Postpartum Physiology
What is uterine involution?
The process of the uterus shrinking back to its pre-pregnancy size after birth.
What does each letter in “BUBBLE EER” stand for?
Breasts, Uterus, Bladder, Bowels, Lochia, Episiotomy, Extremities, Emotions/Attachment, and Rubella/Rhogam.
What amount of blood loss defines postpartum hemorrhage (PPH)?
Blood loss greater than or equal to 1000 mL.
What is the purpose of Rhogam?
Prevents Rh isoimmunization in Rh-negative mothers after delivering an Rh-positive infant.
What should a patient do if lochia suddenly becomes bright red and heavy after initially lightening?
Contact their healthcare provider immediately—possible hemorrhage.
What is lochia, and what are the three types?
Postpartum vaginal discharge.
Types: lochia rubra, serosa, and alba.
What are the two stages of psychological adaptation after birth?
“Taking in” (mother focuses on herself) and “Taking hold” (mother focuses on baby care).
What are common causes of postpartum hemorrhage?
Uterine atony, retained placenta, trauma, or thrombin disorders.
When should Rhogam be administered?
Within 72 hours after birth.
When should a postpartum patient call the provider regarding temperature?
If temperature is greater than 100.4°F for more than 24 hours.
What is colostrum, and how is it different from mature milk?
Colostrum is the first milk, thick and yellow, rich in antibodies and protein; mature milk is thinner and higher in fat.
How should the uterus feel on palpation during postpartum assessment?
Firm and midline.
What are key nursing interventions to prevent postpartum hemorrhage?
Massage the uterus, empty bladder, administer oxytocic medications, and monitor for excessive bleeding.
What teaching should be given after administering the rubella vaccine postpartum?
Avoid pregnancy for one month after receiving it.
What are two signs of DVT to report?
Calf pain and swelling or redness.
What is a normal postpartum urinary output range?
150mL/hour
30mL minimum
What does a distended bladder cause during the postpartum period?
Uterine atony and increased bleeding.
What are signs of postpartum infection?
Fever >100.4°F for 2+ days, foul-smelling lochia, and uterine tenderness.
Name at least three oxytocic medications used to manage postpartum hemorrhage.
Oxytocin (Pitocin), Methergine, Hemabate, Misoprostol, TXA
What postpartum teaching should be given to prevent infection?
Perform hand hygiene, change perineal pads frequently, and wipe front to back.
Name two “normal abnormals” in the postpartum CBC.
Elevated WBCs and decreased RBC, Hgb, & Hct are common and expected.
What emotional changes distinguish postpartum blues from postpartum depression?
Blues are mild, transient mood swings; depression is prolonged sadness, anxiety, and disinterest or thoughts of harming baby or self.
What are the symptoms and management for mastitis?
Sxs: Red, hot, painful breast, fever, chills.
Mgmt: Continue breastfeeding, apply warm compresses, antibiotics, and rest.
Which medication used for postpartum hemorrhage should NOT be given to patients with asthma?
Carboprost (Hemabate).
What are two key signs of postpartum depression to educate patients and families about?
Persistent sadness or hopelessness, and lack of interest in baby or self-care.