1
OB 101 - OB Final Exam Study Guide.
Exam (elaborations)
, 2
OB FINAL EXAM
Postpartum
The postpartum or the puerperium period is the period of time following the delivery of the child during which the body
tissues, especially the reproductive system reverts back to the pre-pregnant state, both anatomically and
physiologically.
The puerperium or the postpartum period lasts for 6 weeks.
o 1) Immediate Postpartum: the 24-hour period immediately following delivery.
o 2) Early Postpartum or puerperium: up to 7 days.
o 3) Remote postpartum or puerperium: up to 6 weeks.
Reproductive system
Involution of the uterus: rapid reduction in size of the uterus to a nonpregnant state following birth.
Following delivery of the placenta the uterus contracts into a hard mass; the size of a grapefruit
Exfoliation is a very important aspect of involution; if healing of the placenta site leaves a fibrous scar, the area available
for future implantation is limited, as is the number of possible pregnancies.
With the dramatic decrease in the levels of circulating estrogen and progesterone following placental separation, the
uterine cells atrophy, and the hyperplasia of pregnancy begins to reverse.
Factors that enhance involution include:
o an uncomplicated labor and birth
o complete expulsion of the placenta or membranes
o breastfeeding
o manual removal of the placenta during a cesarean birth
o and early ambulation.
Factors that slow uterine involution include:
o Prolonged labor
o Anesthesia
o Difficult birth
o Grand multiparity
o Full bladder
o Incomplete expulsion of the placenta or membranes
o Infection
o Over distension of the uterus (Overstretching of uterine muscles with conditions such as multiple
gestation, hydramnios, or a very large baby may set the stage for slower uterine involution.)
Uterus
At delivery fundus is at the umbilicus
1-2 hours: midway between umbilicus and symphysis pubis
12 hours: 1 cm above or at umbilicus
After that the height of the uterine fundus decreases (involutes) by approximately 1 cm per day.
Within 6 to 12 hours after birth, the fundus of the uterus rises to the level of the umbilicus because of blood and clots that
remain within the uterus and changes in support of the uterus by the ligaments.
A fundus that is above the umbilicus and boggy (feels soft and spongy rather than firm and well contracted) is associated with
excessive uterine bleeding. As blood collects and forms clots within the uterus, the fundus rises; firm contractions of the uterus
are interrupted, causing a boggy uterus (uterine atony). When the fundus is higher than expected on palpation and is not in the
midline (usually deviated to the right), distention of the bladder should be suspected; the bladder should be emptied
immediately and the uterus remeasured.
If the woman is unable to void, in-and-out catheterization of the bladder may be required.(straight cath)
After birth the top of the fundus remains at the level of the umbilicus for about half a day. On the first postpartum day, the top
of the fundus is located about 1 cm below the umbilicus. The top of the fundus descends approximately one finger
breadth(width of index, second, or third finger), or 1 cm, per day until it descends into the pelvis on about the 10th day.
Breast feeding hastens this process.
oversized uterus during the pregnancy(because of hydramnios, [LGA] infant, or multiple gestation), the time frame for
uterine involution process is lengthened.
, 3
If intrauterine infection is present, in addition to foul-smelling lochia or vaginal discharge, the uterine fundus descends
much more slowly.
o When infection is suspected, other clinical signs such as fever and tachycardia in addition to delayin involution must
be assessed.
o Any slowing of descent is called subinvolution (is the failure of the uterus to return to a nonpregnant state)
o Common causes- retained placental fragments and infection
Lochia- more common in the mornings and multiparous mom tend to have more, also moms who had a vaginal birth VS a Csection
Rubra- 1-3 days – dark red, bloody, fleshy, musty, stale non-offensive odor; clots, sometimes meconium and vernix. A few
clots (no larger than a nickel is common) LARGE clots are not normal
Serosa- 4-10 days – pinkish, watery, odorless
Alba-11-21 days; ( a week or two) yellow to white, possible stale odor
When the lochia flow stops, the cervix is considered closed, and chances of infection ascending from the vagina to the
uterus decrease.
Foul smelling lochia: assess for (WBC) count and differential and assessment for uterine tenderness and fever.
Persistent discharge of lochia rubra or a return to lochia rubra indicates subinvolution or late postpartal hemorrhage
Continuous bleeding is consistent with vaginal/uterine lacerations. Lacerations should be suspected if the uterus is firm and
of expected size and if no clots can be expressed.
Vaginal changes
Edematous
Multiple small lacerations
Perineal pain can last for up to 2 weeks
By 6 weeks the nonbreastfeeding woman’s vagina usually appears normal.
The lactating woman is in a hypoestrogenic state because of ovarian suppression, and her vaginal mucosa may be pale
and without rugae; the effects of the low estrogen level may lead to dyspareunia (painful intercourse), may be reduced by
the addition of lubricant.
Tone and contractility of the vaginal orifice may be improved by perineal tightening exercises such as Kegel exercises
Painful intercourse due to lowered estrogen which leads to decreased vaginal lubrication and vasoconstricition for 6–10
weeks
Perineal changes
• Edematous and bruising
• If episiotomy present ; sore tender, pain subsides in 5-6 days
• Observe for REEDA
• Healing can take up to 2-3 weeks; complete up to 4-6 months
• Perineal discomfort
• Perineal lacerations: place ice pack, sitz bath, or packing
• DO NOT give pt enema or suppository
•
Recurrence of ovulation & menstruation
In nonbreastfeeding mothers, menstruation generally returns between 4 and 6 weeks after birth.
nonlactating mothers the average time to first ovulation can be as early as 27 days with a mean time of 70 to 75 days (6-8
weeks)
OB 101 - OB Final Exam Study Guide.
Exam (elaborations)
, 2
OB FINAL EXAM
Postpartum
The postpartum or the puerperium period is the period of time following the delivery of the child during which the body
tissues, especially the reproductive system reverts back to the pre-pregnant state, both anatomically and
physiologically.
The puerperium or the postpartum period lasts for 6 weeks.
o 1) Immediate Postpartum: the 24-hour period immediately following delivery.
o 2) Early Postpartum or puerperium: up to 7 days.
o 3) Remote postpartum or puerperium: up to 6 weeks.
Reproductive system
Involution of the uterus: rapid reduction in size of the uterus to a nonpregnant state following birth.
Following delivery of the placenta the uterus contracts into a hard mass; the size of a grapefruit
Exfoliation is a very important aspect of involution; if healing of the placenta site leaves a fibrous scar, the area available
for future implantation is limited, as is the number of possible pregnancies.
With the dramatic decrease in the levels of circulating estrogen and progesterone following placental separation, the
uterine cells atrophy, and the hyperplasia of pregnancy begins to reverse.
Factors that enhance involution include:
o an uncomplicated labor and birth
o complete expulsion of the placenta or membranes
o breastfeeding
o manual removal of the placenta during a cesarean birth
o and early ambulation.
Factors that slow uterine involution include:
o Prolonged labor
o Anesthesia
o Difficult birth
o Grand multiparity
o Full bladder
o Incomplete expulsion of the placenta or membranes
o Infection
o Over distension of the uterus (Overstretching of uterine muscles with conditions such as multiple
gestation, hydramnios, or a very large baby may set the stage for slower uterine involution.)
Uterus
At delivery fundus is at the umbilicus
1-2 hours: midway between umbilicus and symphysis pubis
12 hours: 1 cm above or at umbilicus
After that the height of the uterine fundus decreases (involutes) by approximately 1 cm per day.
Within 6 to 12 hours after birth, the fundus of the uterus rises to the level of the umbilicus because of blood and clots that
remain within the uterus and changes in support of the uterus by the ligaments.
A fundus that is above the umbilicus and boggy (feels soft and spongy rather than firm and well contracted) is associated with
excessive uterine bleeding. As blood collects and forms clots within the uterus, the fundus rises; firm contractions of the uterus
are interrupted, causing a boggy uterus (uterine atony). When the fundus is higher than expected on palpation and is not in the
midline (usually deviated to the right), distention of the bladder should be suspected; the bladder should be emptied
immediately and the uterus remeasured.
If the woman is unable to void, in-and-out catheterization of the bladder may be required.(straight cath)
After birth the top of the fundus remains at the level of the umbilicus for about half a day. On the first postpartum day, the top
of the fundus is located about 1 cm below the umbilicus. The top of the fundus descends approximately one finger
breadth(width of index, second, or third finger), or 1 cm, per day until it descends into the pelvis on about the 10th day.
Breast feeding hastens this process.
oversized uterus during the pregnancy(because of hydramnios, [LGA] infant, or multiple gestation), the time frame for
uterine involution process is lengthened.
, 3
If intrauterine infection is present, in addition to foul-smelling lochia or vaginal discharge, the uterine fundus descends
much more slowly.
o When infection is suspected, other clinical signs such as fever and tachycardia in addition to delayin involution must
be assessed.
o Any slowing of descent is called subinvolution (is the failure of the uterus to return to a nonpregnant state)
o Common causes- retained placental fragments and infection
Lochia- more common in the mornings and multiparous mom tend to have more, also moms who had a vaginal birth VS a Csection
Rubra- 1-3 days – dark red, bloody, fleshy, musty, stale non-offensive odor; clots, sometimes meconium and vernix. A few
clots (no larger than a nickel is common) LARGE clots are not normal
Serosa- 4-10 days – pinkish, watery, odorless
Alba-11-21 days; ( a week or two) yellow to white, possible stale odor
When the lochia flow stops, the cervix is considered closed, and chances of infection ascending from the vagina to the
uterus decrease.
Foul smelling lochia: assess for (WBC) count and differential and assessment for uterine tenderness and fever.
Persistent discharge of lochia rubra or a return to lochia rubra indicates subinvolution or late postpartal hemorrhage
Continuous bleeding is consistent with vaginal/uterine lacerations. Lacerations should be suspected if the uterus is firm and
of expected size and if no clots can be expressed.
Vaginal changes
Edematous
Multiple small lacerations
Perineal pain can last for up to 2 weeks
By 6 weeks the nonbreastfeeding woman’s vagina usually appears normal.
The lactating woman is in a hypoestrogenic state because of ovarian suppression, and her vaginal mucosa may be pale
and without rugae; the effects of the low estrogen level may lead to dyspareunia (painful intercourse), may be reduced by
the addition of lubricant.
Tone and contractility of the vaginal orifice may be improved by perineal tightening exercises such as Kegel exercises
Painful intercourse due to lowered estrogen which leads to decreased vaginal lubrication and vasoconstricition for 6–10
weeks
Perineal changes
• Edematous and bruising
• If episiotomy present ; sore tender, pain subsides in 5-6 days
• Observe for REEDA
• Healing can take up to 2-3 weeks; complete up to 4-6 months
• Perineal discomfort
• Perineal lacerations: place ice pack, sitz bath, or packing
• DO NOT give pt enema or suppository
•
Recurrence of ovulation & menstruation
In nonbreastfeeding mothers, menstruation generally returns between 4 and 6 weeks after birth.
nonlactating mothers the average time to first ovulation can be as early as 27 days with a mean time of 70 to 75 days (6-8
weeks)
