Lochia _______ is mostly blood, fragments of decidua, and mucus and starts in postpartum
days 1-3 - ANSWER Lochia Rubra (red)
Lochia _____ is blood, mucus, and invading leukocytes and starts in postpartum days 3-10. -
ANSWER Lochia serosa (pink/brown)
Lochia ______ is non-odorous, mucus-like, with high leukocyte counts and starts in postpar-
tum days 10-14 days (can last 6 weeks.) - ANSWER Lochia Alba (white to yellow-white)
The greatest risks to a postpartum mom - ANSWER •The greatest risk in postpartum
stage is *hemorrhage, shock, and infection*
___________ medications can be given to help promote contraction of the uterus thus de-
creasing bleeding and chances of hemorrhage - ANSWER Oxytoxics
________are the contractions pains that help with involution of the uterus (similar to men-
strual cramps.)
▪ they can be much more painful for multiparas women and those with an over distended
uterus (polyhydramnios, multiple gestations, macrosomic infant, etc.).
▪ they are usually not as bad after the first few days. - ANSWER *afterpains*
▪ breastfeeding increases the afterpains as oxytocin is released with nipple stimulation.
Lochia Evaluation - *Amount* - ANSWER ▪ Lochia amount varies greatly from woman to
woman.
1
,▪ Mothers who breastfeed tend to have less lochial discharge than those who do not be-
cause the natural release of the hormone oxytocin during breastfeeding strengthens uterine
contractions.
▪ Lochial flow increases on exertion, especially the first few times a woman is out of bed but
decreases again with rest.
▪ Saturating a perineal pad in less than 1 hour is considered an abnormally heavy flow and
should be reported.
▪ Don't use tampons to halt the flow or this could lead to infection.
Lochia Evaluation - *Consistency* - ANSWER ▪ Lochia should contain no exceedingly large
clots as these may indicate a portion of the placenta has been retained and is preventing clo-
sure of the maternal uterine blood sinuses.
▪ In any event, large clots denote poor uterine contraction, which needs to be corrected.
Lochia Evaluation - *Pattern* - ANSWER ▪ Lochia is red for the first 1 to 3 days (lochia ru-
bra), pinkish-brown from days 4 to 10 (lochia serosa), and then white (lochia alba) for as long
as 6 weeks after birth.
▪ The pattern of lochia (rubra to serosa to alba) should not reverse as this suggests a placen-
tal fragment has been retained or uterine contraction is decreasing and new bleeding is be-
ginning.
Lochia Evaluation - *Odor* - ANSWER ▪ Lochia should not have an offensive odor as this
suggests the uterus has become infected.
▪ Immediate intervention is needed to halt postpartal infection.
Lochia Evaluation - *Absence* - ANSWER ▪ Lochia should never be absent during the first
1 to 3 weeks as absence of lochia, like presence of an offensive odor, may indicate postpartal
infection.
▪ Lochia may be scant in amount after cesarean delivery, but it is never altogether absent.
2
,Name the 5 types of lochia amounts and their measurements - ANSWER •Scant - less
than 2.5cm
•Light - less than 10cm
•Moderate - more than 10cm
•Heavy - one pad saturated within 2 hours
•Excessive - one pad saturated in 15mins or less
Postpartum: *Fundal Height Changes* - ANSWER *It decreases by one fingerbreadth, or
1 cm, per day*
▪ Right after birth it's at the umbilicus
▪ For example, on the first postpartal day, it will be palpable 1 cm below the umbilicus.
▪ In the average woman, by the ninth or tenth day, the uterus will have contracted so much
that it is withdrawn into the pelvis and can no longer be detected by abdominal palpation
How do you palpate the fundus? - ANSWER ▪ Palpate the fundus of the uterus by placing
one hand on the base of the uterus, just above the symphysis pubis, and the other at the
umbilicus.
▪ Press in and downward with the hand at the umbilicus until you "bump" against a firm
globular mass in the abdomen: the uterine fundus
incision made into the perineum to enlarge the vaginal opening to help with delivery - AN-
SWER episiotomy
a tear during labor - ANSWER laceration
Nursing Care: *Laceration/Episiotomy* - ANSWER •Promote measures for the client to
help soften her stool (stool softeners or high fiber foods like fruit, fluids)
•Sitz baths
3
, •NO Enemas or Suppositories
•Analgesics
•Ice packs for comfort
•Educate on proper cleaning to prevent infection
- wash hands before and after
- use squeeze bottle filled with warm water after each void to cleanse perineal area
- clean from front to back
- blot dry not wipe
Postpartum: *Bladder Assessment* - ANSWER •If fundus is displaced, then the bladder
needs to be emptied.
•Pressure from the trauma of delivery cause urinary retention so it is important to monitor
I&O and to promote getting up and using the restroom every 2-3 hours
Causes of *Urinary Retention* - ANSWER epidurals
spinal tap
urinary catheters
vaginal swelling/trauma from birth
Is an infection of the breast involving the interlobular connective tissue and is usually unilat-
eral - ANSWER mastitis
S/S: *Mastitis* - ANSWER •Localized heat and swelling
•Pain; tender axillary lymph nodes
•Elevated temperature
•Complaints of flulike symptoms
4
days 1-3 - ANSWER Lochia Rubra (red)
Lochia _____ is blood, mucus, and invading leukocytes and starts in postpartum days 3-10. -
ANSWER Lochia serosa (pink/brown)
Lochia ______ is non-odorous, mucus-like, with high leukocyte counts and starts in postpar-
tum days 10-14 days (can last 6 weeks.) - ANSWER Lochia Alba (white to yellow-white)
The greatest risks to a postpartum mom - ANSWER •The greatest risk in postpartum
stage is *hemorrhage, shock, and infection*
___________ medications can be given to help promote contraction of the uterus thus de-
creasing bleeding and chances of hemorrhage - ANSWER Oxytoxics
________are the contractions pains that help with involution of the uterus (similar to men-
strual cramps.)
▪ they can be much more painful for multiparas women and those with an over distended
uterus (polyhydramnios, multiple gestations, macrosomic infant, etc.).
▪ they are usually not as bad after the first few days. - ANSWER *afterpains*
▪ breastfeeding increases the afterpains as oxytocin is released with nipple stimulation.
Lochia Evaluation - *Amount* - ANSWER ▪ Lochia amount varies greatly from woman to
woman.
1
,▪ Mothers who breastfeed tend to have less lochial discharge than those who do not be-
cause the natural release of the hormone oxytocin during breastfeeding strengthens uterine
contractions.
▪ Lochial flow increases on exertion, especially the first few times a woman is out of bed but
decreases again with rest.
▪ Saturating a perineal pad in less than 1 hour is considered an abnormally heavy flow and
should be reported.
▪ Don't use tampons to halt the flow or this could lead to infection.
Lochia Evaluation - *Consistency* - ANSWER ▪ Lochia should contain no exceedingly large
clots as these may indicate a portion of the placenta has been retained and is preventing clo-
sure of the maternal uterine blood sinuses.
▪ In any event, large clots denote poor uterine contraction, which needs to be corrected.
Lochia Evaluation - *Pattern* - ANSWER ▪ Lochia is red for the first 1 to 3 days (lochia ru-
bra), pinkish-brown from days 4 to 10 (lochia serosa), and then white (lochia alba) for as long
as 6 weeks after birth.
▪ The pattern of lochia (rubra to serosa to alba) should not reverse as this suggests a placen-
tal fragment has been retained or uterine contraction is decreasing and new bleeding is be-
ginning.
Lochia Evaluation - *Odor* - ANSWER ▪ Lochia should not have an offensive odor as this
suggests the uterus has become infected.
▪ Immediate intervention is needed to halt postpartal infection.
Lochia Evaluation - *Absence* - ANSWER ▪ Lochia should never be absent during the first
1 to 3 weeks as absence of lochia, like presence of an offensive odor, may indicate postpartal
infection.
▪ Lochia may be scant in amount after cesarean delivery, but it is never altogether absent.
2
,Name the 5 types of lochia amounts and their measurements - ANSWER •Scant - less
than 2.5cm
•Light - less than 10cm
•Moderate - more than 10cm
•Heavy - one pad saturated within 2 hours
•Excessive - one pad saturated in 15mins or less
Postpartum: *Fundal Height Changes* - ANSWER *It decreases by one fingerbreadth, or
1 cm, per day*
▪ Right after birth it's at the umbilicus
▪ For example, on the first postpartal day, it will be palpable 1 cm below the umbilicus.
▪ In the average woman, by the ninth or tenth day, the uterus will have contracted so much
that it is withdrawn into the pelvis and can no longer be detected by abdominal palpation
How do you palpate the fundus? - ANSWER ▪ Palpate the fundus of the uterus by placing
one hand on the base of the uterus, just above the symphysis pubis, and the other at the
umbilicus.
▪ Press in and downward with the hand at the umbilicus until you "bump" against a firm
globular mass in the abdomen: the uterine fundus
incision made into the perineum to enlarge the vaginal opening to help with delivery - AN-
SWER episiotomy
a tear during labor - ANSWER laceration
Nursing Care: *Laceration/Episiotomy* - ANSWER •Promote measures for the client to
help soften her stool (stool softeners or high fiber foods like fruit, fluids)
•Sitz baths
3
, •NO Enemas or Suppositories
•Analgesics
•Ice packs for comfort
•Educate on proper cleaning to prevent infection
- wash hands before and after
- use squeeze bottle filled with warm water after each void to cleanse perineal area
- clean from front to back
- blot dry not wipe
Postpartum: *Bladder Assessment* - ANSWER •If fundus is displaced, then the bladder
needs to be emptied.
•Pressure from the trauma of delivery cause urinary retention so it is important to monitor
I&O and to promote getting up and using the restroom every 2-3 hours
Causes of *Urinary Retention* - ANSWER epidurals
spinal tap
urinary catheters
vaginal swelling/trauma from birth
Is an infection of the breast involving the interlobular connective tissue and is usually unilat-
eral - ANSWER mastitis
S/S: *Mastitis* - ANSWER •Localized heat and swelling
•Pain; tender axillary lymph nodes
•Elevated temperature
•Complaints of flulike symptoms
4
