Normal Postpartum OB Lecture 1

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?

1-3 days, dark red Signup and view all the answers

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

4-10 days, pinkish with tissue debris Signup and view all the answers

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

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

What is the normal order of lochia?

Rubra --> Serosa --> Alba Signup and view all the answers

How do you perform a perineal assessment?

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

How often should a pad be changed?

Every 3-4 hours, or as needed Signup and view all the answers

What kind of peri care should be taught?

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. Signup and view all the answers

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

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

How should a woman care for her breasts while breastfeeding?

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

How do you know if a newborn is feeding enough?

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

What is the key measure to suppress lactation?

Teach measures to decrease stimulation to the breasts. Signup and view all the answers

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

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

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

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

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

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

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

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

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

Cold foods such as ice chips and ice cream. Signup and view all the answers

How many extra calories do lactating mothers need?

500 calories Signup and view all the answers

What happens to vital signs after birthing?

Temperature may be transiently increased. Signup and view all the answers

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.