ch. 20+21: maternal care in postpartum

involution

return of the uterus to its prepregnancy state

lochia rubra

dark red blood seen from birth until 3-4 days

lochia serosa

pinkish-brown discharge seen for about 2 weeks

lochia alba

yellow-white discharge seen for about 3-4 weeks

should be firm, will be 1cm above umbilicus postpartum, will do down 1cm/day

normal findings for fundus postpartum

CV system

• 500-1000mL blood loss during birth

• lose more fluid through excessive sweating and urination 

• CO increases 60-80% after birth then gradually decreases to prepregnant levels by 6-8wks

• increased HR 1hr after birth

• decreased RR

• H+H may drop for 3-4 days but will return to normal in 4-6wks

• increased WBC up to 7 days postpartum

• increased coagulation factors→ increased risk for VTE/DVT

27 days after birth

when will ovulation occur for nonlactating women?

70-75 days after birth

when will ovulation occur for lactating women?

urinary system

• returns to normal after 8wks

• postpartum diuresis of ECF within 12 hr

diastasis recti abdominis

when abdominal wall muscles separate

rubella, varicella, Tdap

what live vaccines can mom now get?

given after delivery within 72hr if fetus Rh positive

when is RHOGAM given in postpartum?

breast care

lanolin cream for sore nipples, ice packs and tight sports bra to relieve engorgement for nonlactating women, frequent breastfeeding to relieve engorgement for lactating women

engorgement

discomfort in breasts due to increase in blood and lymphatic tissue

mastitis

infection in milk ducts