Class Notes (838,371)
Canada (510,867)
Nursing (204)
NUR1 233 (6)

Chapter 20.docx

4 Pages
Unlock Document

NUR1 233
Sonia Elizabeth Semenic

Chapter 20: Maternal Physiological Changes Uterus  Involution process o Return of the uterus to a nonpregnant state o Begins rdmediately after expulsion of the placenta with contraction of the uterine smooth muscle o End of 3 stage labor: uterus midline 2cm below level of umbilicus – weighs 1000g o 24 hours after birth: same size as it was at 20 weeks gestation o Fundus descends 1-2cm every 24 hours and by 6 postpartum day the fundus halfway between umbilicus and symphysis pubis o Nth palpable after 2 weeks o 6 week postpartum: 50g o After birth and decrease in estrogen/progesterone, autolysis of excess hypertrophied tissue o Additional cells laid down during pregnancy remain and account for slight increase in uterine size after each pregnancy o Subinvolution: uterus doesn’t go back to normal size – cause: fragments of placenta left inside and infection  Contractions o Oxytocin: strengthens and coordinates contractions – compress blood vessels and promote hemostasis o 1-2 hours postpartum: uterine contractions decrease in intensity and become uncoordinated  Afterpains o First time mothers: uterine tone good, fundus generally firm and mild uterine cramping o Subsequent pregnancies: periodic relaxation and vigorous contractions – more in large baby – breastfeeding and oxytocin make it worse  Placental site o After placenta and membranes expelled, vascular constriction and thromboses reduce placental site to an irregular nodular and elevated area o Endometrium: upward growth causes sloughing of necrotic tissue and prevents scar formation characteristic of normal wound healing – enables endometrium to resume usual cycle of changes and permit implantation and placentation in future pregnancies  Regeneration: completed by postpartum day 16 except at placental site  Regeneration at placental site: 6 weeks postpartum  Lochia o Postbirth uterine discharge o Rubra: bright red – small clots – initially heavy o Serosa: pink – old blood, serum, leukocytes, and tissue debris – 22-27 days o Alba: yellow/white – leukocytes, decidua, epithelial cells, mucus, serum, and bacteria – at 10 days for 2-6 weeks o Less lochia after caesarean birth o Flow increases after ambulation and breastfeeding o Pools in vagina when supine o Persistence of lochia rubra early in postpartum: bleeding as result of retained fragments of placenta or membranes o Continued flow of serosa and alba by 3-4 weeks after can suggest endometritis, especially if with fever and pain o Smell like normal menstrual flow Cervix  Soft immediately after birth  2-3 days: shortened, firm, regained form  Cervix up to lower uterine segment remains edematous, thin and fragile for days after birth  Ectocervix: protrudes into vagina – appears bruised and small lacerations  Cervical os: dilated 10cm in labor – closes gradually  External cervical os never regains prepregnant appearance – not shaped like circle – like a slit  Lactation delays production of cervical and other estrogen-influenced mucus and mucosal characteristics Vagina and Perineum  Thinning of vaginal mucosa and absence of rugae  Returns to size by 6-10 weeks postpartum  Rugae: appear within 3 weeks but are never prominent as they are in nulliparous women – permanently flattened  Mucosa remains atrophic in lactating woman until menstruation resumes  Thickening of vaginal mucosa returns with ovarian function  Decreased vaginal lubrication – because of decreased estrogen  Localized dryness and coital discomfort until ovarian function and menstruation resumes  Episiotomies visible only if woman lying on side with upper butt raised – heals same way as surgical incision – healing takes 2-3 weeks  Hemorrhoids: common – internal hemorrhoids may evert while woman pushing during birth – decrease within 6 weeks of birth o Defecation: itching, discomfort, bleeding  Pelvic muscular support o Supportive tissues of pelvic floor that are torn or stretched during childbirth – 6 months to regain tone o Pelvic relaxation: lengthening and weakening of fascial supports of pelvic structures – uterus, bladder, urethra, rectum – can occur in any woman but more a complication of childbirth Abdomen  First 2 weeks: abdominal wall relaxed  Takes 6 weeks to return to prepregnancy state  Regains most elasticity but some straie may remain  Diastasis recti abdominis: abdominal wall muscles separate – large fetus or multiple fetuses Endocrine System  Placental hormones o Decreased in human chorionic somatomammotrpin (human placental lactogen), estrogen, cortisol, and placental enzyme insulinase reverse diabetogenic effects of pregnancy – lower blood sugar initially o Decrease estrogen/progesterone – breast engorgement and diuresis of excess extracellular fluid o Nonlactating: estrogen levels increase by 2 weeks after birth and by postpartum day 17 are higher than in women who are breastfeeding o hCG gone after 14 days  Pituitary hormones and ovarian function o Prolactin and oxytocin increased – suppresses ovulation o Nonlactating: decrease and reach prepregnancy level by 3-4 weeks postpartum  Ovulation: 27 days after – most by 12 weeks o Lactating: resumption of ovulation by 6 months and determined by breastfeeding patterns o First
More Less

Related notes for NUR1 233

Log In


Join OneClass

Access over 10 million pages of study
documents for 1.3 million courses.

Sign up

Join to view


By registering, I agree to the Terms and Privacy Policies
Already have an account?
Just a few more details

So we can recommend you notes for your school.

Reset Password

Please enter below the email address you registered with and we will send you a link to reset your password.

Add your courses

Get notes from the top students in your class.