Reproductive:
Involution – rapid ↓ in size of uterus to
nonpregnant state. Decidua sheds as lochia; placental site is exfoliated. Cells grow smaller,
reversing the uterine hyperplasia. Factors slowing down process: prolonged labor, anesthesia
or excessive analgesia, difficult birth, full bladder, multiparity, incomplete expulsion of the
placenta or membrane fragments. Factors enhancing involution: breastfeeding, early
ambulation, & uncomplicated birth.
Changes in fundal position: /p placental delivery:
uterus grapefruit-size. Fundus midline; at level of umbilicus at 6 -12 hrs /p. Boggy uterus: blood &
clots collect, uterus rises, contractions interrupted; moves to R side: suspect distended bladder. PP day
#1: 1 cm ↓ umbilicus; descends 1 fingerbreath/day. Breastfeeding → pitocin
→ faster; nonpregnant size @ 5-6wks
Lochia: uterine debris /p birth.
rubra – 3-4 days – dark red, bloody, fleshy, musty, stale
non-offensive odor; clots < nickle; composition: blood /c sm amts mucus, shreds of diciua,
epithelial cells, leukocytes; may contain fetal meconium, lanugo, or vernix caseosa
serosa – 4 – 10 days – pink,or
brownish; watery; odorless. Composition: serum, erythrocytes, shreds of degenerating decidua, leukocytes,
cervical mucus, numerours bacteria
alba – 11 – 21 days; u/t 6 wks if
lactating – yellow to white, possible stale odor. Composition: leukocytes,
decidual cells, epithelial cells, fat, cervical mucus, cholesterol,
bacteria
Cervical changes: soft, irregular, edematous; bruised-looking /c multiple
small lacerations; closes to 2 -3 cm /p few days; admits
fingertip /p 1 wk; permanent change to os /p 1st delivery to slit-like
Vaginal changes: smooth walls, edematous, multiple small lacerations;
perineal pain d/c /p 2 wks; ↓ PP estrogen → ↓ vaginal lubrication &
vasoconstricition 6 – 10 wks →
painful intercourse.
Chp 9, Figure 9-9, p 197 : Perineal muscle tightening,
also called Kegel
exercises strengthen the pubococcygeus muscle, which
improves support to the pelvic organs. p 195: how to teach: compare to elevator, 1-4 floors;
properly done, does not contract the buttocks & thighs; done any time
Perineal: bruising; episiotomy edges together; separation
Recurrence of ovulation & menstruation: nonlactating: 6-8 wks; 1st cycle usually anovulatory; breastfeeding: delayed, but not reliable form of birth
control. Exclusive breastfeeding → wider spacing of pregnancies