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POSTPARTUM

ADAPTATION AND
ASSESSMENT

ANNA C. LATORRE, MSN, APN,NP-C
Postpartum uterine changes
Decrease in weight 100 g
Spongy layer of the decidua is sloughed off
Basal layer differentiates into two layers
outer layer sloughs off
inner layer begins the foundation for the new
endometrium
Placental site heals by exfoliation
Postpartum uterine changes
(continued)
Uterine cells will atrophy
Uterine debris in the uterus is discharged
through lochia
lochia rubra is red (first 23 days)
lochia serosa is pink (day 3 to day 10)
lochia alba is white (continues until the cervix is
closed)
Involution of the uterus. A, Immediately after delivery of the placenta, the top of the
fundus is in the midline and approximately halfway between the symphysis pubis and the
umbilicus. About 6 to 12 hours after birth, the fundus is at the level of the umbilicus. B,
The height of the fundus then decreases about one finger breadth (approximately 1 cm)
each day.
Postpartum cervical and vaginal
changes
Cervix is spongy, flabby, and may appear
bruised
External os may have lacerations and is
irregular and closes slowly
Shape of the external os changes to a lateral
slit
Postpartum cervical and vaginal
changes (continued)
Vagina may be edematous, bruised with small
superficial lacerations
Size decreases and rugae reappear within 3 to
4 weeks
Returns to prepregnant state by 6 weeks
Perineal changes and return of
menstruation
Perineum may be edematous, with bruising
Lacerations or an episiotomy may be present
Menstruation generally returns between 6 and
10 weeks (nonbreastfeeding woman)
Postpartum abdominal and breast
changes
Abdomen is loose and flabby but will respond
to exercise
Uterine ligaments will gradually return to their
prepregnant state
Diastasis recti abdominis
Striae will take on different colors based on the
mothers skin color
Breasts are ready for lactation
Diastasis recti abdominis, a separation of the abdominal musculature, commonly occurs
after pregnancy.
Postpartum bowel changes
Bowels will be sluggish
Episiotomy, lacerations, or hemorrhoids may
delay elimination
Postpartum bladder changes
Increased bladder capacity
Swelling and bruising of tissues around the
urethra
Decrease in sensitivity to fluid pressure
Decrease in sensation of bladder filling
Urinary output is greater due to puerperal
diuresis
Increased chance of infection due to dilated
ureters and renal pelves
The uterus becomes displaced and deviated to the right when the bladder is full.
Postpartum changes in vital
signs
Temperature may be elevated to 38C for up
to 24 hours after birth
Temperature may be increased for 24 hours
after the milk comes in
BP rises early and then returns to normal
Bradycardia occurs during first 6 to 10 days
Postpartum changes in lab
values
Nonpathologic leukocytosis occurs in the early
postpartum period
Blood loss averages 200 to 500 mL (vaginal),
700 to 1000 mL (cesarean)
Plasma levels reach the prepregnant state by
4 to 6 weeks postpartum
Platelet levels will return to normal by the 6th
week
Diuresis
Cardiac output returns to normal by 6 to 12
weeks

Postpartum weight changes
Initial weight loss of 10 to 12 lb
Postpartum diuresis causes a loss of 5 lb
Return to their prepregnant weight by the 6th
to 8th week
Nursing Care
Evaluate for history of risk factors
Provide privacy
Monitor for signs of:
infection
respiratory difficulty
constipation
voiding problems
circulatory problems
Cultural influence in the
postpartum period
Non-Western cultures emphasize postpartum
period
Food and liquids after birth
Hot-cold balance
Role of grandmother
Nursing support involves
Individualizing care to each patient
Assessing patients level of acculturation and
assimilation to Western culture
Involving cultural foods and customs when
possible
Principles of conducting a
postpartum assessment
Selecting the time that will provide the most
accurate data
Providing an explanation of the purpose of the
assessment
Ensuring that the woman is relaxed before
starting
Recording and reporting the results clearly
Body fluid precautions
12 Point Postpartum
Assessment
VS
Rest/Sleep/Exercise
Appetite
Bonding/Attachment
Breasts
Fundus
Lochia
Perineum



Bladder
Bowels
Homans Sign
Comfort
Teaching/Learning
Lab Work
Rubella/RhoGAM
Social Support
Postpartum assessment
B Breasts
U Uterus
B Bowel
B Bladder
L Lochia
E Episiotomy/Lacerations
H Homans/Hemorrhoids
E Emotions
Breast assessment
Size and shape
Abnormalities, reddened areas, or
engorgement
Presence of breast fullness due to milk
presence
Assess nipples for cracks, fissures, soreness,
or inversion
Abdominal assessment
Position of fundus related to umbilicus
Position of fundus to midline
Firmness
Assess incision for bleeding, approximation,
and signs of infection
Assessment of lochia and
perineum
Assess lochia for amount, color, and odor
Presence of any clots
Wound is assessed for approximation,
redness, edema, ecchymosis, and discharge
Presence of hemorrhoids
Level of comfort/discomfort
Efficacy of any comfort measures
Assessment of extremities, bowel,
and bladder
Homans sign
Assess calf for redness and warmth
Adequacy of urinary elimination
Bladder distention and pain during urination
Intestinal elimination
Maternal concerns regarding bowel
movements
Assessment of psychological
adaptation and nutrition
Adaptation to motherhood
Fatigue
Nutritional status
Cesarean birth
return of bowel function
tolerance of dietary progression
Postpartum concerns of the
mother
Vaginal bleeding (gushing of blood after laying
for long periods of time)
Passing clots
Night sweats
Afterpains
Weight loss
Abnormal vital signs
High BP: preeclampsia, essential
hypertension, renal disease, anxiety
Low BP: uterine hemorrhage
Tachycardia: difficult labor and birth,
hemorrhage
Marked tachypnea: respiratory disease
Temp of 100.4F or above: infection
Positive Homans sign: thrombophlebitis
Breasts
Mastitis (infection)
Engorgement (venous
stasis)
Cracked nipples
Types of Breasts
Relief of Breast Discomfort
Postpartum
Non-Breastfeeding
Avoid stimulation
Ice packs
Supportive bra
Cabbage leaves
Medicate
Breastfeeding
Feed the Baby
Nipple Care
Supportive bra
Medicate

Abdomen
Diastasis recti abdominis
Boggy fundus
Uterine infections
Endometritis
Dehiscence of incision (c-section)
Lochia
Clots
Hemorrhage
Infection
Subinvolution of uterus
Perineum
Vulvar hematoma
Infection
Hemorrhoids
Bladder
InfectionUTI
Urinary retention
Bowel
Constipation
Diet
Not Ambulating
Physical and developmental
tasks
Gain competence in caregiving
Gain confidence in role as parent
Return of all physical systems to prepregnant
state
Factors that influence parent-infant
attachment
Family of origin
Relationships
Stability of the home environment
Communication patterns
The degree of nurturing the parents received
as children