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Questions and Answers

What is the typical duration of moderate pain after childbirth?

  • 2 days (correct)
  • 7 days
  • 1 day
  • 5 days

    • What is the primary cause of afterpain in multiparas?

  • Tonic uterine contractions
  • Infant suckling
  • Hormonal changes
  • Vigorous uterine contractions (correct)

    • What is the function of oxytocin in relation to afterpain?

  • Stimulating uterine contractions (correct)
  • Inhibiting gonadotrophin releasing hormone
  • Relaxing the uterine muscles
  • Regulating milk production

    • What is the typical duration of lochia?

    <p>Variable, but usually around 5 weeks</p> Signup and view all the answers

    What is the color of lochia alba?

    <p>Yellow</p> Signup and view all the answers

    Why does ovulation not occur immediately postpartum?

    <p>Due to the presence of prolactin hormone</p> Signup and view all the answers

    What is the duration of the puerperium period?

    <p>6 weeks postpartum</p> Signup and view all the answers

    What is the weight of the uterus immediately after delivery?

    <p>1000g</p> Signup and view all the answers

    When does the uterus return to its non-pregnant state?

    <p>6 weeks postpartum</p> Signup and view all the answers

    What happens to the cervix after childbirth?

    <p>It becomes a large, transverse, stellate slit</p> Signup and view all the answers

    What happens to the vagina during the puerperium period?

    <p>It shrinks to a non-pregnant state</p> Signup and view all the answers

    What happens to the perineum after childbirth?

    <p>It returns to its non-pregnant state within 1-2 weeks</p> Signup and view all the answers

    What happens to the vaginal epithelium during the puerperium period?

    <p>It appears atrophic on smear</p> Signup and view all the answers

    When is the vaginal epithelium restored to its non-pregnant state?

    <p>Within 6-10 weeks</p> Signup and view all the answers

    What is the average weight loss due to the delivery of the fetus, placenta, and amniotic fluid?

    <p>6 kg</p> Signup and view all the answers

    When can lactation occur during pregnancy?

    <p>16 weeks' gestation</p> Signup and view all the answers

    What percentage of women who do not breastfeed return to their menstrual periods within 36 weeks?

    <p>50-75%</p> Signup and view all the answers

    What is the primary reason for feeding a newborn every 2-3 hours after delivery?

    <p>To stimulate milk production</p> Signup and view all the answers

    Which of the following is NOT a contraindication for breastfeeding?

    <p>Hypertension</p> Signup and view all the answers

    What is the main component of colostrum?

    <p>Protein</p> Signup and view all the answers

    How long does it take for milk to mature after delivery?

    <p>A week</p> Signup and view all the answers

    What is the additional weight loss during the puerperium due to?

    <p>All of the above</p> Signup and view all the answers

    What percentage of gestational weight gain is typically lost in the first six weeks after delivery?

    <p>One-half</p> Signup and view all the answers

    What is a crucial factor in returning the abdominal wall to a pre-pregnant state?

    <p>Regular exercise</p> Signup and view all the answers

    What is a common guideline for resuming sexual intercourse postpartum?

    <p>When Red bleeding ceases and the vagina and vulva are healed</p> Signup and view all the answers

    What is the primary purpose of pelvic floor rehabilitation during the postpartum period?

    <p>To prevent and manage pelvic organ prolapse and urinary incontinence</p> Signup and view all the answers

    What is a benefit of moderate-intensity exercise during the postpartum period?

    <p>All of the above</p> Signup and view all the answers

    What is the role of a women's health physiotherapist during the postnatal period?

    <p>To improve health outcomes through a combination of manual therapies and specific treatments</p> Signup and view all the answers

    What is a potential outcome of postnatal exercise?

    <p>All of the above</p> Signup and view all the answers

    What is a benefit of physical therapy during the postnatal period?

    <p>All of the above</p> Signup and view all the answers

    Study Notes

    Normal Puerperium

    • Puerperium is the time from delivery of the placenta to 6 weeks postpartum
    • By 6 weeks, most changes of pregnancy, labor, and delivery have resolved and the body has reverted to a non-pregnant state

    Uterus

    • Immediately after delivery, the uterus can be palpated at or near the umbilicus
    • By 2 weeks postpartum, the uterus should be located in the true pelvis
    • The uterus shrinks rapidly in the first 2 weeks, with a significant reduction in size and weight
    • Weight: 1000g immediately postpartum, 500g at 1 week, 300g at 2 weeks, and 100g or less thereafter

    Cervix

    • The external os is closed to the extent that a finger could not be easily introduced
    • The external os never resumes its pre-gravid shape; it becomes a large, transverse, stellate slit after childbirth

    Vagina

    • The vagina shrinks to a non-pregnant state, with resolution of the increased vascularity and edema by 3 weeks
    • The vaginal epithelium appears atrophic on smear, restored by weeks 6-10

    Perineum

    • Swelling and engorgement are completely gone within 1-2 weeks
    • The gapping of the vulva that occurs during vaginal delivery remains for 2-3 weeks then gradually disappears, but never returns to the pre-pregnancy state
    • Muscle tone may or may not return to normal, depending on the extent of injury

    Afterpain

    • Moderate pain for 2 days, mild pain by the 3rd day postpartum
    • Occasionally severe enough to require an analgesic
    • Causes: uterine contractions, infant suckling (breastfeeding)

    Lochia

    • Duration: variable, lasts about 5 weeks
    • At week 6 postpartum, only 15% of women have lochia
    • Types:
      • Lochia rubra: red, variable duration
      • Lochia serosa: brownish-red, more watery consistency, decreasing in amount
      • Lochia alba: yellow

    Ovulation and Menstruation

    • No ovulation immediately postpartum due to prolactin hormone inhibiting GnRH release
    • Ovulation restored after a duration depending on whether the woman is breastfeeding or not
    • Menstrual cycles resume when ovulation is restored
    • Breastfeeding: variable duration, ovulation may be as early as 27 days after delivery
    • 50-75% of women return to periods within 12 weeks, the rest may not have periods until stopping breastfeeding

    The Breasts

    • Changes prepare for breastfeeding throughout pregnancy
    • Lactation can occur by 16 weeks' gestation
    • Colostrum: high in protein and immune factors, 1st 2-4 days after delivery
    • Milk: matures over the first week, containing all necessary nutrients

    Breastfeeding

    • Initiation: neither easy nor automatic, should be initiated as soon as possible after delivery
    • Feed the baby every 2-3 hrs to stimulate milk production
    • Contraindications: alcohol use, certain medications, active untreated tuberculosis, infections, and galactosemia

    Physiologic Weight Loss

    • Mean weight loss from delivery of fetus, placenta, and amniotic fluid: 6 kg
    • Additional loss of 2-7 kg during the puerperium
    • Approximately one-half of gestational weight gain is lost in the first six weeks

    Abdominal Wall

    • Remains soft with poor tone for many weeks
    • Return to a pre-pregnant state depends greatly on exercise

    Sexual Intercourse

    • May resume when red bleeding ceases, vagina and vulva are healed, physically comfortable, and emotionally ready
    • Physical readiness usually takes ~3 weeks

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