Marquette Maternity Final Exam - Fall 2025

Involution

Uterus returns to pre-pregnant state, 6-8 weeks

Involution prevents...

hemorrhage

How much blood loss during birth?

500-1000 cc

How long does it take for blood volume to return to normal

2 weeks, watch for HTN

Maternal VS and fundal and lochia assessments

q15 mins x 1 hour

q30 mins x 1-2 hours

q1-2 hours x 2 (or up to 4-8 hours)

q4 hours (up to 24 hours)

then q 8 hours

what focused assessments should be done q shift or 8 hours

CV, resp, GI, pernieum, breast, pain, DVT, pre-eclampsia, infection, education

BUBBLEHEAD

B - breasts

U - uterine fundus

B - bladder

B - bowel

L - lochia

E - episiotomy

H - hemoglobin and hematocrit

E - extremities

A - affect

D - discomfort

breast assessment

nipple inspection for breastfeeding, breast firmness, engorgement

uterine fundus assessment

boggy - massage, displaced - void

bladder assessment

<150 mL = sign of urinary retention, check for UTI

bowel assessment

hemorrhoids, BM may not occur for 2-5 days following birth

lochia assessment

vaginal discharge, rubra/serosa/alba

episiotomy assessment

check incisions site for edema, ecchymosis, and size

hemoglobin and hematocrit assessment

>500 mL loss average for vaginal birth, >1000 mL average for c-section

extremity assessment

edema, cool extremities for DVT risk

affect assessment

baby blues - emotional up to 2 weeks, postpartum depression is longer

discomfort assessment

pharm and non-pharm methods for pain relief

uterine involution by 12 hours

1 cm below umbilicus

uterine involution by 1-8 days

decreases 1 cm/day

uterine involution day 9

not palpable

uterine involution by 5-6 weeks

near non-pregnant size

assessing uterus

height, position/displacement, firmness, lochia

medications for involution

pitocin, methergine

involution interference

full bladder, prolonged labor, difficult birth, anesthesia, retained placenta, grand multipara, over-distension, infection

uterus - interventions for bleeding

uterine massage, breastfeeding, meds - pitocin, ergot drugs, prostaglandin

when should patient void after removing foley

< 4 hours post foley out

how often should pt attempt to void

at least 1 2 hours

how long do after-birth pains last

2-3 days, caused by oxytocin, prostaglandins, over-distended uterus, breast-feeding

lochia amount terms

scant, light, moderate, heavy

lochia first 2-3 days

rubra, dark red, some small clots

lochia 3-10 days

serosa, pink, brown

lochia 10-21 days

alba, yellow, clear

lochia odor

fleshy, not foul

lochia warning signs

large clots, gushes

os permanent change

more open, more oval, parous

perineum laceration degrees

1st-4th degrees

episiotomy

2nd degree, midline or mediolateral (left to right)

other vulva and vaginal lacerations

periurethral, labial, vaginal, cervical

1st degree lacerations

vaginal mucosa, posterior, fourchette, perineal skin. can be left unrepaired if no bleeding

2nd degree lacerations

vaginal mucosa, posterior fourchette, perineal skin and perineal muscles, always repaired

3rd degree lacerations

tears through entire anal sphincter, muscle retracts to surrounding tissue and can be hard to see

partial 3rd degree

sheering of muscle fibers of sphincter, requires repair

4th degree lacerations

extension of 3rd degree into rectum mucosa, skin of rectal sphincter disrupted, "nothing per rectum" orders (suppository, enema)

REEDA scale

Redness

Edema

Ecchymosis

Discharge

Approximation

nursing laceration assessment

side-lying position better to see, usually heals in 2-3 weeks

sitz bath

helps with hemorrhoids, improves blood flow to perineum, can be used 2x daily home or hospital

PP thrombosis assessment

superficial vein thrombosis - more common PP, warm, hard, red over site

DVT - more common during pregnancy, unilateral leg pain, calf tenderness, homan's sign

MMR

if rubella titer is non-immune, protects future pregnancies

TDaP

pertussis - adults - minor, newborn - deadly, given 3rd trimster or PP, given to family or caretakers

Rhogam

given when mom is Rh-, coombs, baby Rh+, within 72 hours

family planning

progestin only or non hormone if breastfeeding, can get pregnant before period returns

good PP activity

early ambulation - decreased risk DVT, recovery

exercise - 4 weeks for abs, kegels

diastasis recti abdominus

separation of two rectus muscle along median line of abdominal wall

assessing diastasis recti abdominus separation

assess in fingerbreadths, teach abdominal exercises

post c-section care

immobility --> complications, encourage mobility, pain management on a schedule

cleaning c-section incision

only warm water, no friction

post c-section pain management

NSAIDs schedules, accetaminophen, opioids, intra-op long-acting meds

post c-section comfort measures

incision splinting, rolling in bed, exhale while moving, distracting/breathing in fundal checks, side-lying or football breatfeeding

discharge teaching

self and NB care, s/sx illness, envrionment, safety, follow-up

menses non breast feeding

6-10 weeks, can be heavy

exclusive breast feeding menses

4-7 months, up to a year, prolactin suppressess ovarian function

intercourse with intact perineum

2-4 weeks when lochia alba

intercourse following episiotomy/perineal repair

delay until 6 weeks

black women disparity

maternal mortality rate 3.4x higher

native american disparity

maternal mortality rate 2-3x higher

PP complications

hemorrhage, cardiac, infection, embolic, mental healh

hemorrhage causes

uterine atony, lacerations, retained placental fragments, birth trauma, clotting issues

atony associate with...

overdistended uterus, grand multiparity, anesthesia, rapid labor, long labor, pitocin use in labor, MgSO4 in labor, ruptured uterus

PPH

leading cause of maternal death/morbidity

early/acute/primary PPH

first 24 hours

Late PPH

day 2 up to 6-12 weeks PP

non-adherent retained placenta

partial separation of normal placenta, mismanagement of 3rd labor stage

adherent retained placenta

abnormal attachments, placenta removal unsuccessful

adherent retained placenta degrees

accreta, increta, percreta

accreta

penetration into uterine wall but not through to muscle - most common

increta

penetration to the uterine muscle (myometrium)

percreta

penetrates through entire uterine wall and muscle, attaches to another organ like bladder

primary prevention of PPH

routine IV pitocin after delivry, fundal massage, empty bladder

secondary prevention of PPH

frequent checks for at risk, keep IV for high-risk, type and cross PRCBs for high-risk conditions

medications for PPH

pitocin, misoporstol, hemabate, methergine

vaginal/pelvic hematoma s/sx

deep, increasing pain, difficulty emptying and voiding, can happen immediately or after discharge

vaginal/pelvic hematoma treatment

ice, time, surgery if not resolved

hypovolemic shock d/t PPH symptoms

lightheaded with elevation, anxiety, air hunger, racing HR

hypovolemic shock d/t PPH signs

hypotension, tachycardia, pallor or gray/ashen skin, capillary refill delay, extremities cold to touch, decreased urine output

hypovolemic shock treatment

bolus initially then maintenance, can dilute clotting and oxygen carrying capacity, PRBCs, platelets PRN, plasma for volume, check vitals for effectiveness

PP uterine/genitourinary tract infections risk

prolonged ROM, multiple vaginal exams, urinary stasis, prolonged indwelling catheter, underlying diseases - diabetes, traumatic birth, forceps

endometritis symptoms

sub-involution, foul smelling lochia, tender/boggy uterus, increased lochia, fever, tachycardia (most common PP infection)

endmoetritis management

antibiotics - cillins, mycins, frequent fundal/lochia checks, rest, nutrition/hydration, pain mgmt, pre/post cart for curettage

mastitis occurence

1-10% women, any time during lactation

mastitis factors

cracked/infected nipples, fatigue, stress, milk stasis, poor drainage from blocked duct

mastitis sx

red, warm, swollen, painful, unilateral, flu-like, chills, fever > 101, HA

mastitis intervention

prevention, rest, fluids, supportive bra, frequent nursing, heat/cold, analgesics, antibiotics (dicloxacillin)

PP embolic phenomena

DVT - + Homan's sign, more common is pregnancy, unilateral leg pain, calf tenderness

SVT - more common PP, warm, hard, red over site

pulmonary embolus

dislodged clot that goes to lung, post-thrombophlebitis, blocks blood flow to lung portion, EMERGENCY

pulmonary embolus sx

chest pain, apprehension, SOB, tachycardia, hypotension, diaphoresis, atelectasis

baby blues

50-80%, first few days, usually noted days 2-10, peaks at day 5, crying, fatigued, sleep disrupt, no treatment needed

PPD

pervasive sadness - beyond 1-2 weeks PP, ruminations of guilt/inadequacy, anger, thought of harming self/baby, professional counseling and meds, inc risk with depression hx

postpartum psychosis

usually starts with severe depression - fatigue, insomnia, restlessness, emotional liability - delusions / auditory hallucinations

PP psychosis common behaviors

incoherence/irrational statements, suspiciousness, agitation, confusion

PP psychosis onset

2-3 weeks, needs immediated Dx and Tx