POSTPARTUM CARE

MARIAN MENDOZA RN MAN

POST-PARTUM PERIOD

POST-PARTUM CARE
ANTEPARTAL / PRENATAL PERIOD
- Period between conception and the onset
of labor
INTRAPARTAL PERIOD
- period extends from the beginning of
contractions that cause cervical dilatation to
the first 1 to 4 hours after delivery of the
new born and placenta
POSTPARTAL PERIOD
- Is the interval between the birth of the
Newborn and the return of maternal
reproductive organs to their normal
nonpregnant state.
 Post-partal Period
Puerperium – latin puer “child”
and parere “to bring forth”
Refers to the 6-week period after
childbirth
Post partum; fourth trimester in
pregnancy
Postpartum warning signs and
symptoms to report
• Increased bleeding, clots or passage of tissue
• Bright red vaginal bleeding any time after birth
• Pain greater than expected
• Elevated temperature
• Feeling of full bladder accompanied by inability to void
• Enlarging hematoma
• Feeling restless accompanied by pallor, cool, clammy
skin, rapid heart rate, dizziness and visual disturbance
• Pain, redness, and warmth accompanied by firm area
in the calf
• Difficulty breathing rapid heart rate, chest pain , cough,
feeling of apprehension, pale, cold or blue skin color
 Postpartal Period
Immediate postpartum period – first 24
hours
Early postpartum period – first week
Late postpartum period – 2nd to 6th week
It is a time of maternal changes
– involution of the uterus and vagina
– production of milk for lactation
– restoration of menstrual cycle
– beginning of parental role


The focus of Nursing Care is:


On the woman’s physiologic recovery,
psychologic well-being, and her ability
to care for herself and her new baby.
The nurse considers the needs of
other family members and includes
strategies in the plan of care to assist
the family in adjusting to the new
baby.


MATERNAL ADAPTATIONS:




I. PHYSIOLOGIC CHANGES
I. PHYSIOLOGIC CHANGES
a. Reproductive System
Involution- returning to normal size of the
uterus, cervix & vagina, to a non-pregnant
state following birth. This process begins
immediately after expulsion of the
placenta with contraction of the uterine
smooth muscle.
 MATERNAL ADAPTATIONS
Subinvolution – is the failure of the uterus to
return to a non-pregnant state. This is due to
a retained placental fragments and infection.

1. Uterus (contraction and involution)

Involution- 2 processes
a. Area where the placenta was implanted
sealed off to prevent bleeding.
• Contracts inward to seal off the open
blood vessels at the former site of the
placenta (7cm wide)
 MATERNAL ADAPTATIONS
b. Uterus is reduced to its approximate
pregestational size
• From a container large enough to hold a full
term infant to one the size of a grapefruit.

• Full term – 11 times its prepregnancy weight

• After birth – 1000g
• 1 week after birth – 500g
• 2 weeks after birth – 350g
• 6 weeks after birth – 50 to 60g (involution is
complete )
Involution – caused by uterine contraction.
Assessed by measuring the fundal height.
Few minutes after birth – fundus is firm;
midline halfway between the umbilicus &
symphysis pubis
One hour – contracted firmly ; midline at
the level of the umbilicus
One day – 1 cm below the umbilicus
9th or 10th day after delivery, the uterus
once again lies in the true pelvis.
 MATERNAL ADAPTATIONS
Uterus should descend approximately 1
fingerbreath per day until it is below the
pubic bone & can no longer be palpated.

Factors that promote contraction &

involution:
a. breastfeeding
b. early ambulation
c. proper nourishment
 MATERNAL ADAPTATIONS

Normally, Fundus in the midline of the

abdomen
Full bladder deviates it from the midline,
pushing it upward & to the side preventing
uterine contraction leading to excessive
bleeding.
It is vital that the uterus remains firm and
well contracted

UTERINE ATONY - If fundus is boggy (soft

or flabby) & relaxed during the 1st hour
after birth; rapid blood loss.

Oxytocin (Pitocin) is usually administered

intramuscularly immediately within 1
minute after birth of the baby.
Mothers are encouraged to breastfeed the
baby immediately after birth because
suckling stimulates oxytocin* release.
The uterus of a breastfeeding mother may
contract even more quickly, because
oxytocin which is released with BF
stimulates uterine contraction. However,
BF alone is not enough to protect against
postpartum hemorrhage.
AFTERPAINS – uterine cramping; usually
being felt by women with large babies and
multifetal gestation & with breastfeeding.
The uterus was greatly distended
 LOCHIA
Postbirth uterine discharge consisting of blood,
mucus, fragments of decidua, WBC & some bacteria
TYPE
• Lochia rubra
Blood – dark red and has fleshy odor
1-3 days, small to moderate amount, fragments of
decidua and mucus
• Lochia serosa
4-10 days, minimal to scanty, brownish to pinkish in
color
• Lochia alba
After 10 days to 3 weeks
White or pale yellow
OVARIES
Ovulation occur as soon as 3 weeks after
delivery
Menstrual period begins 6-8 weeks who
is
not breastfeeding.
Prolactin* levels in blood rises
progressively
during the period of pregnancy.
Prolactin produced by anterior pituitary
begins to increase early in the first trimester
and increases progressively to term. It is
responsible for initial lactation
 Women who breastfeed, the prolactin level
remains elevated; duration of breastfeeding
and the degree of supplementary feedings
affect the level of prolactin in the blood.

Lactation suppresses ovulation until 18

months.
• For Non-lactating women, the prolactin level
declines after birth and reach the pre-
pregnant range in 3-4 weeks.
 CERVIX
becomes soft and malleable immediately
after birth.
The external cervical os never regains its
pre pregnant appearance; appears as a
jagged slit that is often described as a
“fish mouth”.
Internal os – closes after few days
External os – end of 7 days narrowed to
about the size of a pencil opening
Complete cervical involution may take 3 to
4 months
 VAGINA
soft with few rugae
Small tears will heal without
intervention.
Vaginal walls are smooth
Diameter of the introitus becomes
smaller by contraction
Hymen permanently torn & heal
Takes the entire postpartal period to
involute
 VAGINA
For breastfeeding mothers- continue to
have thin walled or fragile vaginal cells
that cause slight vaginal bleeding during
sexual intercourse until 6 weeks
Kegel’s exercise for rapid increase in
strength & tone of the vagina for sexual
enjoyment
 PERINEUM
develops edema & generalized
tenderness; may appear bruised

Labia minora & majora remain

atrophic (decrease in siza) and softened
after birth
 Integumentary System
Striae gravidarum (stretch marks) on the
breasts, abdomen, and thighs may fade
but usually do not disappear.
Stretch marks on the abdomen still
appear reddened after birth
Chloasma and linea nigra are barely
detectable in 6 weeks time
Profuse diaphoresis that occurs in the
immediate postpartum period is the most
noticeable change in the integumentary
system.


Gastrointestinal System


Digestion and absorption begin to be
active soon after birth
Bowel sounds are active
Passage of stool may be slow due to the
effect of relaxin
Hunger and thirst are common after
delivery
GI motility and tone return to non pregnant
state within 2 weeks after delivery


Gastrointestinal System


Constipation commonly occurs during
early postpartum period due to decreased
intestinal muscle tone, perineal discomfort,
and anxiety
Hemorrhoids (distended rectal vein) are
common problem in the early postpartum
period due to pressure on the pelvic floor
and straining during labor
 Hormones
Pregnancy hormones begin to decrease
as soon as placenta is no longer present.
Levels of HCG (human chorionic
gonadotropin) & HPL ( Human placental
lactogen) are almost negligible by 24
hours
FSH remains low for about 12 days &
begins to rise as new menstrual cycle is
initiated.
Estrogen & Progesterone levels drop after
expulsion of the placenta; lowest level 1
week postpartum
 Circulatory System
Transient bradycardia (50- 70 bpm) occurs
for 24 to 48 hrs after delivery and may
persist for 6 -8 days
Blood volume decrease to nonpregnant
levels by 4 weeks after delivery
Hematocrit (proportion of RBC to
circulating plasma) rises by the 3rd to 7th
postpartum days
Hemoglobin decreases from 11g/dl to
10g/dl
Blood pressure remains stable and the
pulse returns to non pregnant rate by 3
months postpartum
 Urinary System
Extensive diuresis immediately after birth
due to fluid accumulation during
pregnancy about 2,000 to 3,000ml

Daily urine output of 1,500 to 3,000 ml

during 2nd to 5th day after birth.


BREAST

Breast feeding mothers feel a lump or
mass at the breast which is a filled milk
sac that consists of a yellowish fluid.
Tenderness may persist for about 48
hours after the start of lactation.
Bluish-white milk with a skim-milk
appearance (true milk) can be expressed
from the nipples.
nipples
Women who breast feed, the prolactin
level remains elevated; duration of
breastfeeding and the degree of
supplementary feedings affect the level of
prolactin
Lactation suppresses ovulation until 18
For the non-breastfeeding mother, the
breasts generally feel nodular, that is
bilateral.
> Prolactin levels drop rapidly. And reaches
the pre-pregnant range in 3-4 weeks
> Colostrum is present for the first few days
after childbirth.
> Palpation of breast on the 2nd and 3rd day,
as milk production begins, may reveal
tissue tenderness.
Colostrum – antibody-rich breast
secretion that is the precursor to
breast milk.
Colostrum excreted by the breast in
the last weeks of pregnancy &
continues to be excreted in the first
few postpartum days
Prolactin – stimulates milk production.
>Prolactin rises its level due to
continuous suckling
 Breast engorgement
> The breasts are distended (swollen), firm,
and warm to touch because of
vasocongestion – caused by the temporary
congestion of lymphatics rather than the
accumulation of milk. Engorgement
resolves spontaneously, and discomfort
decreases within 24 to 36 hours.
> A breast binder, tight bra, ice packs, mild
analgesics maybe used to relieve
discomforts.
 Vital Sign Changes

Temperature
Normal findings
• During 1st 24 hrs slight increase because
of dehydration that occurred during labor
• Rises for a few hours during the 3rd or 4th
postpartum day when breast fill with milk
Deviation from normal and probable causes
• Temp. of 38C after 24hrs after childbirth
or persists for 2 days – postpartal
infection
 Vital Sign Changes

Pulse
Normal findings
• Usually slightly slower than normal during
the postpartal period
• End of 1st week, PR will return to normal
Deviation from normal and probable causes
• A rapid PR or one that is increasing may
have hemorrhage
 Vital Sign Changes

Blood pressure
Normal findings
• BP is altered slightly
• Orthostatic hypotension- feelings of faintness
or dizziness immediately after standing up due
to lack of adequate blood volume to maintain
nourishment of brain cells
Deviation from normal and probable causes
• Decrease BP may indicate bleeding
• Elevation above 140/90 may indicate
postpartal PIH
• Oxytocin administered for uterine contractions
can increase the BP
Thank you for listening