Postpartum and Newborn Care – Exam Review (Units 3 & 4)

Vocabulary-style flashcards covering postpartum involution, lochia, vitals, RN care, parenting transitions, bonding, hemorrhage, neonatal care, newborn assessment, feeding, jaundice, thermoregulation, and pain management.

Involution

Return of the uterus to a nonpregnant state after birth; fundus descends 1–2 cm every 24 hours and is no longer palpable by about 2 weeks; by 6 weeks it should be back to nonpregnant location.

Lochia rubra

Bright red vaginal discharge occurring 1–3 days after birth; contains blood, placental site tissue, vernix, lanugo, and meconium.

Lochia alba

Whitish-yellow vaginal discharge beginning around 10–14 days postpartum and lasting about 3–6 weeks; contains WBCs, tissue debris.

Lochia serosa

Pinkish-brown discharge occurring around 4–10 days postpartum; contains blood, wound exudate, RBCs/WBCs, cervical mucus, tissue debris.

Lochia considerations

Bleeding is heaviest 1–2 hours after birth and should gradually decrease; breastfeeding, ambulation, and fundal massage can increase bleeding; persistent lochia rubra may indicate retained placenta.

Postpartum temperature norms

Temperature may be elevated in the first 24 hours; a fever (>100.4°F / 38°C) after 24 hours can indicate infection.

Puerperal bradycardia

Common resting heart rate of about 40–50 BPM during the first 6–8 days postpartum.

Postpartum tachycardia

Rapid pulse that may indicate hemorrhage or other complications.

Orthostatic hypotension postpartum

Lower blood pressure when standing; can be normal in the first 48 hours postpartum.

Postpartum diuresis

Significant urine output (up to ~3000 mL/day) for 2–3 days due to fluid shifts.

Urinary retention postpartum

Difficulty voiding after delivery, which can be caused by anesthesia (epidural/spinal) or perineal trauma.

Voiding goal postpartum

Aim to void within 6–8 hours after delivery.

GI/postpartum bowel changes

Decreased bowel sounds and slowed peristalsis are common; bowel habits reestablish as tone returns.

Routine postpartum labs

CBC, BMP, glucose, UA/UC used to monitor status and detect complications.

Rh negative mother prophylaxis

Rh immune globulin given within 72 hours of birth to Rh− mothers with Rh+ babies to prevent alloimmunization.

Coombs test (indirect/direct)

Negative Coombs test suggests no maternal antibodies against RBCs; important in Rh incompatibility risk assessment.

Rh incompatibility risk

Increased risk for pathologic jaundice in the newborn when mother is Rh− and baby is Rh+.

Maintaining uterine tone

Prevent uterine atony and bladder distention to reduce hemorrhage risk.

Uterine atony

Insufficient uterine contractions leading to boggy uterus and heavy postpartum bleeding.

Fundal massage

Manual technique to stimulate uterine contraction and firm the uterus; assist voiding if uterus boggy.

Bladder distention postpartum

Full bladder can displace the uterus and worsen uterine atony; assess and promote voiding.

Excessive bleeding indicator

Pad saturating within 15 minutes or pooling under buttocks indicates heavy bleeding.

Uterotonic medications

Medications to stimulate uterine contractions (e.g., oxytocin, misoprostol, methergine, Hemabate).

Rubin’s maternal adaptations – Taking in

First 2–3 days; mother focuses on her own needs, is passive, and discusses L&D experience.

Rubin’s maternal adaptations – Taking hold

Days 3–10; mother focuses on self-care and infant care; may have mood swings.

Rubin’s maternal adaptations – Letting go

10 days to 6 weeks; mothering role established; infant seen as a separate person.

Engrossment (paternal adaptation)

Father’s absorbed, preoccupied, and highly interested involvement with the newborn.

Attachment

Process by which parents come to love and accept the child; reciprocal bonding.

Bonding

Mutually satisfying experiences between parent and infant; foundation for secure attachment.

Attachment promotion

Strategies to support bonding: discuss norms, skin-to-skin contact, opportunities to hold and examine the newborn.

Attachment behaviors

Infant cues and parent responses: looking, vocalizing, touch, facial expressions, and identification of the infant.

Postpartum hemorrhage (PPH)

Excessive bleeding after birth; can be caused by uterine atony, lacerations, hematomas, retained placenta, or coagulation disorders.

Risk factors for postpartum hemorrhage

Uterine atony, overdistended uterus, high parity, prior bleed, chorioamnionitis, prolonged labor, lacerations, placental problems, coagulation disorders, HTN, magnesium use, previa/abruption.

Hematomas (perineal/rectal)

Bleeding into tissue planes causing perineal pain and pressure; often require evacuation.

Retained placenta

Placental tissue remaining after birth; can cause prolonged lochia rubra and heavy bleeding; may require manual removal or D&C.

Genital lacerations

Cervical, vaginal, or perineal lacerations contributing to bleeding; repair may be needed if uterus is firm but bleeding persists.

Nursing interventions for PPH

Recognize bleeding, perform rapid assessments, fundal massage, bladder emptying, clamp/evacuate clots, IV fluids, and administer uterotonics as ordered.

Endometritis

Postpartum uterine infection; fever, chills, uterine tenderness, foul lochia; treated with IV antibiotics.

Wound infection (postpartum)

Infection of perineal or surgical wound; fever, erythema, edema, drainage.

Urinary tract infection (postpartum)

UTI risk after delivery due to catheterization/place for pelvic exams; symptoms include dysuria, frequency, and urgency.

Venous thromboembolism (VTE)

Blood clot in a vessel postpartum; signs include unilateral leg edema, erythema, warmth, pain; Homan sign is not reliable.

Postpartum depression (PPD)

Clinically significant depressive symptoms occurring within months after birth; may include anhedonia, guilt, anxiety, and detachment; requires treatment.

Postpartum blues

Transient mood lability and crying spells peak around day 5 and subside by day 10 postpartum; common and usually mild.

APGAR score

Newborn assessment at 1 and 5 minutes evaluating Appearance, Pulse, Grimace, Activity, and Respiration; 0–10 scale; <7 at 5 minutes prompts further evaluation but does not replace resuscitation.

Newborn weight (term)

2700–4000 g; 10th–90th percentile considered average.

Newborn length (term)

46–56 cm.

Head circumference (term)

32–36 cm.

Newborn vital signs norms

Temperature 97.7–99.5°F (axillary); HR 120–160 bpm; RR 30–60 breaths/min; BP not routinely measured; acrocyanosis common; jaundice not normal.

Acrocyanosis

Bluish hands/feet with pink trunk; considered normal in the newborn.

Vernix and lanugo

Vernix alba is a white coating; lanugo is fine downy hair present in preterm infants and diminished in term newborns.

Newborn reflexes – Rooting

Turning head toward a stimulus near the mouth to search for feeding; typically present at birth and fades older.

Newborn reflexes – Sucking

Sucking reflex in response to tactile stimulation of lips/mouth; becomes coordinated with swallowing.

Newborn reflexes – Swallowing

Coordinated with sucking and breathing; absence or weakness may indicate problems.

Newborn reflexes – Palmar grasp

Fingers curl around examiner’s fingers when placed in the infant’s palm; fades by 3–4 months.

Newborn reflexes – Plantar grasp

Toes curl downward when the sole is touched; fades around 8 months.

Newborn reflexes – Moro

Startle reflex present at birth; should disappear by ~6 months.

Newborn reflexes – Stepping

Faint stepping motion when baby is held upright; present for about 3–4 weeks.

Newborn reflexes – Babinski

Toes fan upward when the lateral sole is stroked; normally present up to 1 year.

Erythromycin ophthalmic ointment

Prophylactic eye treatment given to all newborns to prevent ophthalmia neonatorum; typically within an hour of birth.

Vitamin K (newborn)

0.5–1 mg IM dose given to prevent hemorrhagic disease; may be delayed for skin-to-skin contact.

Hepatitis B vaccine (newborn)

HBV vaccination given to all newborns prior to discharge; consent obtained; high-risk infants treated per status.

Meconium

First stool of the newborn; usually passed within 12–24 hours (up to 48 hours possible).

Transitional stools and milk stools

Transition stools around day 3; milk stools begin around day 4; feeding pattern influences stool type.

Early breastfeeding patterns

Breastfeeding encouraged on demand; typical interval every 2–3 hours with 8–12 feeds per day.

Formula feeding amounts (first day)

Approximately 15–30 mL per feeding on day 1 with gradual increase as tolerated.

Premature infant risks

Higher risk of mortality/morbidity; respiratory problems, temperature instability, feeding difficulties, hyperbilirubinemia; NICU admission.

Post-term infant characteristics

Possible placental insufficiency; little vernix/lanugo; peeling skin; long nails; increased risk of fetal distress and mortality.

Cord care goals

Prevention of hemorrhage and infection; clamp initially, then remove when stump is dry; clean with water; air exposure.

Bathing guidelines for newborns

Use neutral pH soap without preservatives; bath should be warm, not hot; submerge only up to shoulders when safe.

Infant abduction prevention

Limit unit entry, verify caregivers; pink infant bracelets (HUGS) and monitors used.

Handwashing importance

Infection control measure to prevent neonatal exposure to pathogens.

Newborn stabilization – Oxygenation

Ensure effective respirations; provide rescue ventilation if apneic or gasping; positive pressure ventilation as needed.

NRP (Neonatal Resuscitation Program)

Guidelines used for neonatal resuscitation and stabilization; include airway management and ventilation strategies.

Thermal regulation – neutral environment

Maintain stable body temperature; skin-to-skin contact is optimal in the first hour.

Skin-to-skin (Kangaroo) care

Immediate contact between parent and newborn to promote warmth and bonding.

Types of heat loss

Convection, radiation, evaporation, and conduction describe how heat is lost from the infant.

Cold stress

Increased metabolic demand and risk of hypoglycemia due to hypothermia; maintain warmth.

Hypoglycemia threshold (neonatal)

Low blood glucose; initial lower limit is typically 40–45 mg/dL in the first 72 hours.

Hyperbilirubinemia (general)

Elevated bilirubin in the newborn; screening at 8–12 hours recommended.

Physiologic jaundice

Mild jaundice appearing after 24 hours with gradual rise and fall without severe complications.

Pathologic jaundice

Jaundice appearing within 24 hours or rapidly rising; risk of serious complications if untreated.

Breastfeeding jaundice

Early onset jaundice (first week) due to insufficient effective feeding and milk intake.

Breastfeeding jaundice – late onset

Jaundice around days 5–10 in well-fed infants due to slower milk intake; bilirubin may rise gradually.

Phototherapy

Treatment to lower bilirubin using light to alter bilirubin structure for excretion; monitor for dehydration and temperature changes.

Phototherapy precautions

Expose as much skin as possible; eye protection; avoid creams; monitor hydration; frequent repositioning.

Circumcision

Removal of the foreskin; typically done in the first few days with parental choice and cultural factors.

Gomco/Mogen technique

Circumcision method using a shield or clamp with petroleum gauze; pain management used.

PlastiBell technique

Circumcision method with a plastic bell; no petroleum gauze; the rim falls off as healing occurs.

Postcircumcision care

Assess for bleeding, monitor I&O, manage pain, educate parents on care and when to seek help.

Neonatal pain management – nonpharmacologic

Swaddling, nonnutritive sucking (pacifier), oral sucrose, skin-to-skin, soft distraction and environmental control.

Neonatal pain management – pharmacologic

Local or topical anesthesia; oral analgesics; morphine or fentanyl for more invasive procedures; IV opioids as needed.