POSTPARTUM

By: Liza Marie C. Adarne 2-NUR1 R.L.E. 1

WHAT IS POSTPARTUM?
it is the interval between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state. sometimes referred as puerperium. traditionally been considered to last 6 weeks, time frame varies among women. 4th trimester transition for woman/family (pregnancy ends/parenting role begins.)

FEMALE REPRODUCTIVE SYSTEM

REPRODUCTIVE SYSTEM AND ASSOCIATED STRUCTURES

INVOLUTION PROCESS rapid reduction in size of the uterus and its return to a condition similar to its prepregnancy state. begins immediately after expulsion of the placenta with contraction of the uterine smooth muscle. SUBINVOLUTION the failure of the uterus to return to a nonpregnant state. - most common causes are retained placenta fragments and infection.

REPRODUCTIVE SYSTEM AND ASSOCIATED STRUCTURES

@ the end of the 3rd stage of labor - uterus is in the midline, approx. 2 cm below the level of the umbilicus, fundus resting on the sacral promontory, uterus weighs approx. 1000 g. w/in 12 hrs. fundus may rise approx. 1 cm above the umbilicus. by 24 hrs. postpartum uterus is about the same size it was at 20 wks. of gestation. Every 24 hrs. fundus descends 1 to 2 cm. 6th postpartum day fundus normally located halfway between the umbilicus and the symphisis pubis. Within 2 wks. after childbirth uterus once again lies in the true pelvis.

REPRODUCTIVE SYSTEM AND ASSOCIATED STRUCTURES

UTERUS weight: at full term - weighs approx. times its pregnancy weight at first week after birth approx. 500 g after birth by 2 weeks after birth 350 g at 6 weeks weighs 50 60 g NOTE: estrogen & progesterone levels are responsible for stimulating the massive growth of the uterus during pregnancy

REPRODUCTIVE SYSTEM AND ASSOCIATED STRUCTURES

CONTRACTIONS Postpartum hemostasis achieved primarily by compression of intramyometrial blood vessels as the uterine muscle contracts. Oxytocin released from the pituitary gland, strengthens and coordinates these uterine contractions, compress blood vessels and promote hemostasis. first 1 to 2 postpartum hrs. uterine contractions may decrease in intensity and become uncoordinated.

REPRODUCTIVE SYSTEM AND ASSOCIATED STRUCTURES

AFTERPAINS
Primiparas: puerperal uterus tends to remain tonically

contracted
Multiparas : contracts vigorously at interval afterpain Infant suckles oxytocin release Ut. contraction

afterpain NOTE: More severe when breastfeeding in both primiparas and multiparas.

REPRODUCTIVE SYSTEM AND ASSOCIATED STRUCTURES

LOCHIA: RUBRA, SEROSA & ALBA Rubra - dark red in color, present the 1st - 3rd days postpartum, a few small clots are considered normal. Serosa - pinkish to brownish in color, from the 4th - 10th day post delivery. Alba - creamy or yellowish in color,10th 14th day , may be later in breastfeeding clients.

REPRODUCTIVE SYSTEM AND ASSOCIATED STRUCTURES

CERVIX soft immediately after birth. w/in 2-3 postpartum days it has shortened, become firm, regained its form. cervix up to the lower uterine segment remains edematous, thin, and fragile for several days after birth. ectocervix appears bruised and has some lacerations. cervical os which dilated to 10 cm during labor, closes gradually.

REPRODUCTIVE SYSTEM AND ASSOCIATED STRUCTURES

CERVIX 4-6 days two fingers may still be introduced into the cervical os, ONLY THE SMALLEST CURETTE CAN BE INTRODUCED BY THE END OF 2 WEEKS. external cervical os never regains its prepregnant appearance, no longer shaped like a circle but appears as a jagged slit that is often described as a fish mouth.

REPRODUCTIVE SYSTEM AND ASSOCIATED STRUCTURES

VAGINA CHANGES Following birth appears edematous May be bruised Small superficial lacerations may be present Size and rugae return to pre pregnancy in 3 weeks By 6 weeks appears normal

REPRODUCTIVE SYSTEM AND ASSOCIATED STRUCTURES

PERINEAL CHANGES May appear edematous with some bruising Episiotomy edges should be approximated Ecchymosis may occur and delay healing

ASSESSMENT

B - REAST S - KIN U UTERUS H OMANS B LADDER SIGN B OWEL E - MOTIONAL L OCHIA RESPONSE E - PISIOTOMY

BREAST
(ENGORGE)

BENEFITS OF BREASTFEEDING
Best for baby, also best for mommy Reduces the incidence of allergies Economical no waste Antibodies to protect baby against infection Sterile and pure Temperature is always ideal Fresh milk never goes off

BENEFITS OF BREASTFEEDING
Easy to prepare and to digest Eradicates feeding difficulties Develops mother & child bonding Immediately available Nutritionally optimal Gastroenteritis greatly reduced Promote rapid involution LAM (Lactation Amenorrhea Method)3-4months

UTERUS - hard

BLADDER
void after 4-6 hrs.

BOWELS
should defecate w/in 24 hrs.

LOCHIA (Rubra, Serosa, Alba)

EPISIOTOMY
cutted perinium Episiorapy repair or sewing of the cutted perineum

SKIN
Chloasma usually disappears at the end of pregnancy Hyperpigmentation of the areolae and linea nigra may not regress completely after childbirth. Striae gravidarum breasts, abdomen, and thighs may fade but usually do not disappear.

HOMANS SIGN

EMOTIONAL RESPONSE
Taking in phase dependent phase (1st - three days) mom passive, cant make decisions, activity is totell child birth experiences. During this time, the womans attention is focused on her own needs for sleep, rest and she is dependent on others. Nursing Care: - proper hygiene

EMOTIONAL RESPONSE
Taking hold phase dependent to independent phase (4 to 7 days). Mom is active, can make decisions, The concern of the mother at this time is focused on her ability to control body function and her ability to assume the mothering role. She prefers to do things by herself. As she is not yet completely recovered, she feels impatient that shes not strong enough to do everything she wishes to accomplish.

EMOTIONAL RESPONSE
Taking hold phase Because of the tendency of the woman to overwork herself, fatigue and exhaustion is common at this stage. HT: Begins to take a strong interest for her child- Give the woman brief demonstration of baby care- Allow her to care for the child herself with watchful guidance common postpartum blues/ baby blues present 4 5 days 5080% moms overwhelming feeling of depression characterized by crying, despondence- inability to sleep & lack of appetite. let mom cry therapeutic.

EMOTIONAL RESPONSE
Letting go phase interdependent phase 7 days & above. Mom redefines new roles may extend until child grows. the act of ending old ways of thinking or believingThe woman finally redefines her new role- Gives up fantasized image of her child and accepts the real one- Gives up her old role of being childless or the mother of only one or two- Extended and continues during the childs growing years

MANIFESTATIONS OF POSTPARTUM DEPRESSION

interest in surroundings interest in food unable to feel pleasure fatigue health c/o sleep disturbance panic attacks obsessive thinking hygiene ability to concentrate odd food cravings irritability rejection of infant

HOSPITAL CARE

HOSPITAL CARE
Attention immediately after labor
for the first hour after delivery - BP & PR : should be taken every 15 minutes monitor amount of vaginal bleeding Fundus should be palpated to ensure that it is well contracted
if relaxation detected, uterus should be massaged through abdominal wall until it remains contracted

HOSPITAL CARE
Early ambulation
Advantages less frequent bladder complications & constipation reduced frequency of puerperal venous thrombosis & pulmonary embolism

HOSPITAL CARE
Care of the Vulva
Should be instructed to cleanse vulva from anterior to posterior (vulvaanus) Ice bag applied to perineum Warm sitz bath : beginning about 24 hours after delivery Tub bathing after uncomplicated delivery is allowed

HOSPITAL CARE
Bowel function
early ambulation and early feeding constipation

Subsequent discomfort
during the first few days after vaginal delivery uncomfortable by afterpains, episiotomy & lacerations, breast engorgement codeine, aspirin, acetaminophen Episiotomy & lacerations - early application of an ice bag - local analgesic spray - healed and nearly asymptomatic by the 3rd weeks

THE END There is no other organ quite like the uterus. If men had such an organ they would brag about it. So should we. ~Ina May Gaskin