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Medical 2-34-Postpartal


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Define involution?
decribes the rapid reduction in size of uterus and its return to a condition similar to its prepregnant state, although it remains slightly larger than it was before the first pregnancy
Weight of uterus decreases from ______ g in immediate postpartal period to _____ g at the end of the first week.
It reaches _____ g by the end of the second weeks, finally terminating the involution process with a weight of ____ g or less.
100 grams or less terminates involution process
Involution of placental site takes up to ____ to ___ weeks for completion.
6 to 7
Define puerperium?
postpartal period
takes about 6 weeks
Define fundus?
top portion of uterus
situated in mmidline of abdomen
one half to two thirds of the way between symphysis pubis and umbilicus
Prolonged labor retards involution by?
muscles relax because of prolonged time of contraction during labor
Anesthesia prolongs involution by?
muscles relax
Difficult birth prolongs involution by?
uterus is manipulated excessively
Grandmultiparity prolongs involution by?
repeated distention of uterus during pregnancy and labor leads to muscle stretching, diminished tone, and muscle relaxation
Full bladder prolongs involution by?
as the uterus is pushed up and usually to the right, pressure on it interferes with effective uterine contraction
Incomplete expulsion of placenta or membranes prolongs involution by?
the presence of even small amounts of tissue interferes with ability of uterus to remain firmly contracted
Infection prolongs involution by?
Inflammation interferes with uterine muscles' ability to contract effectively
Overdistention of uterus prolongs involution by?
overstretching of uterine muscles with conditions such as multiple gestation, hydramnios, or a very large baby may set the stage for slower uterine involution
Define lochia?
has a musty, stale
unoffensive odor
Define lochia rubra?
dark red in color
present for first 3 to 4 days postpartum
should not contain large clots..investigate immediately
nickel-sized clots are considered normal

epithelial cells
shreds of decidua
occasional fetal meconeum
vernix caseosa
Define lochia serosa?
pinkish to brownish color
follows from fourth to tenth day
serous exudate
shreds of degenerating decidua
cervical mucus
Define lochia alba?
final discharge
rbc component decreases
creamy or yellowish
discharge persists for one
to two weeks
decidual cells
epithelial cells
cervical mucus
cholesterol crystals

may continue for 2 to 86 days
Define diastasis recti abdominis?
separation of rectus abdominis muscles
Define afterpains?
occur more commonly in multipareas than primaparas..
caused by intermittent uterine contractions
Normal findings in postpartum mother?
blood pressure back to baseline
pulse: 50-90 bpm; check for possible bradycardia 50-70 bpm
respirations: 16-24/minute
temp: 98-100.4 F
breasts: smooth, even pigmentation, changes of pregnancy still apparent, one may appear larger

palpation: depending on postpartal day, may be soft, filling, full, or engorged

nipples: supple, pigmented, intact, become erect when stimulated

musculature: may be soft, have a "doughy" texture; rectus muscle intact
fundus: firm, midline, following expected process of involution

lochia: scant to moderate amount, earthy odor, no clots
normal progression: first 1-3 days: rubra then serosa

perineum slight edema and bruising in intact perineum

episiotomy: no redness, edema, ecchymosis, or discharge; edges well approximated

hemorrhoids: none present; if present, should be small and nontender

urinary output: voiding in sufficient quantities at least every 4-6 hours; bladder not palpable

bowel elimination: should have normal bowel movement by second or third day after birth

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