placental circulation and an increase in venous return. The increase is responsible for
profound diuresis in early postpartum and a fall in hematocrit. This is why early
postpartum time is the greatest risk for heart failure in patients with cardiac disease or
limited cardiac reserve.
b. Hematocrit. The hematocrit drops because of blood loss during actual
delivery. It usually rises by the third to seventh postpartum day unless substantial blood
loss has occurred. Normal blood loss is about 250cc for vaginal delivery. This varies
considerably. Blood loss must be greater than 500cc to be considered hemorrhage.
6-4.
FACTS ABOUT THE URINARY SYSTEM FOLLOWING DELIVERY
The bladder mucosa shows varying degrees of edema and hyperemia, with
diminished bladder tone after delivery. This results in decreased sensation to increased
pressure, increased capacity, overdistention with overflow incontinence, and incomplete
emptying of the bladder. Nursing care must include careful monitoring of the condition
of the bladder. Distention and urinary retention are common occurrences and can
cause discomfort as well as predispose a patient to infection, uterine atony and heavy
bleeding, and may cause the patient's blood pressure to increase. With adequate
emptying of the bladder, tone is usually restored within five to seven days.
6-5.
FACTS ABOUT OVULATION AND MENSTRUATION FOLLOWING DELIVERY
Amenorrhea (cessation of menstruation) helps the body to conserve body fluids.
Reestablishment of ovulation and menstruation is influenced by whether the mother is
breast-feeding or not. Ovulation is delayed in direct proportion to the amount and length
of time the baby is breast-fed. The absence of menstruation in a breast-feeding mother
does not necessarily indicate absence of ovulation. Breast-feeding is not a means of
birth control; contraceptives should be used.
6-6.
FACTS ABOUT BREASTS AND LACTATION FOLLOWING DELIVERY
The concentrations of hormones that stimulated breast development during
pregnancy decreases promptly after delivery. The time it takes for the return of these
hormones to prepregnancy levels is determined in part by whether the mother
breast-feds her infant.
a. Milk. Does not appear until three or four days after delivery.
b. Colostrum. This is the watery prolactations secretion that is first evident
during the second trimester. It is secreted for the first several days after delivery in
increasing amounts. Characteristics of colostrum are as follows:
(1)
Thick, yellow fluid during pregnancy which changes to thin before
delivery.
MD0922
6-7
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