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Questions and Answers
What is the expected time frame for tone restoration after adequate uterine emptying post childbirth?
What is the expected time frame for tone restoration after adequate uterine emptying post childbirth?
What might contribute to the delay in spontaneous bowel evacuation after childbirth?
What might contribute to the delay in spontaneous bowel evacuation after childbirth?
What is a known complication of 3rd and 4th degree lacerations during childbirth?
What is a known complication of 3rd and 4th degree lacerations during childbirth?
What is likely to happen to the abdominal wall in the first two weeks postpartum?
What is likely to happen to the abdominal wall in the first two weeks postpartum?
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What can cause headaches postpartum that necessitate careful assessment?
What can cause headaches postpartum that necessitate careful assessment?
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What is the average blood loss for a vaginal birth?
What is the average blood loss for a vaginal birth?
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What are common characteristics of lochia during the postpartum period?
What are common characteristics of lochia during the postpartum period?
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How long may it take for lacerations or an episiotomy to heal completely postpartum?
How long may it take for lacerations or an episiotomy to heal completely postpartum?
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Which statement best describes the process of uterine involution?
Which statement best describes the process of uterine involution?
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What is a common symptom of engorgement in breastfeeding mothers?
What is a common symptom of engorgement in breastfeeding mothers?
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What is a typical timeframe for postpartum cardiac output to return to pre-pregnancy levels?
What is a typical timeframe for postpartum cardiac output to return to pre-pregnancy levels?
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Which of the following statements about afterpains is true?
Which of the following statements about afterpains is true?
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What is a common change in cervical position after childbirth?
What is a common change in cervical position after childbirth?
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What is the correct definition of uterine involution?
What is the correct definition of uterine involution?
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Which factor is likely to lead to subinvolution of the uterus?
Which factor is likely to lead to subinvolution of the uterus?
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What are the expected characteristics of lochia during the first two hours postpartum?
What are the expected characteristics of lochia during the first two hours postpartum?
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Which statement about afterpains is true?
Which statement about afterpains is true?
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At what point should the uterus be nonpalpable abdominally after childbirth?
At what point should the uterus be nonpalpable abdominally after childbirth?
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What is the role of oxytocin in the postpartum period?
What is the role of oxytocin in the postpartum period?
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Lochia can last for how long postpartum?
Lochia can last for how long postpartum?
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What cervical change is likely to occur immediately after vaginal delivery?
What cervical change is likely to occur immediately after vaginal delivery?
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Study Notes
Postpartum Physiologic Changes
- Postpartum period: interval between birth and return of reproductive organs to a nonpregnant state (AKA puerperium, last 6 weeks).
Reproductive Systems and Associated Structures
Uterus
- Involution: Uterus returns to nonpregnant state after childbirth, begins immediately after placenta expulsion with uterine smooth muscle contractions.
- At end of third stage of labor, uterus weighs ~1000g, midline, ~2 cm below umbilicus.
- Within 12 hours, uterus rises ~1cm above umbilicus.
- By 24 hours, uterus is the same size as at 20 weeks gestation.
- Daily, fundus descends 1-2 cm.
- By 6th day, fundus is halfway between umbilicus and symphysis pubis.
- After 2 weeks, uterus is not palpable abdominally.
- By one week, uterus weighs ~500g.
- By 4 weeks, uterus weighs ~100g, and has returned to nonpregnant size/location.
- Subinvolution: Failure of uterus to return to nonpregnant state, commonly due to retained placental fragments or infection. This is caused by ineffective contractions.
Contractions
- Postpartum hemostasis achieved by uterine contractions.
- Initial contractions are intense, but they decrease in intensity over the first 1-2 hours and may become uncoordinated.
- Pitocin (oxytocin) may be given IV or IM to help with contractions and/or breastfeeding can also stimulate oxytocin release.
- Afterpains: Periodic relaxation and vigorous uterine contractions in subsequent pregnancies cause cramping. This typically lasts for 3-7 days.
Placental Site
- Factors that intensify afterpains: uterine overdistension, breastfeeding, Pitocin.
- Vascular restriction and thromboses reduce the placental site.
- Endometrial regeneration begins at day 3 and is complete by week 3.
- Regeneration of the placenta site is complete by week 6.
Lochia
- Blood discharge from the uterus after childbirth.
- Classification based on color and characteristics (rubra, serosa, alba) and duration; typically lasts 4-6 weeks.
Cervix
- Soft immediately after birth, and protrudes into the vagina.
- 12-18 hours after birth, cervix shortens and becomes firmer.
- 2-3 days after birth, cervix is shortened, firm, and it regains its original shape.
- 1 week after birth, the cervical os is 1 cm in size.
- external os may be a jagged slit (fish-mouth) shape.
Ovaries
- Ovulation may resume as early as 27 days postpartum in non-lactating women.
- Lactating women may suppress ovulation, but ovulation may return within 6 months.
- First menstruation may be heavier than normal.
- Returns to normal cycles in 3-4 postpartum months.
Vagina and Perineum
- Vaginal mucosa thinness and loss of rugae (folds) may occur due to estrogen decrease after pregnancy.
Breasts
- Decrease in placental hormones may stimulate breast development.
- Colostrum: Early milk, clear yellow fluid, produced during the first 24 hours postpartum.
- Becomes fuller and heavier as colostrum transitions to mature milk in 72-96 hours.
- Breast tissue may feel lumpy (nodular) or shift in position due to milk production.
- Engorgement: Increased blood and lymphatic fluid in breasts may lead to hard, uncomfortable breasts. This may only last for 24-48 hours.
Cardiac System
- Blood volume averages 300-500 mL for vaginal delivery, and 500-1000 mL for C-section.
- Plasma volume decreases within a few days of birth due to diuresis, but returns to pre-pregnancy levels within 3 days.
- Cardiac output increases by 60-80% after birth, then returns to pre-labor values within 1 hour.
- CO decreases by 30% at 2 weeks and returns to normal by weeks 6-8.
Vital Signs (Page 420)
- HR increase initially, then decreases to 40-50 bpm.
- BP may be slightly elevated initially.
Respiratory System
- Intrabdominal pressure decreases.
- Rib cage elasticity returns gradually.
- Costal angle (angle between ribs) may take time to return to pre-pregnancy sizes.
- The partial pressure of carbon dioxide (PaCO2) may decrease due to changes in progesterone levels.
Endocrine System
- Estrogen and Progesterone levels drop considerably after childbirth.
- HCG disappears fairly quickly (within 3-4 weeks).
- Pituitary hormones (e.g., prolactin) increase in those breastfeeding to promote milk production.
- Oxytocin release with breastfeeding.
Urinary System
- Renal function returns to normal by 8 weeks.
- Pelvic organs (ureters, renal pelvis) may take up to 6 weeks to recover from pregnancy-related changes.
- Risk of UTI may be increased.
GI System
- Bowel movements may be delayed for 2-3 days due to slowed peristalsis.
Integument
- Melasma, hyperpigmentation of areolae and linea nigra may not regress completely.
- Striae gravidarum may fade (stretch marks from pregnancy).
- Vascular abnormalities may regress due to hormonal changes (e.g. angiomata, palmar erythema).
Musculoskeletal
- Back pain often resolves in a few weeks or months.
- Joints stabilize by 6-8 weeks.
- Shoe size may increase.
Neurologic
- Headaches or other neurological issues may occur in the immediate postpartum period.
- Relief of carpal tunnel symptoms may occur due to diuresis.
- Nasal stuffiness, tinnitus, and laryngeal changes resolve shortly after birth.
Immune
- Exact time for immune system recovery is unclear.
- Autoimmune conditions (like multiple sclerosis or lupus) may exacerbate.
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Description
This quiz explores the changes that occur in the reproductive system during the postpartum period. It covers key concepts such as uterine involution, the timeline of changes, and potential complications like subinvolution. Test your knowledge on the physiological adaptations following childbirth.
