NCLEX Review Guide: Maternal Newborn Health - Postpartum Period

Involution and Lochia

• Involution is the process where the uterus returns to its pre-pregnancy size, occurring over 6 weeks postpartum. The fundus should descend approximately 1 cm (one fingerbreadth) per day.
• Lochia progresses through three stages: rubra (days 1-3, bright red), serosa (days 4-10, pink-brown), and alba (days 11-21, yellow-white).
• Normal lochia flow should not exceed one saturated pad per hour for the first 24 hours postpartum.

Postpartum Hemorrhage (PPH)

• Primary PPH occurs within 24 hours (≥500mL vaginal, ≥1000mL cesarean) and is most commonly caused by uterine atony. Secondary PPH occurs 24 hours to 12 weeks postpartum.
• The "4 T's" of PPH causes: Tone (uterine atony), Trauma (lacerations), Tissue (retained placenta), Thrombin (coagulation disorders).

Postpartum Infections

• Puerperal sepsis is defined as fever ≥38°C (100.4°F) on any two of the first 10 postpartum days, excluding the first 24 hours. Endometritis is the most common postpartum infection.
• Risk factors include prolonged labor, prolonged rupture of membranes, multiple vaginal exams, and cesarean delivery.

BUBBLE-HE Assessment

1. Breasts - Check for engorgement, cracks, mastitis signs
2. Uterus - Fundal height, firmness, position
3. Bladder - Voiding pattern, distention, UTI signs
4. Bowel - Bowel sounds, first BM, hemorrhoids
5. Lochia - Amount, color, odor, clots
6. Episiotomy/Incision - REEDA scale (Redness, Edema, Ecchymosis, Discharge, Approximation)
7. Homan's sign - Check for DVT
8. Emotional status - Bonding, postpartum blues/depression

Quick Check Knowledge

Common Pitfalls

• Don't massage a firm fundus - this can cause uterine inversion or increased bleeding
• Remember that breastfeeding mothers may have delayed return of menses but can still ovulate
• Methylergonovine (Methergine) is contraindicated in hypertensive clients