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The Normal Puerperium
Randy Heninger
LT, NC, USN
Student Nurse Midwife/WHNP
1/10/05
Newborn Infants need
•
•
•
•
•
•

Easy access to mother
Appropriate feeding
Adequate environment
Parental care
Cleanliness
Observation of body signs by someone who
cares and can take action if necessary
• Access to health care for suspected of
manifested complications
• Nurturing, cuddling, stimulation
Newborn Infants need
• Protection from
– Illness

– Harmful practices

– Abuse/violence
Newborn Infants need
• Acceptance of
– Sex

– Appearance

– Size
Newborn Infants need

• Recognition by the state (vital registration
system
In the Postpartum Period
Women Need:
• Information/counseling
on
– Care of the baby and
breastfeeding

– What happens with and
in their bodies including
signs of possible
problems
In the Postpartum Period
Women Need:
• Information/counseling
on
– Self care/hygiene and
healing

– Sexual Life
In the Postpartum Period
Women Need:
• Information/counseling
on
– Contraception

– Nutrition
In the Postpartum Period
Women Need:
• Support from
– Health care providers

– Partner and familyemotional and
psychological
In the Postpartum Period
Women Need:
• Health care for suspected or manifested
complications
• Time to care for the baby
• Help with domestic tasks
• Maternity leave
• Social reintegration into her family
• Protection from abuse/violence
In the Postpartum Period
Women Need:
• Women may fear
– Inadequacy
– Loss of marital intimacy
– Isolation
– Constant responsibility for care of the baby
and others
Respiratory
•
•
•
•
•
•

Mechanical
Biochemical
Lung Volumes
Ventilation
Diffusing Capacity
Acid Base Changes
Respiratory
Mechanical

•Immediate reduction in intraabdominal pressure
•Chest wall compliance returns to
normal with the relief of
diaphragmatic pressure
•All diameters and angles return
to normal 1 – 3 weeks postpartum

Biochemical

•Feelings of dyspnea disappear
shortly after delivery

Lung Volumes

•Tidal volume and residual
volume return to normal
•Expiratory reserve volume may
remain low for several months
Respiratory
Ventilation

•Rate returns to normal in First few
hours

Diffusing Capacity

•May remain decreased up to 12
months

Acid Base Changes

•Maternal antepartum alkalosis
and intrapartum respiratory
acidosis resolve in first few hours
Cardiovascular
•
•
•
•
•
•
•
•
•

Anatomic
Cardiac Output
Heart Rate
Stroke Volume
Blood Pressure
Regional Blood Flow
Heart Sounds
EKG
Echocardiogram
Cardiovascular
Anatomic

•Heart returns to normal
placement
•PMI returns to normal placement
•Diaphragm returns to normal
placement
•Decrease in venous and arterial
pulsation

Cardiac Output =HR x
Stroke Volume

•Increase significantly for 1-2
hours postpartum(60-80% pre
labor) then stabilizes
•Returns to normal although may
stay elevated for up to 1 year

Heart Rate

•Decreases immediately PP
•Returns to normal 6-8 weeks
Cardiovascular
Stroke Volume

•Increases immediately PP
•Returns to normal 6-8 weeks

Blood pressure

•Transient rise in first 4 days
•Returns to normal 6-8 weeks

Regional blood flow

•Blood returns to maternal
circulation form heart, uterus,
renal, lungs, extremities, skin
•Returns to normal 6-8 weeks

Heart Sounds

•Split in first heart sound resolves
by 2-4 weeks
•SEM – 80% resolve by 4 weeks

EKG and Echo-cardiogram

•Returns to normal 6-8 weeks
Hematological
•
•
•
•
•
•
•
•
•

Total Blood Volume
Plasma Volume
RBCs
Hgb & Hct
WBCs
Platelets
ESR
Serum Fe
Coagulation
Hematological
Total blood volume

•Decreases immediately PP due
to blood loss at delivery

Plasma volume

•Decreases immediately PP due
to blood loss and delivery
•Increases 3 days PP due to shift
of extra cellular fluid into vessels

RBCs

•RBC production returns to
normal levels
•RBC count returns to normal by
8 weeks PP
Hematological
Hgb & Hct

•Immediate decrease in Hgb
immediately PP due to blood loss
at delivery
•Hgb levels stabilize by 2-3 days
•HCT remains relatively stable
immediately after delivery
•Hct returns to non-pregnant
levels 4-6 weeks

WBCs

•Decrease to 6- 10,000 after high
of 25-30,000 during intrapartum
and immediate postpartum
•Returns to normal 4-7 days

Platelets

•Increases at 3-4 days
•Gradually returns to nonpregnant levels
Hematological
ESR

•Gradually returns to nonpregnant levels after antepartum
increase

Serum Fe

•Increases as Hgb is catabolized
•Gradually returns to nonpregnant levels

Coagulation factors

•Increase in fibrolytic activity in
first hours
•Slow decrease to non-pregnant
levels by 1-4 weeks
•Slow decrease in coagulation
factors by 1-4 weeks

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Normal puerperium-1

  • 1. The Normal Puerperium Randy Heninger LT, NC, USN Student Nurse Midwife/WHNP 1/10/05
  • 2. Newborn Infants need • • • • • • Easy access to mother Appropriate feeding Adequate environment Parental care Cleanliness Observation of body signs by someone who cares and can take action if necessary • Access to health care for suspected of manifested complications • Nurturing, cuddling, stimulation
  • 3. Newborn Infants need • Protection from – Illness – Harmful practices – Abuse/violence
  • 4. Newborn Infants need • Acceptance of – Sex – Appearance – Size
  • 5. Newborn Infants need • Recognition by the state (vital registration system
  • 6. In the Postpartum Period Women Need: • Information/counseling on – Care of the baby and breastfeeding – What happens with and in their bodies including signs of possible problems
  • 7. In the Postpartum Period Women Need: • Information/counseling on – Self care/hygiene and healing – Sexual Life
  • 8. In the Postpartum Period Women Need: • Information/counseling on – Contraception – Nutrition
  • 9. In the Postpartum Period Women Need: • Support from – Health care providers – Partner and familyemotional and psychological
  • 10. In the Postpartum Period Women Need: • Health care for suspected or manifested complications • Time to care for the baby • Help with domestic tasks • Maternity leave • Social reintegration into her family • Protection from abuse/violence
  • 11. In the Postpartum Period Women Need: • Women may fear – Inadequacy – Loss of marital intimacy – Isolation – Constant responsibility for care of the baby and others
  • 13. Respiratory Mechanical •Immediate reduction in intraabdominal pressure •Chest wall compliance returns to normal with the relief of diaphragmatic pressure •All diameters and angles return to normal 1 – 3 weeks postpartum Biochemical •Feelings of dyspnea disappear shortly after delivery Lung Volumes •Tidal volume and residual volume return to normal •Expiratory reserve volume may remain low for several months
  • 14. Respiratory Ventilation •Rate returns to normal in First few hours Diffusing Capacity •May remain decreased up to 12 months Acid Base Changes •Maternal antepartum alkalosis and intrapartum respiratory acidosis resolve in first few hours
  • 15. Cardiovascular • • • • • • • • • Anatomic Cardiac Output Heart Rate Stroke Volume Blood Pressure Regional Blood Flow Heart Sounds EKG Echocardiogram
  • 16. Cardiovascular Anatomic •Heart returns to normal placement •PMI returns to normal placement •Diaphragm returns to normal placement •Decrease in venous and arterial pulsation Cardiac Output =HR x Stroke Volume •Increase significantly for 1-2 hours postpartum(60-80% pre labor) then stabilizes •Returns to normal although may stay elevated for up to 1 year Heart Rate •Decreases immediately PP •Returns to normal 6-8 weeks
  • 17. Cardiovascular Stroke Volume •Increases immediately PP •Returns to normal 6-8 weeks Blood pressure •Transient rise in first 4 days •Returns to normal 6-8 weeks Regional blood flow •Blood returns to maternal circulation form heart, uterus, renal, lungs, extremities, skin •Returns to normal 6-8 weeks Heart Sounds •Split in first heart sound resolves by 2-4 weeks •SEM – 80% resolve by 4 weeks EKG and Echo-cardiogram •Returns to normal 6-8 weeks
  • 18. Hematological • • • • • • • • • Total Blood Volume Plasma Volume RBCs Hgb & Hct WBCs Platelets ESR Serum Fe Coagulation
  • 19. Hematological Total blood volume •Decreases immediately PP due to blood loss at delivery Plasma volume •Decreases immediately PP due to blood loss and delivery •Increases 3 days PP due to shift of extra cellular fluid into vessels RBCs •RBC production returns to normal levels •RBC count returns to normal by 8 weeks PP
  • 20. Hematological Hgb & Hct •Immediate decrease in Hgb immediately PP due to blood loss at delivery •Hgb levels stabilize by 2-3 days •HCT remains relatively stable immediately after delivery •Hct returns to non-pregnant levels 4-6 weeks WBCs •Decrease to 6- 10,000 after high of 25-30,000 during intrapartum and immediate postpartum •Returns to normal 4-7 days Platelets •Increases at 3-4 days •Gradually returns to nonpregnant levels
  • 21. Hematological ESR •Gradually returns to nonpregnant levels after antepartum increase Serum Fe •Increases as Hgb is catabolized •Gradually returns to nonpregnant levels Coagulation factors •Increase in fibrolytic activity in first hours •Slow decrease to non-pregnant levels by 1-4 weeks •Slow decrease in coagulation factors by 1-4 weeks