Question

Diana is a healthy 35-year-old G5 P5 who delivered an 8 pound, 6-ounce baby girl vaginally with an intact perineum. Her EBL was 500 mL. During the fourth stage of labor her vital signs, fundus, and lochia was WNL. She is transferred to the mother-baby unit 3 hours after birth.

1. What is the postpartum period?

2. What is the process of uterine involution after childbirth?

3. How is postpartum hemostasis achieved?

4. After the report, the nurse goes in to assess Diana. Her vital signs are WNL but her fundus is 2 cm above the umbilicus and displaced to the right. Her sanitary pad is completely saturated with lochia rubra. Is this an expected finding 3 hours after birth?

5. The nurse asks Diana to dangle her feet at the bedside for several minutes. After confirming that Diana does not feel dizzy or lightheaded, she helps Diana up to the bathroom to void. Why does the nurse think that Diana’s bladder is full?

6. When Diana first gets out of bed, she has a gush of blood.s this a sign of hemorrhage? What would be the uses and contraindications for administering methylergonovine?

7. Diana voids 500 mL of urine. Her fundus is boggy but became firm with massage and is now at the level of the umbilicus. Her lochial flow is slightly decreased. Diana has an IV of LR with 20 units of oxytocin infusing at 125 mL an hour. What else can the nurse do to help Diana’s uterus contract?

Answer 1

1.Post partum period-the period of about six weeks after childbirth during which the mother's reproductive organs return to their original non-pregnant condition.

This period also called as purperium

2.process of uterine involution after childbirth-

Involution is the process by which the uterus decreases in size and revert back to pre pregnant state.

The underlying etiopathology is autolysis and helped by retraction lysozyme released from ribosome.which release into muscle cells and autolysis of protein occurs and for this involution of uterus occurs.

After delivery height of uterus us 13.5 cm.no change for 48 hours.after that decrease by 1.25cm/24 hours.on 10-12th day it lie in public symphysis level then after 4 weeks it revert back to its normal position and become a pelvic organ.

3.postpartum hemostasis-

Post partum hemostasis can be achieved by 3 methods-

*Mechanical method-i)uterine messaging with abdominal hand

ii)bimanual compression with one hand in the anterior fornix and other on the abdomen.

iii)uterine packing

iv)uterine tamponade with condom or sengstaken tube or multiple Foley's catheter bulb.

v)abdominal aorta compression with abdominal hand.

*Medical method-i)synthetic Oxytocin-20 units in 500 ml RL or NS to be run rapidly at about 60 drops/min.Syntocinon may be given I.M. 10 units.

ii)In.j Methyl Ergotamine(Methergine)-0.2 mg i.v. or i.m. may be repeated after 15 minutes. 4 hourly × 3 such can be given.contraindicated in hypertension,rheumatic heart disease.

iii)Inj. ProsProstaglandin F2a-250 microgram IM.maximum 8 doses may be given.

iv)Tab Misoprostasol-800 microgram per rectum

*Surgical methods-i)purse string suture also called undersewing

ii)block suture (anterior and posterior wall apposed with catgut)

iii)B-Lynch suture

iv)ligation of uterine and ovarian vessels close to uterus.

v) hysterectomy.

vi)uterine artery embolization.

4.this is not and expected finding it is due to post delivery prolapse of the uterus which is due to sagging of supporting muscle of uterus for this uterus displaced from the normal position.