Postpartum Care Quiz

Postpartum Changes and Care

• Mental/emotional adaptation: Changes in mood, hunger, and thirst are common.
• Family-infant interaction: Hormonal changes influence bonding and milk production.
• Breast changes: Breast filling, colostrum secretion, and prolactin levels increase.
• Uterine involution: The uterus returns to its non-pregnant size. Descent is tracked relative to the umbilicus. Sub-involution can cause hemorrhage.
• Uterine fundus descent: Descends approximately 1 cm/day for the first 14 days, then no longer palpable abdominally.
• Afterpains: Intermittent uterine contractions, often more intense while breastfeeding due to oxytocin release.
• Lochia: Uterine discharge following birth; indicative of involution progression. Types include rubra (dark red/red-brown, 1-3 days), serosa (pink/brown-tinged, 4-10 days), and alba (white/cream/light yellow, 11-21 days).
• Cardiovascular system: Blood loss (up to 500ml vaginal, up to 1000ml cesarean) with transient increase in cardiac output. Leukocytosis possible, with WBC counts peaking up to 30,000/mm3. Clotting factors may stay elevated, causing thrombus risk.
• Gastrointestinal system: Hunger and thirst are typical due to energy expenditure. Constipation may occur due to reduced bowel tone.
• Urinary system: Protein and acetone may be present in urine for first few days postpartum. Dehydration may occur during labor. Urinary retention is common postpartum.
• Musculoskeletal system: Muscle fatigue and aches are common in the first 1-2 days due to exertion. Gentle massage and warmth can help.
• Integumentary system: Stretch marks (striae gravidarum) may remain. Hair loss is common for 2-4 months, returning to normal in 6-12 months.
• Neurological system: Temporary numbness, dizziness, and headaches are possible. Postpartum headaches are common.
• Endocrine system: Ovulation and menstruation may resume within 3 weeks. Contraceptives are vital.
• Lactation: Estrogen and progesterone levels drop. Prolactin initiates milk production within 2-3 days.
• Weight loss: 4.5-5.8kg is frequently lost during childbirth (fetus, placenta, fluids, blood). Further 2.3-3.6kg may be lost through diuresis; 0.9-1.4kg via involution and lochia within one week.

Postpartum Assessment

• Vital signs: Temperature, pulse, respiratory rate, blood pressure.
• Skin color: Palpate for any pallor, cyanosis, or jaundice.
• Fundal height: Location, firmness, and consistency of the fundus.
• Lochia: Amount, color, and odor of vaginal discharge.
• Perineum: Edema, episiotomy, lacerations, and hematomas.
• IV lines: Type, rate, medications, patency, redness, pain.
• Pain assessment: Presence, degree, and location.
• Urinary output: Frequency, color, character, catheter presence.
• Abdominal incision: Inspection of any incisions or dressings.
• Sensorium and ability to move: Degree of responsiveness and mobility if regional anesthesia was administered.

Focused Postpartum Assessments After Vaginal Birth

• Every 15 minutes for first hour
• Every 30 minutes for second hour
• Every 4 hours for first 24 hours
• Every 8-12 hours thereafter

Taking in/Hold/Letting go phases

• Taking-in phase: Mothers are focused on their own needs (fluid, food, sleep) and the baby.
• Taking-hold phase: Mothers become more independent and concerned with managing their own body functions.
• Letting-go phase: Mothers and fathers may adjust to new roles and loss of childless lifestyle.

Postpartum Blues

• Mild, temporary depression affecting 60-80% of new mothers.
• Begins within the first week, peaks around day 5, and typically resolves within 2 weeks. Persistent symptoms beyond 2 weeks warrant further evaluation.

Bladder Elimination

• Frequent, small voiding: Suggests urinary retention.
• Palpable, midline fundus often indicates an empty bladder.
• Postpartum voiding should be assessed to determine whether normal bladder function is present after birth.

Lower Extremities

• Assessment for varicosities, thrombophlebitis, and pain during dorsiflexion (Homans' sign); can indicate deep vein thrombosis.

###Edema and Reflexes

• Edema (swelling) is common; should resolve as fluid is excreted.
• Deep tendon reflexes typically range from 1+ to 2+. Elevated reflexes may suggest preeclampsia.

Perineum Assessment

• Use REEDA assessment (Redness, Edema, Ecchymosis, Discharge, Approximation) to assess the perineum for episiotomy or lacerations.