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APGO educational topic number 13
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postpartum care miss poly partum has
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just delivered her baby 30 minutes ago
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and her placenta 15 minutes ago in this
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video we will review how Miss Pardons
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body will transition to the non pregnant
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state and how we can provide optimal
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care for women during this time the
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objectives of this video are to review
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the normal maternal physiologic changes
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of the postpartum period describe the
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components of normal postpartum care
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outline the topics to cover in
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postpartum counseling and lastly provide
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appropriate postpartum contraception
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prior to her delivery poly Pardons
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uterus weight approximately 1,000 grams
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and had a volume of 5000 cc this is in
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comparison to the non pregnant uterine
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weight of 70 grams and a volume of 5 CCS
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there are obviously many changes that
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will occur to poly part of his body in
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the postpartum period let’s review them
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by system in the immediate postpartum
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period the uterus contracts down and
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returns to the pelvis by 2 weeks
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postpartum and if it is normal-sized by
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6 weeks postpartum lochia or the vaginal
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discharge of the postpartum time goes
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through three phases after delivery
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initially it is menses like blood known
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as lochia rubra and this may last for
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the first few days after delivery the
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second phase is lochia serosa a lighter
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more watery discharge which will last
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for a few weeks the last phase is lochia
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alba a yellowish white discharge that
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may persist for six to eight weeks these
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are all normal and should be
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distinguished from malodorous discharge
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concerning for infection poly Pardons
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vagina and vulva will likely be very
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sore especially if she has had a
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laceration with her vaginal delivery
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most women will need some sort of
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regular analgesia for the pain and
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usually over-the-counter medications are
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sufficient vaginal tone and pelvic floor
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muscles gradually strengthen but they
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may never return to the pre pregnancy
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state pregnancy regardless of mode of
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delivery is associated with incontinence
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and pelvic organ prolapse Kegel or
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pelvic floor exercises may help women
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during this muscle recovery phase
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Pauli’s cardiovascular system has been
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revved up during pregnancy with cardiac
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output increased by 30 to 50 percent and
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circulating volume increased by about 30
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percent approximately 1,000 CCS of
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volume is lost during delivery there is
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also a large fluid shift from the x
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vascular to the intravascular space
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leading to significant diuresis normal
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cardiovascular function returns about
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two to three weeks following delivery
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moving on to the coagulation system the
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human body has procoagulant and
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anticoagulant pathways with the goal of
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a balance between the risks of forming a
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blood clot and the risks of bleeding
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pregnancy is a hypercoagulable state
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with an increase in procoagulant factors
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this protects the body from excessive
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bleeding at the time of delivery the
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risk of venous Rambo leak event is
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increased during pregnancy and is
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especially increased in the postpartum
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time the balance is restored at
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approximately six to eight weeks
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postpartum during pregnancy there is
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increased blood flow to the kidneys this
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leads to an increase in the glomerular
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filtration rate or GFR also remember
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that the creatinine of a pregnant woman
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is usually around 0.8 the GFR will stay
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elevated for two to three weeks after
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delivery now let’s switch gears and talk
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about how to best take care of poly
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partum during her postpartum period here
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you are
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medical student extraordinaire ready to
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take care of your postpartum patients
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you remember that your attending doctor
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dave Marzano had a handy trick for
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remembering the important aspects of
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postpartum care remember the seven B’s
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of postpartum care breast versus bottle
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determine her method of feeding and
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encourage breastfeeding as much as
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possible the American College of
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Obstetricians I know colleges in the
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American Academy of Pediatrics both
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recommend exclusive breastfeeding for at
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least six months
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bladder ask about urinary retention and
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incontinence some women may have slow
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return of bladder functions secondary to
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nerve compression during delivery or
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from the anesthetic effects of regional
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anesthesia all woman should urinate
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within six hours of delivery or six
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hours after catheter removal 25 percent
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of women will also have stress urinary
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incontinence during the immediate time
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after a vaginal delivery number three
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bowel has your patient had a bowel
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movement woman taking opioid pain
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medications or those with a third or
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fourth degree laceration should be
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offered a stool softener number four
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bleeding ask about volume and presence
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of clots review expectations about
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length of bleeding and discharge number
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five bottom ask about perineal pain or
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irritation and examine the perineum if
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there are any complaints ensure that
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appropriate pain medications are
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provided
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that the postpartum blues are very
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common in the immediate postpartum time
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see if she has any risk factors for
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developing postpartum depression such as
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a history of depression or poor social
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support discuss warning signs of
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postpartum depression and lastly number
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seven birth control it is important to
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discuss this because approximately 15%
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of non-nursing women are fertile at six
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weeks and approximately 50% of women
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will resume sexual intercourse prior to
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their six-week follow-up visit if a
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patient is breastfeeding she is
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partially protected against pregnancy
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however the breastfeeding must be
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exclusive and every three hours and the
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patient must be amenorrhea typically a
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combination estrogen progesterone
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contraception is avoided while
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breastfeeding because of the fear that
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it may hamper milk production however it
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is considered safe for breastfeeding
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once milk supply has been established
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progesterone only forms of contraception
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including the mini pillar Micra nor
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Nexplanon or the progesterone IUD will
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not affect milk supply if she is not
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breastfeeding then she may be placed on
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any contraception however combination
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estrogen and progesterone she probably
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started two to three weeks postpartum to
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decrease the thromboembolic risk this
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concludes the aapko video on postpartum
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care we reviewed maternal physiological
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changes the components and what to
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discuss in postpartum counseling and
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appropriate postpartum contraception