Exam (elaborations) MATERNITY FINAL EXAM STUDY GUIDE.

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) 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