{"id":117,"date":"2020-08-12T20:12:38","date_gmt":"2020-08-12T20:12:38","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=117"},"modified":"2023-09-30T11:13:18","modified_gmt":"2023-09-30T11:13:18","slug":"13-postpartum-care","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/basic_obgyn\/overview\/13-postpartum-care\/","title":{"rendered":"13. Postpartum Care"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/CCa50OS6jyo\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe><\/p>\n<p>Duration = 5:49<\/p>\n<input type='hidden' bg_collapse_expand='69e9dc17c24451014516117' value='69e9dc17c24451014516117'><input type='hidden' id='bg-show-more-text-69e9dc17c24451014516117' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9dc17c24451014516117' value='Hide Transcript'><button id='bg-showmore-action-69e9dc17c24451014516117' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9dc17c24451014516117' ><\/p>\n<p>00:00<br \/>\nAPGO educational topic number 13<br \/>\n00:02<br \/>\npostpartum care miss poly partum has<br \/>\n00:05<br \/>\njust delivered her baby 30 minutes ago<br \/>\n00:07<br \/>\nand her placenta 15 minutes ago in this<br \/>\n00:09<br \/>\nvideo we will review how Miss Pardons<br \/>\n00:11<br \/>\nbody will transition to the non pregnant<br \/>\n00:13<br \/>\nstate and how we can provide optimal<br \/>\n00:15<br \/>\ncare for women during this time the<br \/>\n00:17<br \/>\nobjectives of this video are to review<br \/>\n00:19<br \/>\nthe normal maternal physiologic changes<br \/>\n00:21<br \/>\nof the postpartum period describe the<br \/>\n00:24<br \/>\ncomponents of normal postpartum care<br \/>\n00:25<br \/>\noutline the topics to cover in<br \/>\n00:27<br \/>\npostpartum counseling and lastly provide<br \/>\n00:30<br \/>\nappropriate postpartum contraception<br \/>\n00:32<br \/>\nprior to her delivery poly Pardons<br \/>\n00:35<br \/>\nuterus weight approximately 1,000 grams<br \/>\n00:37<br \/>\nand had a volume of 5000 cc this is in<br \/>\n00:40<br \/>\ncomparison to the non pregnant uterine<br \/>\n00:42<br \/>\nweight of 70 grams and a volume of 5 CCS<br \/>\n00:44<br \/>\nthere are obviously many changes that<br \/>\n00:47<br \/>\nwill occur to poly part of his body in<br \/>\n00:48<br \/>\nthe postpartum period let&#8217;s review them<br \/>\n00:50<br \/>\nby system in the immediate postpartum<br \/>\n00:52<br \/>\nperiod the uterus contracts down and<br \/>\n00:54<br \/>\nreturns to the pelvis by 2 weeks<br \/>\n00:56<br \/>\npostpartum and if it is normal-sized by<br \/>\n00:58<br \/>\n6 weeks postpartum lochia or the vaginal<br \/>\n01:01<br \/>\ndischarge of the postpartum time goes<br \/>\n01:03<br \/>\nthrough three phases after delivery<br \/>\n01:05<br \/>\ninitially it is menses like blood known<br \/>\n01:07<br \/>\nas lochia rubra and this may last for<br \/>\n01:09<br \/>\nthe first few days after delivery the<br \/>\n01:11<br \/>\nsecond phase is lochia serosa a lighter<br \/>\n01:13<br \/>\nmore watery discharge which will last<br \/>\n01:15<br \/>\nfor a few weeks the last phase is lochia<br \/>\n01:18<br \/>\nalba a yellowish white discharge that<br \/>\n01:20<br \/>\nmay persist for six to eight weeks these<br \/>\n01:22<br \/>\nare all normal and should be<br \/>\n01:23<br \/>\ndistinguished from malodorous discharge<br \/>\n01:25<br \/>\nconcerning for infection poly Pardons<br \/>\n01:27<br \/>\nvagina and vulva will likely be very<br \/>\n01:29<br \/>\nsore especially if she has had a<br \/>\n01:30<br \/>\nlaceration with her vaginal delivery<br \/>\n01:32<br \/>\nmost women will need some sort of<br \/>\n01:34<br \/>\nregular analgesia for the pain and<br \/>\n01:36<br \/>\nusually over-the-counter medications are<br \/>\n01:38<br \/>\nsufficient vaginal tone and pelvic floor<br \/>\n01:40<br \/>\nmuscles gradually strengthen but they<br \/>\n01:42<br \/>\nmay never return to the pre pregnancy<br \/>\n01:44<br \/>\nstate pregnancy regardless of mode of<br \/>\n01:47<br \/>\ndelivery is associated with incontinence<br \/>\n01:49<br \/>\nand pelvic organ prolapse Kegel or<br \/>\n01:51<br \/>\npelvic floor exercises may help women<br \/>\n01:54<br \/>\nduring this muscle recovery phase<br \/>\n01:56<br \/>\nPauli&#8217;s cardiovascular system has been<br \/>\n01:58<br \/>\nrevved up during pregnancy with cardiac<br \/>\n02:00<br \/>\noutput increased by 30 to 50 percent and<br \/>\n02:02<br \/>\ncirculating volume increased by about 30<br \/>\n02:05<br \/>\npercent approximately 1,000 CCS of<br \/>\n02:08<br \/>\nvolume is lost during delivery there is<br \/>\n02:10<br \/>\nalso a large fluid shift from the x<br \/>\n02:12<br \/>\nvascular to the intravascular space<br \/>\n02:14<br \/>\nleading to significant diuresis normal<br \/>\n02:16<br \/>\ncardiovascular function returns about<br \/>\n02:18<br \/>\ntwo to three weeks following delivery<br \/>\n02:20<br \/>\nmoving on to the coagulation system the<br \/>\n02:23<br \/>\nhuman body has procoagulant and<br \/>\n02:25<br \/>\nanticoagulant pathways with the goal of<br \/>\n02:27<br \/>\na balance between the risks of forming a<br \/>\n02:29<br \/>\nblood clot and the risks of bleeding<br \/>\n02:31<br \/>\npregnancy is a hypercoagulable state<br \/>\n02:32<br \/>\nwith an increase in procoagulant factors<br \/>\n02:35<br \/>\nthis protects the body from excessive<br \/>\n02:37<br \/>\nbleeding at the time of delivery the<br \/>\n02:39<br \/>\nrisk of venous Rambo leak event is<br \/>\n02:41<br \/>\nincreased during pregnancy and is<br \/>\n02:42<br \/>\nespecially increased in the postpartum<br \/>\n02:44<br \/>\ntime the balance is restored at<br \/>\n02:46<br \/>\napproximately six to eight weeks<br \/>\n02:47<br \/>\npostpartum during pregnancy there is<br \/>\n02:50<br \/>\nincreased blood flow to the kidneys this<br \/>\n02:52<br \/>\nleads to an increase in the glomerular<br \/>\n02:54<br \/>\nfiltration rate or GFR also remember<br \/>\n02:57<br \/>\nthat the creatinine of a pregnant woman<br \/>\n02:58<br \/>\nis usually around 0.8 the GFR will stay<br \/>\n03:02<br \/>\nelevated for two to three weeks after<br \/>\n03:04<br \/>\ndelivery now let&#8217;s switch gears and talk<br \/>\n03:07<br \/>\nabout how to best take care of poly<br \/>\n03:08<br \/>\npartum during her postpartum period here<br \/>\n03:11<br \/>\nyou are<br \/>\n03:11<br \/>\nmedical student extraordinaire ready to<br \/>\n03:13<br \/>\ntake care of your postpartum patients<br \/>\n03:15<br \/>\nyou remember that your attending doctor<br \/>\n03:17<br \/>\ndave Marzano had a handy trick for<br \/>\n03:19<br \/>\nremembering the important aspects of<br \/>\n03:20<br \/>\npostpartum care remember the seven B&#8217;s<br \/>\n03:23<br \/>\nof postpartum care breast versus bottle<br \/>\n03:26<br \/>\ndetermine her method of feeding and<br \/>\n03:28<br \/>\nencourage breastfeeding as much as<br \/>\n03:29<br \/>\npossible the American College of<br \/>\n03:32<br \/>\nObstetricians I know colleges in the<br \/>\n03:33<br \/>\nAmerican Academy of Pediatrics both<br \/>\n03:35<br \/>\nrecommend exclusive breastfeeding for at<br \/>\n03:37<br \/>\nleast six months<br \/>\n03:38<br \/>\nbladder ask about urinary retention and<br \/>\n03:41<br \/>\nincontinence some women may have slow<br \/>\n03:44<br \/>\nreturn of bladder functions secondary to<br \/>\n03:45<br \/>\nnerve compression during delivery or<br \/>\n03:47<br \/>\nfrom the anesthetic effects of regional<br \/>\n03:49<br \/>\nanesthesia all woman should urinate<br \/>\n03:51<br \/>\nwithin six hours of delivery or six<br \/>\n03:53<br \/>\nhours after catheter removal 25 percent<br \/>\n03:56<br \/>\nof women will also have stress urinary<br \/>\n03:57<br \/>\nincontinence during the immediate time<br \/>\n03:59<br \/>\nafter a vaginal delivery number three<br \/>\n04:01<br \/>\nbowel has your patient had a bowel<br \/>\n04:03<br \/>\nmovement woman taking opioid pain<br \/>\n04:05<br \/>\nmedications or those with a third or<br \/>\n04:07<br \/>\nfourth degree laceration should be<br \/>\n04:08<br \/>\noffered a stool softener number four<br \/>\n04:10<br \/>\nbleeding ask about volume and presence<br \/>\n04:12<br \/>\nof clots review expectations about<br \/>\n04:14<br \/>\nlength of bleeding and discharge number<br \/>\n04:16<br \/>\nfive bottom ask about perineal pain or<br \/>\n04:19<br \/>\nirritation and examine the perineum if<br \/>\n04:20<br \/>\nthere are any complaints ensure that<br \/>\n04:22<br \/>\nappropriate pain medications are<br \/>\n04:24<br \/>\nprovided<br \/>\n04:25<br \/>\nthat the postpartum blues are very<br \/>\n04:27<br \/>\ncommon in the immediate postpartum time<br \/>\n04:28<br \/>\nsee if she has any risk factors for<br \/>\n04:30<br \/>\ndeveloping postpartum depression such as<br \/>\n04:32<br \/>\na history of depression or poor social<br \/>\n04:34<br \/>\nsupport discuss warning signs of<br \/>\n04:36<br \/>\npostpartum depression and lastly number<br \/>\n04:38<br \/>\nseven birth control it is important to<br \/>\n04:41<br \/>\ndiscuss this because approximately 15%<br \/>\n04:43<br \/>\nof non-nursing women are fertile at six<br \/>\n04:45<br \/>\nweeks and approximately 50% of women<br \/>\n04:48<br \/>\nwill resume sexual intercourse prior to<br \/>\n04:50<br \/>\ntheir six-week follow-up visit if a<br \/>\n04:52<br \/>\npatient is breastfeeding she is<br \/>\n04:53<br \/>\npartially protected against pregnancy<br \/>\n04:54<br \/>\nhowever the breastfeeding must be<br \/>\n04:56<br \/>\nexclusive and every three hours and the<br \/>\n04:58<br \/>\npatient must be amenorrhea typically a<br \/>\n05:00<br \/>\ncombination estrogen progesterone<br \/>\n05:02<br \/>\ncontraception is avoided while<br \/>\n05:03<br \/>\nbreastfeeding because of the fear that<br \/>\n05:05<br \/>\nit may hamper milk production however it<br \/>\n05:07<br \/>\nis considered safe for breastfeeding<br \/>\n05:08<br \/>\nonce milk supply has been established<br \/>\n05:10<br \/>\nprogesterone only forms of contraception<br \/>\n05:13<br \/>\nincluding the mini pillar Micra nor<br \/>\n05:14<br \/>\nNexplanon or the progesterone IUD will<br \/>\n05:17<br \/>\nnot affect milk supply if she is not<br \/>\n05:19<br \/>\nbreastfeeding then she may be placed on<br \/>\n05:21<br \/>\nany contraception however combination<br \/>\n05:23<br \/>\nestrogen and progesterone she probably<br \/>\n05:25<br \/>\nstarted two to three weeks postpartum to<br \/>\n05:27<br \/>\ndecrease the thromboembolic risk this<br \/>\n05:28<br \/>\nconcludes the aapko video on postpartum<br \/>\n05:30<br \/>\ncare we reviewed maternal physiological<br \/>\n05:33<br \/>\nchanges the components and what to<br \/>\n05:34<br \/>\ndiscuss in postpartum counseling and<br \/>\n05:36<br \/>\nappropriate postpartum contraception<\/p>\n<p><\/div>\n","protected":false},"excerpt":{"rendered":"<p>\ufeff Duration = 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