PHYSIOLOGICAL CHANGES

• SYSTEM CHANGES

  
  

  after 24 hours

  • levels of HCG and HPL are negligible
• by 1 week

  • progesterone, estrone, and estradiol are all at pre pregnancy levels
• additional week

  • estrol may be elevated before it reaches pre pregnancy levels
• about 12 days

  • FSH remain low and then begins to rise as a new menstrual cycle is initiated
• The urinary system

  2000 to 3000 ML excess fluid

  • accumulates in the body during pregnancy
• an extensive diuresis begins to take place almost immediately after birth to rid the body fluid
• 1500 ML

  • normal daily output of a postpartal woman
• 3000 ML/day

  • increases during the second to fifth after birth
• on palpation

  • a full bladder is felt as hard or firm area just above symphiphis pubis
• on percussion

  • a full bladder sounds resonant
• on contrast to dull means thudding sound of non fluid tissue
• the circulatory system

  normal blood loss

  300 to 500 ML
• caesarian birth blood loss

  • 500 to 1000 ML
• woman usually continue to have the same high level of plasma fibrogen during the first post partal week as they did during the pregnancy
• PLASMA FIBROGEN

  • This is a protective measure againts hemorrhage
  • however, this high level also increases the risk of thrombus formation
• the gastrointertinal system

  digestion and absorption

  • begins to be active agan soon after birth unless a woman has had caesarian birth
• hemorrhoids (distended rectal veins) that had been pushed out of rectum because of pelvic stage are often present
• the integumentary system

  after birth, stretch mark (striae gravidarum) still appear reddened may be more prominent than during pregnancy as the were stretched
• chloasma

  • face and neck excessive pigment will barely detectable after 6 weeks
• linea nigra

  abdomen excessive pigment will barely detectable after 6 weeks
• diastasis recti

  • overstrectching of abdomiunal musculature
  • the area will appear slightly indented
• LACTATION

  • the formation of breastmilk
  • begins in post partal women wheather or not she plans to breastfeed
• for the first 2 days after birth

  • an average women notices little changes in her breast
• since midway though pregnancy

  • she has been secreting colostrum, a thin watery pre lactation secretion
  • she continues to exrete this fluid the first two postpartum days
• on the third day

  • her breast becomes full and tense or tender as milk forms within breast ducts
• breast milks form

  • in response to the decrease in estrogen and progesterone levels that follows delivery of placenta
• delivery of placenta

  • stimulates prolactin
• breastmilk form is equal to milk ducts becomes distended
• return of menstrual flow
• 6 to 10 weeks after birth

  • return of menstrual of not breastfeeding woman
• 3 to 4 months of entire lactation period

  • return of menstrual flow of breastfeeding woman
• phases of puerperium

  taking in phase

  • a time of reflection
  • two to three days period
  • a woman is largely passive
• phases of puerperium

  taking hold phase

  • a woman begins to initiate action
  • she begins take a strong interest
• phases of puerperium

  letting go phase

  • a woman finally redefines her new role
  • she give up her old role of being childless
• homans sign

  • press down gentrly on knee, ask her to flex her foot
  • pain in calves means positive and thres a possibility of thrombophlebitis