MATERNITY FINAL EXAM STUDY GUIDE
POSTPARTUM [8 Questions]
The period between birth & the return of reproductive organs to non-pregnant
state, aka “peurperium” or 4th stage of pregnancy
Usually about 6 weeks
Care of Postpartum Women:
o Focuses on transition to parenting
Physiological recovery
Psychological well-being
Ability to care for herself & the new baby
Reproductive System & Associated Structures:
o Uterus
Involution: return to non-pregnant state after birth
2 cm below umbilicus at end of 3rd stage of labor
Within 12hrs returns to level of umbilicus (+/- 1cm)
Progresses rapidly-
o Fundus descends 1-2 cm every 24 hours
o 2 weeks after birth, uterus lies in true
pelvis- can’t palpate anymore
Subinvolution: failure to return to non-pregnant state
Common causes: retained placental fragments; infection
Contractions
Hemostasis achieved through contractions, which seal off
the vessels at the placental implantation site immediately
after birth
Oxytocin (released from pituitary gland), strengthens &
coordinates contractions
Breastfeeding stimulates its release
o Lochia: postbirth uterine discharge
Rubra: blood & decidual & trophoblastic debris
Duration of ~3-4 days
Serosa-brown: old blood, serum, leukocytes, debris
Begins ~ day 3-4, lasts up to 2 weeks after birth
Bleeding should decrease in amount & the color should be lighter
(closer to brown)
Alba (whitish discharge): leukocytes, decidua, epithelial cells,
mucus, serum, bacteria
Continues 2-6 weeks after birth
**C-section patients are more variable because they lay down
more while recovering**
Keep in mind that C-section patient can still have vaginal
bleeding!
, Excess Bleeding
Saturation of perineal/sanitary pad within 15 minutes or
less
Pooling blood under but
o **Immediate assessment & intervention**
Most lochia described as scant, light, moderate, heavy
o Cervix
Cervical os, dilated to 10 cm during labor, closes slowly
o Vagina & Perineum
Vagina gradually returns to normal size by 6-10wks postpartum
Intro-itus is erythematous and edematous
Episiotomies heal within 2-3wks
Hemorrhoids/anal varicosities are common, decrease within 6
weeks
Patient can rinse using spray botles, sitz baths (warn
water promotes blood flow to area to increase healing,
used after 24 hours)
ICE = first 24 hours
Then HEAT
Pelvic muscular support
Supportive tissues of pelvic floor torn or stretched in
childbirth, require up to 6mo to regain tone
o Kegels can encourage healing
o Abdomen
During first 2 weeks, abdominal wall remains relaxed
Diastasis recti
Gap between left & right abdominal muscles
stretching from xiphoid process to umbilicus
Benign, more common in multiparous women
Woman has a “still-pregnant” appearance
Endocrine system
o Placental Hormones
Expulsion of placenta results in dramatic decreases of placental-
produced hormones
Estrogen & progesterone levels drop markedly
o Pituitary Hormones & ovarian function
Lactating/non-lactating women differ in timing of first ovulation
and menstruation
70% non-breastfeeders menstruate within first 12 weeks
Breast-feeders return of ovulation depends on
breastfeeding paterns; may ovulate before first menstrual
cycle
Urinary System
, o Urine Components
o Post-partum diuresis
With 12 hours women begin to diurese; profuse diaphoresis
occurs at night for first 2-3 days
Increased urine output & diaphoresis to get rid of the excess
plasma
o Urethra & Bladder
Excessive bleeding may occur because of displacement of uterus if
bladder is full
GI system
o Appetite
Most new moms are very hungry after recovery due to analgesia,
anesthesia, and fatigue
o Bowel evacuation
Spontaneous bowel evacuation may not occur for 2-3 days after
Rectal pressure & urge to have bowel movement should raise
awareness because there really shouldn’t get anything in rectum
or perineum (hematoma, collection of blood in the area) palpate
area to make sure its soft (firmàmight be concerned)
Vitals
o Temp: may increases to 38 C for 24 hours
o Pulse: may be higher for an hour
o RR: should be normal, diaphoresis will occur
Ease of stuffy nose, tidal volume returns to normal, normal rate
o BP: normal, observe for hypotension
Cardiovascular
o Blood Volume
Increase eliminated within first 2 weeks after birth; return to
non-pregnant values by 6 months after delivery
Previous excess blood volume od pregnancy protects mothers
from post-delivery shock
Readjustments in maternal vasculature are dramatic, rapid
Assess for peripheral edema
o CO- slightly elevated with remaining increased volume
Blood components
H&H will be stable/high due to loss of plasma volume
WBC ~12,000…elevated WBCs = worried about infection
Neurologic
o Pregnancy related discomfort dissipates after birth
o Headaches should be carefully assessed
May be caused by GHTN, stress, leakage of CSF into extradural
space during needle placement for epidural/spinal anesthesia
Musculoskeletal
, o Joints are completely stabilized by 6-8wks after birth (^ relaxin release)
New mother may have permanent increase in shoe size
Integumentary System
o Chloasma of pregnancy disappears
o Hyperpigmentation of areolae and linea nigra may not regress completely
after childbirth
Stretch marks (breasts, abdomen, thighs) won’t fully fade
o Vascular abnormalities (spider angiomas, palmar erythema, epulis)
decline rapidly due to less estrogens
Some experience permanent spider nevi
o Fine hair during pregnancy usually disappears (coarse/dark hair usually
remains)
Immune System
o No significant changes occur during postpartum period
o Mother’s need for rubella vaccine or RhoGam need should be determined
Rubella is live so contraindicated with pregnancy (testing is fine
during pregnancy)à vaccine given at discharge
tDAP given during pregnancy to help protect mother from
pertussis so baby doesn’t get it; baby receives after birth
Additional Assessments
o Brief head to toe- auscultate heart, lungs, bowel; palpate peripheral, skin
o Maternal/Infant Blood type & Rh- RNs responsibility
RhoGAM if indicated (Rh- mom, Rh+ baby) w/in 72hrs of birth
Prevents Rh isoimmunization: sensitization of maternal
blood and development of antibodies to Rh+ blood-
problem for future pregnancies
BO incompatibility
A/B Infants born to mothers who are type O more at risk
due to maternal antibodies to A & B
Coombs test to assess for increased risk for
jaundice
Severe reactions may need phototherapy
treatment
Focused Assessment & Care (“BUBBLEHE”)
o Breasts
Breastfeeding- goal is to promote continuous milk production
Soft- tingly as milk comes in
Supportive bra & warm compress (prior to feeding) to
stimulate let-down
Massage before feeding
Assess nipple for cracks/bleeding
Expose nipples to air after feeding
Express milk
POSTPARTUM [8 Questions]
The period between birth & the return of reproductive organs to non-pregnant
state, aka “peurperium” or 4th stage of pregnancy
Usually about 6 weeks
Care of Postpartum Women:
o Focuses on transition to parenting
Physiological recovery
Psychological well-being
Ability to care for herself & the new baby
Reproductive System & Associated Structures:
o Uterus
Involution: return to non-pregnant state after birth
2 cm below umbilicus at end of 3rd stage of labor
Within 12hrs returns to level of umbilicus (+/- 1cm)
Progresses rapidly-
o Fundus descends 1-2 cm every 24 hours
o 2 weeks after birth, uterus lies in true
pelvis- can’t palpate anymore
Subinvolution: failure to return to non-pregnant state
Common causes: retained placental fragments; infection
Contractions
Hemostasis achieved through contractions, which seal off
the vessels at the placental implantation site immediately
after birth
Oxytocin (released from pituitary gland), strengthens &
coordinates contractions
Breastfeeding stimulates its release
o Lochia: postbirth uterine discharge
Rubra: blood & decidual & trophoblastic debris
Duration of ~3-4 days
Serosa-brown: old blood, serum, leukocytes, debris
Begins ~ day 3-4, lasts up to 2 weeks after birth
Bleeding should decrease in amount & the color should be lighter
(closer to brown)
Alba (whitish discharge): leukocytes, decidua, epithelial cells,
mucus, serum, bacteria
Continues 2-6 weeks after birth
**C-section patients are more variable because they lay down
more while recovering**
Keep in mind that C-section patient can still have vaginal
bleeding!
, Excess Bleeding
Saturation of perineal/sanitary pad within 15 minutes or
less
Pooling blood under but
o **Immediate assessment & intervention**
Most lochia described as scant, light, moderate, heavy
o Cervix
Cervical os, dilated to 10 cm during labor, closes slowly
o Vagina & Perineum
Vagina gradually returns to normal size by 6-10wks postpartum
Intro-itus is erythematous and edematous
Episiotomies heal within 2-3wks
Hemorrhoids/anal varicosities are common, decrease within 6
weeks
Patient can rinse using spray botles, sitz baths (warn
water promotes blood flow to area to increase healing,
used after 24 hours)
ICE = first 24 hours
Then HEAT
Pelvic muscular support
Supportive tissues of pelvic floor torn or stretched in
childbirth, require up to 6mo to regain tone
o Kegels can encourage healing
o Abdomen
During first 2 weeks, abdominal wall remains relaxed
Diastasis recti
Gap between left & right abdominal muscles
stretching from xiphoid process to umbilicus
Benign, more common in multiparous women
Woman has a “still-pregnant” appearance
Endocrine system
o Placental Hormones
Expulsion of placenta results in dramatic decreases of placental-
produced hormones
Estrogen & progesterone levels drop markedly
o Pituitary Hormones & ovarian function
Lactating/non-lactating women differ in timing of first ovulation
and menstruation
70% non-breastfeeders menstruate within first 12 weeks
Breast-feeders return of ovulation depends on
breastfeeding paterns; may ovulate before first menstrual
cycle
Urinary System
, o Urine Components
o Post-partum diuresis
With 12 hours women begin to diurese; profuse diaphoresis
occurs at night for first 2-3 days
Increased urine output & diaphoresis to get rid of the excess
plasma
o Urethra & Bladder
Excessive bleeding may occur because of displacement of uterus if
bladder is full
GI system
o Appetite
Most new moms are very hungry after recovery due to analgesia,
anesthesia, and fatigue
o Bowel evacuation
Spontaneous bowel evacuation may not occur for 2-3 days after
Rectal pressure & urge to have bowel movement should raise
awareness because there really shouldn’t get anything in rectum
or perineum (hematoma, collection of blood in the area) palpate
area to make sure its soft (firmàmight be concerned)
Vitals
o Temp: may increases to 38 C for 24 hours
o Pulse: may be higher for an hour
o RR: should be normal, diaphoresis will occur
Ease of stuffy nose, tidal volume returns to normal, normal rate
o BP: normal, observe for hypotension
Cardiovascular
o Blood Volume
Increase eliminated within first 2 weeks after birth; return to
non-pregnant values by 6 months after delivery
Previous excess blood volume od pregnancy protects mothers
from post-delivery shock
Readjustments in maternal vasculature are dramatic, rapid
Assess for peripheral edema
o CO- slightly elevated with remaining increased volume
Blood components
H&H will be stable/high due to loss of plasma volume
WBC ~12,000…elevated WBCs = worried about infection
Neurologic
o Pregnancy related discomfort dissipates after birth
o Headaches should be carefully assessed
May be caused by GHTN, stress, leakage of CSF into extradural
space during needle placement for epidural/spinal anesthesia
Musculoskeletal
, o Joints are completely stabilized by 6-8wks after birth (^ relaxin release)
New mother may have permanent increase in shoe size
Integumentary System
o Chloasma of pregnancy disappears
o Hyperpigmentation of areolae and linea nigra may not regress completely
after childbirth
Stretch marks (breasts, abdomen, thighs) won’t fully fade
o Vascular abnormalities (spider angiomas, palmar erythema, epulis)
decline rapidly due to less estrogens
Some experience permanent spider nevi
o Fine hair during pregnancy usually disappears (coarse/dark hair usually
remains)
Immune System
o No significant changes occur during postpartum period
o Mother’s need for rubella vaccine or RhoGam need should be determined
Rubella is live so contraindicated with pregnancy (testing is fine
during pregnancy)à vaccine given at discharge
tDAP given during pregnancy to help protect mother from
pertussis so baby doesn’t get it; baby receives after birth
Additional Assessments
o Brief head to toe- auscultate heart, lungs, bowel; palpate peripheral, skin
o Maternal/Infant Blood type & Rh- RNs responsibility
RhoGAM if indicated (Rh- mom, Rh+ baby) w/in 72hrs of birth
Prevents Rh isoimmunization: sensitization of maternal
blood and development of antibodies to Rh+ blood-
problem for future pregnancies
BO incompatibility
A/B Infants born to mothers who are type O more at risk
due to maternal antibodies to A & B
Coombs test to assess for increased risk for
jaundice
Severe reactions may need phototherapy
treatment
Focused Assessment & Care (“BUBBLEHE”)
o Breasts
Breastfeeding- goal is to promote continuous milk production
Soft- tingly as milk comes in
Supportive bra & warm compress (prior to feeding) to
stimulate let-down
Massage before feeding
Assess nipple for cracks/bleeding
Expose nipples to air after feeding
Express milk
