Nursing 209

N209: Reproductive Health Study Guide

Chapter Five: The Postpartal Family

5.1 Maternal Changes Postpartum Period: “Fourth Stage of Labor” This is also known as puerperium or puerperal period. It usually lasts six weeks after delivery, and during that time , both anatomic and physiologic changes of pregnancy are reversed as the body returns to its pre-pregnant state. It c onsists of three phases: • Initial or acute period: o First 6-12 hours postpartum o Rapid changes; potential for complications o Shivering observed in 25-50% of women; lasts up to 60 minutes • Second phase: o Subacute postpartum period o Major changes (less rapid) in returning to the pre-pregnant state o Changes in hemodynamic state, genitourinary recovery, emotional status, and metabolism • Third phase: o Can last up to six months o Changes are gradual and complications are rare o Muscle tone and connective tissue are restored to pre-pregnant state Uterine Involution • Begins during the third stage of labor and continues over a period of 5-6 weeks • After delivery of the placenta, the uterus is typically at level of umbilicus • Decreases by 1cm/day; returns to pelvic organ at 12 weeks postpartum • Normal endometrial lining occurs by day 16 postpartum, except for placental site • Returns to pre-pregnancy size by 4-6 weeks • Fundus should be firm upon palpation Lochia • Rubra: Dark red, bloody discharge for first 3-4 days PP; may contain small clots • Serosa: Pinkish to light brown watery discharge from approximately 3-10 days PP • Alba: White to yellowish discharge lasting from approximately day 7-10 through 5-6 weeks • Lochia scent: Normally musky scent similar to menses; if odor is present, it may indicate an infection

©2018

Achieve

Page 53

of 109