Normal Postpartum OB Lecture 1
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Questions and Answers

How long does involution last?

6 weeks

What are the 3 components of the assessment of the uterus and their normals?

Placement/size of the fundus, Tone, Lochia

If a fundus feels boggy, what should you do?

Massage it

How long does rubra serosa last and what color is it?

<p>1-3 days, dark red</p> Signup and view all the answers

How long does serosa lochia discharge last and what color is it?

<p>4-10 days, pinkish with tissue debris</p> Signup and view all the answers

How long does alba lochia discharge last and what color is it?

<p>11-21 days, creamy yellow/brown</p> Signup and view all the answers

What is the normal order of lochia?

<p>Rubra --&gt; Serosa --&gt; Alba</p> Signup and view all the answers

How do you perform a perineal assessment?

<p>Turn patient to Sims/lateral position and gently spread buttocks apart to inspect with light.</p> Signup and view all the answers

How often should a pad be changed?

<p>Every 3-4 hours, or as needed</p> Signup and view all the answers

What kind of peri care should be taught?

<p>Hygiene with a peri-bottle using warm water, wiping front to back, using tucks and dermoplast spray, applying ice as needed in 20-30 minute intervals.</p> Signup and view all the answers

How do you teach a breast self-assessment after pregnancy?

<p>Assess her own breasts to keep track of what's normal.</p> Signup and view all the answers

How should a woman care for her breasts while breastfeeding?

<p>No soap on nipples, use colostrum or lanolin, wear a supportive bra, relax for let-down.</p> Signup and view all the answers

How do you know if a newborn is feeding enough?

<p>Should be making 6-10 wet diapers and stool per day.</p> Signup and view all the answers

What is the key measure to suppress lactation?

<p>Teach measures to decrease stimulation to the breasts.</p> Signup and view all the answers

For a woman who does not breastfeed, how do you decrease stimulation of the breasts?

<p>Tight fitting bra or binder, do not express milk, shower with back to warm water, ice packs or cabbage leaves.</p> Signup and view all the answers

What should a woman be taught about urinating immediately after birth?

<p>First two voids should be with nurse to prevent falls, diuresis is common, empty bladder regularly to help the uterus stay contracted.</p> Signup and view all the answers

What is the most common problem relating to urinating after giving birth?

<p>Retention related to decreased elasticity, bladder tone, and decreased sensation from trauma, drugs, anesthesia.</p> Signup and view all the answers

What is the most common problem relating to bowel movements after giving birth?

<p>Constipation related to progesterone, decreased food and fluid intake, perineal tenderness, and fear of pain.</p> Signup and view all the answers

Which kinds of food should be avoided after birth to prevent too much gas?

<p>Cold foods such as ice chips and ice cream.</p> Signup and view all the answers

How many extra calories do lactating mothers need?

<p>500 calories</p> Signup and view all the answers

What happens to vital signs after birthing?

<p>Temperature may be transiently increased.</p> Signup and view all the answers

Flashcards

Involution of the uterus

The process of the uterus returning to its pre-pregnancy size, lasting approximately six weeks after childbirth.

Postpartum Uterine Assessment

The assessment of the uterus after childbirth, focusing on its location, firmness, and the amount and appearance of vaginal discharge.

Fundus

The top of the uterus, which can be felt by a healthcare provider to assess its position and size.

Fundus Tone

The uterus should be firm and feel hard to the touch, indicating it is contracting normally.

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Lochia

The normal vaginal discharge following childbirth, which changes in color and consistency over time.

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Lochia Rubra

The first stage of lochia, typically lasting 1-3 days, characterized by a dark red color due to blood and tissue.

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Lochia Serosa

The second stage of lochia, lasting from day 4 to 10, with a pinkish color due to a combination of blood and mucus.

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Lochia Alba

The final stage of lochia, lasting from day 11 to 21, characterized by a cream or yellowish-brown color with little blood.

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Normal Lochia Progression

The expected sequence of lochia stages: Rubra --> Serosa --> Alba.

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Perineal Assessment

The assessment of the perineum, the area between the vagina and anus, after childbirth, to check for any complications or tears.

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Episiotomy

A surgical incision made to enlarge the vaginal opening during childbirth, often requiring postpartum care to promote healing.

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Perineal Lacerations

Tears or lacerations that may occur in the perineal area during childbirth, requiring assessment and care.

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Perineal Care

Providing care for the perineal area after childbirth, including hygiene practices, use of soothing products, and proper positioning.

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Lactation

The process of the breasts producing milk after childbirth, which can be stimulated or suppressed depending on the mother's choice.

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Breastfeeding Care

Promoting and supporting breastfeeding, including educating mothers on proper techniques, latch, and milk expression.

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Breast Milk Assessment

Monitoring the production of breast milk to ensure adequate supply and assess for any issues or concerns.

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Lactation Suppression

Strategies to suppress lactation, including avoiding breast stimulation, wearing tight-fitting bras, and applying cold compresses.

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Postpartum Urination Assistance

The first two urinations after childbirth, which should be assisted by a nurse to prevent falls due to potential dizziness and decreased bladder control.

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Urinary Retention

A common postpartum urinary issue where the bladder does not empty completely due to decreased tone and sensation caused by trauma or medications.

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Postpartum Constipation

Frequent bowel movements after childbirth, often caused by hormonal changes, decreased food/fluid intake, and discomfort from perineal pain or hemorrhoids.

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Study Notes

Postpartum Assessment Overview

  • Involution of the uterus lasts for 6 weeks post-delivery.
  • The assessment of uterus includes three components:
    • Fundus placement/size - should be level with umbilicus after delivery, roughly the size of a grapefruit.
    • Fundus tone should be firm and midline.
    • Lochia should have a non-offensive odor, medium amount is normal, with potential variations or issues noted.

Lochia Stages and Characteristics

  • Lochia rubra lasts for 1-3 days, appearing dark red.
  • Lochia serosa occurs from 4-10 days, is pinkish with tissue debris.
  • Lochia alba lasts from 11-21 days, presenting as creamy yellow or brown.
  • The normal sequence of lochia is Rubra --> Serosa --> Alba.

Perineal and Breast Care

  • Perform perineal assessment by positioning the patient in the Sims/lateral position, gently spreading buttocks to inspect with light for complications (episiotomy, lacerations, etc.).
  • Pads should be changed every 3-4 hours or as needed.
  • Teach proper peri-care including hygiene with a peri-bottle, front-to-back wiping, and use of soothing products like tucks, dermoplast spray, and ice as needed.

Breastfeeding Guidance

  • Encourage self-assessment of breasts to monitor for normalcy post-pregnancy.
  • For breastfeeding care, avoid soap on nipples and use colostrum or lanolin instead; wear a supportive bra and relax to facilitate let-down.
  • Newborns should produce 6-10 wet diapers and stool daily to indicate adequate feeding.
  • To suppress lactation, teach how to minimize breast stimulation.

Non-breastfeeding Care

  • For non-breastfeeding mothers, reduce breast stimulation using:
    • Tight fitting bras or binders
    • Avoid expressing milk
    • Shower using cool water on the back
    • Apply ice packs or cabbage leaves to reduce discomfort

Urinary and Bowel Movement Considerations

  • After birth, the first two urinations should be assisted by a nurse to prevent falls. Diuresis is common, and women should regularly empty their bladder to help the uterus contract and avoid hemorrhaging.
  • Common urinary issue post-birth is retention due to decreased bladder tone and sensation from trauma or anesthesia.
  • Constipation is the most frequent bowel movement concern, leading to:
    • Slowed GI tract from progesterone
    • Decreased food/fluid intake
    • Perineal tenderness, hemorrhoids, or fear of pain.
    • Recommend stool softeners and increased fluid intake.

Dietary and Caloric Needs

  • Avoid cold foods (e.g., ice chips, ice cream) after delivery to prevent excessive gas.
  • Lactating mothers require an additional 500 calories for energy and nourishment.

Vital Signs Postpartum

  • Vital signs may show a transient increase in temperature after childbirth, reflecting physiological changes.

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Description

This quiz focuses on the BUBBLE clinical assessment related to postpartum care. It covers key concepts including involution duration and the assessment of the uterus post-delivery. Enhance your understanding of normal postpartum practices and procedures with these flashcards.

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