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Uterine Involution
Fundal position changes ; Boggy
Lochia: Rubra, Serosa, Alba
Cervical changes
Vaginal changes
Perineal changes
Recurrence of ovulation and
menustration
Lactation
Cont.
Gastrointestinal System
Urinary tract
Vital signs
Weight loss
Postpartum chill
Postpartal diaphoresis
Afterpains or Afterbirth pains
Uterine Involution
The rapid reduction in size of the
uterus and its return to a condition
similar to its pre-pregnancy state.
The uterus remains slightly larger
than it was before the first
pregnancy.
Process is complete at 3 weeks
Subinvolution may be caused by an
infection or retained placenta
fragments.
Serosa
pinkish to brownish in color, from the 3rd
to the 10th day post delivery.
Alba
creamy or yellowish in color, persists for a
week or two after serosa, may be later in
breastfeeding clients.
Cervical Changes
Following birth it is spongy and
flabby and formless and may appear
bruised.
Original form is regained in a few
hours
The shape is permanently changed
by the first childbearing.
Goes from dimple like to a lateral slit
(fish mouth)
Vaginal Changes
Following birth appears edematous
May be bruised
Small superficial lacerations may be
present
Size and rugae return to pre
pregnancy in 3 weeks By 6 weeks
appears normal
Perineal Changes
May appear edematous with some
bruising
Episiotomy edges should be
approximated
Ecchymosis may occur and delay
healing
Lactation
During pregnancy, the breasts
develop in preparation for lactation
as a result of both estrogen and
progesterone.
After birth, the interplay of maternal
hormones leads to the establishment
of milk production.
Gastrointestinal System
May have a regular diet
Bowels tend to be sluggish
Episiotomy clients may delay bowel
movement for fear of pain
Cesarean birth clients may receive
clear liquids and progress to a
regular diet
Stool softeners may be used
Urinary Tract
The postpartum client has an increased
bladder capacity, swelling and bruising
of tissue, decreased sensitivity to fluid
pressure, and decreased sensation of
bladder filling.
At risk for over-distention, incomplete
emptying, and buildup of residual urine.
Urinary output increases 1rst 24 hours
post delivery (puerperal diuresis)
Urine specimens should be obtained as
a catheterized specimen.
Vital Signs
Client should be afebrile after the
first 24 hours.
A temperature up to 100.4 may be
due to dehydration and/or exertion in
the first 24 hours.
BP WNL, a decrease may occur. An ?
BP may indicate toxemia, PIH.
Pulse rate may decrease to 50-70.
Tachycardia should alert the nurse to
blood loss/difficult birth.
Blood Values
Blood values should return to the prepregnant
state by the end of the postpartum period.
Predisposed to the development of
thromboembolism
Leukocytosis with white blood cell (WBC)
counts up to 30,000 per mL may occur early
postpartum.
Treat the symptoms, not the lab work.
Convenient rule of thumb is a 2 point drop in
hematocrit equals a blood loss of 500 mL.
Weight Loss
An initial weight loss of 10 to 12 lbs
occurs as a result of the birth of the
infant, placenta and amniotic fluid.
Puerperal diuresis accounts for loss
of an additional 5 lbs during the early
postpartum period.
Normally return to pre-pregnant
weight by 6 weeks postpartum.
Ekstremitas bawah
Cont.
Postpartum Psychological
Adaptations
Maternal Role
Postpartum blues
Development of Parent -Infant
attachment
Initial attachment Behavior
Father-Infant Interactions
Cultural Influences
Maternal Role
Time of readjustment and adaptation
During the first day or two, the client tends
to be passive and somewhat dependent
Hesitant about making decisions
Food or sleep are of major importance, May
feel a great need to talk Taking In phase
according to Rubin
By second or third day, client is ready to
resume control. Taking Hold phase
occurs during this time.
Todays client adjust more rapidly as LOS has
shortened.
Maternal role attainment: process by which a
woman learns mothering behaviors.
(anticipatory, formal, informal, and personal)
Postpartum blues
Describes a transient period of depression
that occurs in most women during the first
week or two after birth.
May be manifested by mood swings, anger,
weepiness, anorexia, difficulty sleeping,
and a feeling of letdown.
Hormonal changes and psychological
adjustments are thought to be main
causes.
Usually resolve naturally in 2 to 3 weeks
with support and reassurance. If symptoms
persist, the client should be evaluated for
postpartum depression.
Father-Infant Interactions
Primary role has been supporting role
Engrossment (the characteristic
sense of absorption, preoccupation,
and interest in the infant
demonstrated by fathers during early
contact with the newborn.
Cultural Influences
Postpartum care my be affected by
cultural beliefs : No shower, no
breastfeeding for the first three days,
hot and cold foods
Do not make generalizations
Extended family may play an
important role in care