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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.
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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
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Lochia:
uterine debris /p birth.
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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
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serosa – 4 – 10 days – pink,or brownish; watery;
odorless. Composition: serum, erythrocytes, shreds of degenerating decidua,
leukocytes, cervical mucus, numerours bacteria
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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
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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
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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.
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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
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Perineal: bruising;
episiotomy edges together; separation
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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
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