Postpartum Clinical Prep Sheet

Gravida: Gravida refers to a woman who is or has been pregnant,

regardless of length. Significance: It provides us a number with the
total amount of pregnancies.
Parity: Refers to the number of pregnancies that have ended at 20 or
more weeks, regardless if born alive or stillborn. Significance:
Provides us a number of how many times the patient has had viable
pregnancies.
Elective Cesarean: Elective cesareans (also known as not-medically
indicated) are not suggested for <39 weeks gestational age; nor is it
suggested for those who wish to have a vaginal birth later on.
Significance: Mortality at 37 weeks may be 2.5x the number at 40
weeks, and was elevated compared to at 38 weeks.
Pre-Eclampsia: Is a condition in which hypertension develops during
the last half of pregnancy in a woman who previously had normal blood
pressure. Significance: The elevated blood pressure can eventually
kill both the fetus and the mother. The only cure is birth of the fetus.
LATCH Score: This system assesses and documents the need for
assistance with breastfeeding. Significance: A score of 7 or less
indicates the mother needs more assistance in feeding.
Colostrum: Colostrum is a thick yellow substance in the first phase of
lactogenesis. Its high in protein and some vitamins and minerals
compared to the mature milk. It is lower in carbohydrates, fat, lactose,
and other vitamins. Its rich in IgA in which that helps protect the
infants GI. Significance: High proteins will aid in development and
the IgA will aid in the protection of the baby.
Breast engorgement: This occurs in the mammary glands due to the
expansion and pressure exerted by the synthesis and storage of breast
milk. Significance: This typically happens when the breast milk
switches from colostrum to mature milk. Or if the lactating mother
misses several nursings and not enough milk had been expressed.
Fundus: This is the top portion of the uterus, which is opposite from
the cervix. It is measured from the top of the pubic bone.
Significance: This is used to measure pregnancy in growth rates. It
can also be an indicator of an abnormality.
ABO Incompatibility: This occurs when the mother is blood type O
and the fetus is blood type A, B, or AB. The A, B, and AB contain a
protein component (antigen) that is not present in O blood.

Significance: The antibodies (IgG) cross the placental barrier and can
cause hemolysis of the fetus RBCs.
Rhogam: This is concentrated immunoglobulins directed toward the
red blood cell (RBC) antigen Rho(D). Significance: This is to prevent
the immunological condition known as Rh disease (hemolytic disease
of newborn) it is an intramuscular injection.
Hepatitis B: HBV is a liver virus that can cause cirrhosis if not treated
fast enough, or if the body does not make the necessary antibodies.
Depending on if the mother is positive for the virus or not, the baby will
receive both the vaccine and the immunoglobulins. Significance:
Hepatitis B is passed via blood and the baby is at risk for contracting
HBV during birth.
Episiotomy: An incision of the perineum prior to birth to aid in the
actual birthing process (dystocia, vacuum, occiput, etc.) Significance:
Episiotomies prevent (can) problems that arise during birth. However,
infection is the main risk for an episiotomy.
Peri-urethral Tear: Lacerations occur during child birth and are
classified in degrees of severity. Significance: A laceration in the area
of the urethra may cause the woman to have difficulty urinating after
birth.
Hemorrhoids: Varicosities in the rectum and may be external or
internal. Some causes are vascular engorgement of pelvis,
constipation, straining, and prolonged sitting or standing.
Significance: Can cause itchiness or pain in the rectum, with
bleeding.
Lochia: Is the color and consistency of blood that occurs after giving
birth, depending on the days. Significance: Day 1-3 lochia rubra
(bloody small clots), Day 3-10 lochia serosa (decreased amount,
serosanguinous), and day 10-14 is lochia alba (white, cream,
decreasing amounts). It also provides us information how much lochia
is on the peripads.
Hemorrhage: A major cause of maternal death and morbidity in the
US and world. Blood loss will be >500mL after vaginal birth and
>1000mL after C-Section, a decrease of Hct of 10% since admission
and continued bleeding. Significance: Prevent hemorrhage as it is a
common cause for death.
Boggy uterus: A boggy uterus means that the fundus/uterus is to soft
and needs to be massaged in order for it to be firmed up.
Significance: This can be associated with uterine atony.

Breast self-exam: Is an organized monthly evaluation by the woman.

This is to look for any abnormalities such as cancer. Significance:
Proper and consistent regimen of breast exams will aid in the
treatment of breast cancer, and can prevent it from metastasizing.
Kegel exercises: Kegel exercises strengthen and tightens the urinary
meatus and vagina. Significance: During the contraction of the kegel
exercises, this will prevent prolapse.
Bonding: Mother-baby care. During this time, the mother will learn to
care for her baby and gradually takes over all care. Significance:
Prolonged contact between mothers and infants leads to more
touching and caring for infants as mothers learn the characteristics of
their babies.