RNSG 1412 (Ob/Pedi) - Exam 1|Postpartum and Puerperium
Assessment Exam: Involution, Lactation, Uterine Tone, Fundal Height,
Lochia Rubra/Serosa/Alba, Perineal Healing, REEDA Assessment,
Episiotomy, Laceration Degrees, Breast Engorgement, Colostrum, Milk
Let-Down Reflex, Oxytocin, Prolactin, Kegel Exercises, Urinary
Retention, Bladder Assessment, Gastrointestinal Motility,
Constipation Prevention, Cardiovascular Changes, Hematologic
Adaptation, Thromboembolism Risk, Pain Management, Afterpains,
Hormonal Adjustment, Maternal Attachment, Bonding, Rubin’s
Phases, Family Adaptation, Cultural Considerations, Discharge
Planning, Postpartum Blues Exam Questions Verified and Provided
with Complete A+ Graded Rationales Latest Updated 2026
Normal Puerperium
•WHAT? Puerperium = PostPartum period.
•WHEN? The 6 weeks following birth.
•CHANGES?
•Retrogressive changes: INVOLUTION
•Progressive changes: LACTATION
Involution
The uterine muscles contract: Muscle fibers become shorter controlling the bleeding by compressing
and sealing off blood vessels – acts as “a living ligature” to shrink the uterus
•Cell catabolism: The uterus gradually decreases in size as the muscle cells grow smaller.
Regeneration of the uterine lining
,Top layer sheds with lochia
Bottom layer regenerates new endometrium (16 days)
Placental site: heals by exfoliation rather than by forming scar tissue (6 weeks)
Why is it important that the uterine lining does not have any scars?
So there won't be issues with subsequent pregnancies
A scar-free uterine lining is essential for proper implantation, reducing the risk of miscarriage, avoiding
pregnancy complications, and supporting normal menstruation and uterine function. Scarring can
severely impact fertility and increase risks during pregnancy and delivery, making it crucial for
reproductive health.
Postpartum assessment includes assessment of
*BUBBLE HE*
B = breasts
U = uterus (fundus)
B = bladder
B = bowels
L = lochia
,E = episiotomy/laceration/C-section incision/edema
H = hemorrhoids
E = extremity (DVT signs)
episiotomy assessment = REEDA
R = redness
E = edema
E = ecchymosis
D = drainage
A = approximation (of edges)
Uterine Changes
Placement:
1.FUNDUS is below umbilicus immediately after birth.
2.Within 12 hours at the umbilicus (U)
3.Decreases approx. 1 FB/day per day U-1, U-2, etc.
4.NOT palpable after 14 days.
Is involution progressing normally?
, What is subinvolution? uterus getting bigger instead of smaller
What is the danger of subinvolution? hemorrhage
•Tone: Palpate FUNDUS
•Expectation is FIRM (hard ball). Do not massage if fundus is firm.
•If fundus is NOT firm – Massage fundus! Uterine muscle responds to massage by firming up.
Pain
Afterpains
Approx 3 days of intermittent uterine contractions (increased if multipara or overdistended uterus).
BF implications? Think oxytocin
breast feeding stimulates more contractions/cramps
Pain Management
•Analgesics: short term use… positive/negative?
(Comfort, relaxation, milk ejection reflex, effects on infant, constipation).
•Positioning: prone with pillow on abdomen.
Assessment Exam: Involution, Lactation, Uterine Tone, Fundal Height,
Lochia Rubra/Serosa/Alba, Perineal Healing, REEDA Assessment,
Episiotomy, Laceration Degrees, Breast Engorgement, Colostrum, Milk
Let-Down Reflex, Oxytocin, Prolactin, Kegel Exercises, Urinary
Retention, Bladder Assessment, Gastrointestinal Motility,
Constipation Prevention, Cardiovascular Changes, Hematologic
Adaptation, Thromboembolism Risk, Pain Management, Afterpains,
Hormonal Adjustment, Maternal Attachment, Bonding, Rubin’s
Phases, Family Adaptation, Cultural Considerations, Discharge
Planning, Postpartum Blues Exam Questions Verified and Provided
with Complete A+ Graded Rationales Latest Updated 2026
Normal Puerperium
•WHAT? Puerperium = PostPartum period.
•WHEN? The 6 weeks following birth.
•CHANGES?
•Retrogressive changes: INVOLUTION
•Progressive changes: LACTATION
Involution
The uterine muscles contract: Muscle fibers become shorter controlling the bleeding by compressing
and sealing off blood vessels – acts as “a living ligature” to shrink the uterus
•Cell catabolism: The uterus gradually decreases in size as the muscle cells grow smaller.
Regeneration of the uterine lining
,Top layer sheds with lochia
Bottom layer regenerates new endometrium (16 days)
Placental site: heals by exfoliation rather than by forming scar tissue (6 weeks)
Why is it important that the uterine lining does not have any scars?
So there won't be issues with subsequent pregnancies
A scar-free uterine lining is essential for proper implantation, reducing the risk of miscarriage, avoiding
pregnancy complications, and supporting normal menstruation and uterine function. Scarring can
severely impact fertility and increase risks during pregnancy and delivery, making it crucial for
reproductive health.
Postpartum assessment includes assessment of
*BUBBLE HE*
B = breasts
U = uterus (fundus)
B = bladder
B = bowels
L = lochia
,E = episiotomy/laceration/C-section incision/edema
H = hemorrhoids
E = extremity (DVT signs)
episiotomy assessment = REEDA
R = redness
E = edema
E = ecchymosis
D = drainage
A = approximation (of edges)
Uterine Changes
Placement:
1.FUNDUS is below umbilicus immediately after birth.
2.Within 12 hours at the umbilicus (U)
3.Decreases approx. 1 FB/day per day U-1, U-2, etc.
4.NOT palpable after 14 days.
Is involution progressing normally?
, What is subinvolution? uterus getting bigger instead of smaller
What is the danger of subinvolution? hemorrhage
•Tone: Palpate FUNDUS
•Expectation is FIRM (hard ball). Do not massage if fundus is firm.
•If fundus is NOT firm – Massage fundus! Uterine muscle responds to massage by firming up.
Pain
Afterpains
Approx 3 days of intermittent uterine contractions (increased if multipara or overdistended uterus).
BF implications? Think oxytocin
breast feeding stimulates more contractions/cramps
Pain Management
•Analgesics: short term use… positive/negative?
(Comfort, relaxation, milk ejection reflex, effects on infant, constipation).
•Positioning: prone with pillow on abdomen.
