Endocrine system
Placenta Hormones:
 Dramatic decrease of
hormones produced by
that organ
 Significant low blood
sugar
 Estrogen and progesterone
levels drop. Low estrogen
levels = diuresis of excess
EF.
 Prolactin levels in blood
increase.
 Non-lactating women
resume ovulation 27 days
pp vs 6 months on
lactating women or
depending on their
breastfeeding patterns.
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Urinary system
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Kidney function returns to
normal within 1 month pp.
6 weeks for induced
labour moms
Renal glycosuria induced
by pregnancy disappears
by 1 week pp, lactouria
may occur in lactating
women.
BUN increases during pp
Proteinuria resolves by 6
weeks after birth
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Appetite:
 Hungry after birth, able to
tolerate a regular diet
usually
BM
 BM 2-3 days pp
 Forceps or vacuum moms
may be anal incontinent
flatus than stool
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GI system
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Mothers with type 1
diabetes will likely
require much less insulin
for several days after
birth
In non-lactating women
estrogen levels rise by 2
weeks pp and pp day 17
are higher in women who
breastfeed.
Prolactin levels are
influenced by freq of
breastfeeding, duration
and amount.
Prolactin produced when
breastfeeding inhibits
ovulation.
All women pp need to
use contraceptive.
First menstrual flow is
heavier than normal after
3-4 cycles flow back to
normal
For some women
dilation of the urinary
tract persist for 3 months
or longer, risk for UTI
Ketonuria occur in
women with an
uncomplicated birth or
after prolong labour with
dehydration
Postpartum diuresis
increase urine output
responsible for a weight
loss of approx. 2.25 kg
Discomfort when
pooping due to perineal
tenderness as a result of
episiotomy, lacerations,
hemorrhoids and may
ignore the urge to poo.
Increase fluid and fiber
intake to prevent
constipation and
discomfort.
Breasts
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C-section moms
encourage to move gas
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Stool softeners may be
required
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Hormone resumption
depends on breastfeeding
patterns.
Colostrum (clear/yellow
fluid) may be expressed
from the breast
True milk (bluish-white
milk with a skim milk
appearance) expressed
from the nipple
Should feel warm, firm
and tender also nodular
and lumpy
Non-lactating women:
- Nodularity bilateral
and diffused
- Prolactin level drop
fast
- Day 3-4 engorgement
present and temp
- Discomfort decreases
within 24-36 hrs.
- If suckling is never
begun, lactation ceases
within a few days to a
week
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Lumps associated with
cancer are palpated in the
same location, but
nodules associated with
milk production tend to
shift in position.
Engorgement decreases
with frequent
breastfeeding and proper
care. Temp condition
lasting 24 hrs to 48 hrs.
Non-lactating women:
- Breast distention
caused by a temp
congestion of veins
and lymph rather than
the clump of milk.
- Breast binder or wellfitted support bra, ice
packs, fresh cabbage
leaves or mild
analgesics used to
relieve discomfort.
- Nipple stimulation
should be avoided
Pregnancy-induced
hypervolemia allows
women to tolerate blood
loss during childbirth
A few days after birth the
plasma volume decreases
further as a result of
diuresis
Cardiac output remains
increased for at least
48hrs after birth because
of an increase in stroke
volume due to the return
of blood to the maternal
systemic venous
circulation
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Cardiovascular system
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Three pp physiological
changes that protect the
woman by increasing the
circulating blood volume.
- Elimination of
uteroplacental
circulation reduces
the size of the
maternal vascular bed
- Loss of placental
endocrine function
removes the stimulus
for vasodilation
- Mobilization of
extravascular water
stored during
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Vital Signs
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Respiratory system
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Stroke volume, cardiac
output, end diastolic
volume and systemic
vascular resistance remain
elevated over nonpregnant state until 24
weeks pp
Temp: during the 24hrs
temp may increase to 38 C
as a result of dehydrating
effects of labour. After 24
hrs no fever.
Pulse: along with stroke
volume and cardiac output
remain elevated for the
first hour or so after
childbirth. It decreases
with time
Respiration: should
rapidly decrease to the
pt’s baseline
Blood pressure:
orthostatic hypotension
develops in the first 48 hrs
as a result of the
splanchnic engorgement
that may occur after birth.
Decrease in intraabdominal pressure,
which allows for greater
excursion of the
diaphragm.
Low pressure on the
diaphragm and reduced
pulmonary blood flow,
chest wall compliance
increase
Rib cage elasticity can
take months to return back
to normal.
Costal angle does not
come back to back from
the preggo increase
PaCO2 levels rise due to
decline of progesterone
Basal metabolic rate
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pregnancy occurs
By the 3rd day pp the
plasma volume has been
replenished as
extravascular fluid
returns to the
intravascular space
Report any fevers risks
for mastitis, UTI,
endometritis, other
infections
Rapid pulse rate indicates
hypovolemia due to
hemorrhage or high temp
Resp depression due to
narcotic after c-section
Low BP may indicate the
existence of hypovolemia
secondary to
hemorrhage.
High BP due to the use of
vasopressors or oxytocin
medication.
Gestational hypertension
can persist into or occur
first in the pp. Headache
warning sign
Neurological system
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Muscleoskeltal system
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Integumentary system
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gradually returns to
normal levels usually 1-2
weeks pp
Diuresis relieves carpal
tunnel eases compression
of the median nerve
Numbness and tingling of
fingers disappears
Headaches (diff causes
i.e., pp- onset preeclampsia, stress and leak
of cerebrospinal fluid into
the extradural space
during epidural or spinal
anesthesia )
Relaxation and
subsequent hypermobility
of the joints and the
mom’s center of gravity in
response to the enlarging
uterus
Joints completely
stabilized by week 6 to 8
Feet joints do not come
back to normal and
permanent shoe size
increase
Melasma usually
disappears but it may
persist
Hyperpigmentation of the
areolae and linea nigra
may not disappear
completely
Stretch marks on the
breasts, abdomen, and
thighs may fade but not
disappear
Spider angiomas, palmar
erythema and epulis
generally regresses due to
decline of estrogen but
depends
Hair loss
Fingernails back to
normal strength
Immune system
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Mildly suppress in
pregnancy gradually
returns back to normal
Flare ups of autoimmune
conditions such as
multiple sclerosis or lupus
erythematous