the


umbilicus?
If the postpartum womans fundus is not midline, and sits either to the left or
right of the womans umbilicus, her bladder may be full and urinating will allow
the uterus to return midline with the umbilicus. If the woman is unable to void
after birth, sometimes due to anesthesia during labor, a foley or straight catheter
may be ordered to drain the urine for a short period.
What helps the uterine to contract?
Oxytocin, a hormone produced from the pituitary gland, coordinates and
strengthens uterine contractions naturally after childbirth.
Breastfeeding stimulates the release of endogenous oxytocin from the
pituitary gland. Pitocin is a medical drug that administered postpartum through
the IV route to improve the quality of uterine contractions.
What if the uterine does not contract in a timely manner?
It is important that the uterus contracts and stays firm to prevent the greatest
risks of the postpartum period: infection, shock and hemorrhage. The
contractions of the uterus stops the excessive bleeding from the uterus.
Reasons for ineffective uterine contractions: pelvic infection and
endometritis, excessive vigorous massage of the uterus, and incomplete expulsion
of a placenta or a retained placenta.

What should I expect during the postpartum period?


Immediately postpartum, you may be administered oxytocics (i.e. Pitocin,
Methergene, Hemabate) to ensure effective uterine contractions and prevent
bleeding.
Breastfeeding will also be encouraged, not just for the benefit to the
newborn. Breastfeeding stimulates the pituitary gland in the mother to release
endogenous oxytocin to the body, which facilitates contractions of the uterus.
Your healthcare providers will assess the fundal height, uterine placement,
and uterine firmness at least once a shift after the recovery period has ended.
During the assessment, the nurse will also observe the lochia (normal postpartum
blood flow from uterus) on your perineal pad as the fundus is palpated.
Your nurse will feel your uterus by cupping one hand above the pubis
symphysis to support the lower segment of the uterus, and the other hand will be
able to feel the fundus. The nurse will document the fundal height based on
fingerbreadths above or below the umbilicus. If the uterus is soft, the nurse
may lightly massage the fundus to promote contractions (hardening). At this time,
the nurse will also check to see if the uterus is midline or displaced to the right or
left of the umbilicus.
You will be encouraged to void every 2 to 3 hours to prevent uterine
displacement and the stopping uterine contractions due to less room in the
abdominal cavity.

Lowdermilk, D. & Perry S. (2013). Maternity & Womens Health Care (8th ed.). St. Louis: Mosby.