ch 20 OB

With regard to afterbirth pains, nurses should be aware that these pains are what? Caused by mild, continual contractions for the duration of the postpartum period. More common in first-time mothers. More noticeable in births in which the uterus was overdistended. Alleviated somewhat when the mother breastfeeds.

Afterbirth pains are more common in multiparous women because first-time mothers have better uterine tone. A large infant or multiple infants overdistend the uterus. The cramping that causes afterbirth pains arises from periodic, vigorous contractions and relaxations that persist through the first part of the postpartum period. Breastfeeding intensifies afterbirth pain because it stimulates contractions.

Is similar to a light menstrual period for the first 6 to 12 hours Is usually greater after cesarean births Will usually decrease with ambulation and breastfeeding Should smell like normal menstrual flow unless an infection is present

An offensive odor usually indicates an infection. Lochia flow should approximate a heavy menstrual period for the first 2 hours and then steadily decrease. Less lochia usually is seen after cesarean births. Lochia usually increases with ambulation and breastfeeding.

A nonlactating postpartum woman has discomfort due to breast engorgement. Which interventions does the nurse suggest to the client to relieve the discomfort? Using a breast binder Stimulating the nipple Using mild analgesics Wearing a tight-fitting bra Applying ice packs on the breasts Applying fresh cabbage leaves to the breasts

Applying ice packs on the breasts Applying fresh cabbage leaves to the breasts Using a breast binder

Which of the following changes are consistent with metabolic function during the postpartum period? Moderate hyperglycemia Increased basal metabolic rate (BMR) in the immediate postpartum period Secretion of insulinase T 3 and T 4 levels remain mildly increased for the first several weeks postpartum Decrease in estrogen and cortisol levels

BMR remains elevated for the first two weeks after birth and then returns to prepregnancy levels. Decreases in hormones such as estrogen and cortisol are seen during the postpartum period. Blood sugar levels typically decrease in the postpartum period as a result of the reversal of diabetogenic effects of pregnancy. A decrease in the insulinase enzyme occurs postpartum. Thyroid hormones gradually decrease to prepregnant levels in the 4 weeks following delivery.

The nurse is caring for a postpartum client. The nurse finds that the client has started producing true milk. What finding in the client led the nurse to this conclusion? Nodular breast Distended breast Bluish white milk Clear, yellow milk

Bluish white milk

As part of the postpartum assessment, the nurse examines the breasts of a primiparous breastfeeding woman who is 1 day postpartum. What is an expected finding? Little if any change Leakage of milk at let-down Swollen, warm and tender on palpation A few blisters and a bruise on each areola

Breasts are essentially unchanged for the first 24 hours after birth. Colostrum is present and may leak from the nipples. Leakage of milk occurs after the milk comes in 72 to 96 hours after birth. Engorgement occurs at day 3 or 4 postpartum. A few blisters and a bruise indicate problems with the breastfeeding techniques being used.

The nurse is caring for a client who gave birth to triplets. The nurse observes that the client's abdomen is overdistended and abdominal muscle walls are separated. What condition in the client is likely and should be further evaluated? Subinvolution Persistent lochia rubra Postpartum hemostasis Diastasis recti abdominis

Diastasis recti abdominis

The nurse is caring for a postpartum client. Which changes should be identified as normal, and caused by low levels of estrogen? Diuresis Spider angioma Palmar erythema Breast development

Diuresis

A woman gave birth to a 7-lb, 3-oz boy 2 hours ago. The nurse determines that the woman's bladder is distended because her fundus is now 3 cm above the umbilicus and to the right of the midline. In the immediate postpartum period, the most serious consequence likely to occur from bladder distention is what? Urinary tract infection. Excessive uterine bleeding. A ruptured bladder. Bladder wall atony.

Excessive uterine bleeding.

With regard to the condition and reconditioning of the urinary system after childbirth, nurses should be aware of what? Kidney function returns to normal a few days after birth. Diastasis recti abdominis is a common condition that alters the voiding reflex. Fluid loss through perspiration and increased urinary output account for a weight loss of more than 2 kg during the puerperium. With adequate emptying of the bladder, bladder tone usually is restored 2 to 3 weeks after childbirth.

Fluid loss through perspiration and increased urinary output account for a weight loss of more than 2 kg during the puerperium.

Which of the following findings would cause a concern for the nurse who is monitoring a postpartum patient who had a spontaneous vaginal delivery (SVD) of a 10-pound baby boy? Lochia rubra with minimal clots expressed on fundal massage Fundus midline and firm with nonpalpable bladder Fundus midline and firm with spurts of bright red blood upon fundal massage Patient reports mild to moderate cramping and requests pain medication

Fundus midline and firm with spurts of bright red blood upon fundal massage

What change in a urine test of a client one week after an uncomplicated childbirth is considered normal? Increased ketone levels Increased glucose levels Normal creatinine levels Decreased urea nitrogen levels

Increased ketone levels After giving birth, women experience a deficiency in glucose levels; hence the body adopts an alternate source of energy in the form of ketones. These elevated levels of ketones cause ketonuria, which is generally observed in clients after uncomplicated childbirth or after a prolonged labor with dehydration. Glucose levels normalize within 1 week after childbirth, due to decreased placental insulinase hormone levels. Increased creatinine levels take 6 weeks to normalize after childbirth. Urea nitrogen levels increase postpartum due to autolysis of hypertrophied uterine tissue.

A client who gave birth 4 days ago reports that her vaginal discharge has an offensive odor. What patient clinical condition does the nurse infer from this? Infection. High oxytocin levels. Postpartum hemorrhage. Normal lochial discharge.

Infection

During a follow-up visit after a month, the nurse finds that the postpartum client has fever, pain, abdominal tenderness, and foul-smelling lochia. Which condition is likely to be found in the client? Infection Dyspareunia Subinvolution Diastasis recti abdomini

Infection

The nurse is assessing a postpartum client 6 hours after delivery. The nurse finds that the client's body temperature is 100.3 ° F. What should the nurse do in this situation? Give a cold compresses to the client. Send the client's urine sample for culture. Apply ice packs on the breasts of the client. Recheck the temperature again 24 hours after delivery.

It is natural for a client's body temperature to be slightly elevated for 24 hours following delivery. In this situation, the nurse should check the client's temperature 24 hours postdelivery to see if it has stabilized. The client does not have a fever so does not need to be given a cold compress. The client's urine sample needs to be cultured only if the client is suspected to have urinary tract infection. Based on this information, the nurse cannot conclude that the client has a urinary tract infection. Ice packs can be applied to reduce breast tenderness and discomfort after delivery, but this intervention is not used to bring down the client's body temperature.

The nurse teaches a postpartum client how to perform Kegel exercises and asks the patient to practice these exercises regularly. Which complication is the nurse trying to prevent with this instruction? Hemorrhoids Pelvic relaxation Varicosities in legs Subinvolution of uterus

Kegel exercises strengthen the pelvic floor muscles, which important because vaginal delivery weakens the pelvic floor muscles. Weakening of pelvic muscles can result in pelvic relaxation involving all pelvic organs. Kegel exercises do not prevent hemorrhoids, varicosities in legs, or subinvolution of uterus. Consuming a diet that is rich in fiber may prevent hemorrhoids. Varicosities in legs usually regress during postpartum period. Subinvolution of the uterus can be prevented by proper removal of placental fragments after delivery and maintaining asepsis during delivery and post delivery.

What is the difference between lochial and nonlochial bleeding? Lochial bleeding can be dark in color, and nonlochial bleeding is clear in color. Lochial bleeding usually trickles from the vaginal opening, and nonlochial bleeding spurts from the vagina. Lochial bleeding flow is lighter as the uterus contracts, and with nonlochial bleeding, the uterus does not contract. Lochial bleeding can appear as the uterus is massaged, and with nonlochial bleeding, there is little bleeding at all.

Lochial bleeding usually trickles from the vaginal opening, and nonlochial bleeding spurts from the vagina.

The nurse midwife is caring for a postpartum client who delivered a baby the previous day. When the client stands for the first time the next morning, she experiences a huge gush of blood expelled from the vagina. What should the nurse do in this situation? Administer oxytocin to the client. Assess the uterine tone of the client. Inform the client that it is a normal finding. Immediately order blood for the client.

The nurse should inform the client that this sudden rush of blood is normal. Following delivery, a postpartum client will have a red uterine discharge, called lochia rubra, which is mainly blood and uterine debris. If the client had been sleeping all night, the lochia rubra would have accumulated in the vagina and would have been released when the client stood up. The client does not have a hemorrhage caused by uterine atony ,so the nurse does not need to administer oxytocin or assess the client's uterine tone. This client does not need to have blood administered unless the bleeding continues after the initial rush of lochia rubra when the client first stands up.

The nurse is evaluating a student nurse regarding postpartum physiologic changes to the placental site. Which statement made by the student nurse indicates a need for additional teaching? "Endometrial regeneration takes at least 3 weeks." "Placental site regeneration takes 6 weeks after birth." "The placental site gets reduced to an irregular nodular area." "Upward growth of the endometrium prevents scar formation."

The placental site undergoes many physiologic changes after childbirth. Regeneration of the endometrium is completed by the 16th day postpartum. A minimum of 6 weeks are required for the regeneration of the placental site after childbirth. After expulsion of the placenta during labor, the vascular constriction and thrombosis reduce the placental site to an irregular nodular area. Scar formation is a characteristic feature of wound healing; it is prevented by the upward growth of the endometrium during postpartum.

Which are considered normal findings of vital signs after childbirth? The woman's respiratory rate decreases after delivery. The woman should be afebrile 24 hours after childbirth. Puerperal bradycardia (40 to 50 beats/minute) is not common after childbirth. Blood pressure shows a transient increase of approximately 5% over the first few days after birth. Pulse, along with stroke volume and cardiac output, stay elevated for the first 4 hours after birth. Orthostatic hypotension can develop in the first hour after delivery, because of splanchnic engorgement.

Normal findings of vital signs after childbirth include the woman's respiratory rate being slightly elevated or unchanged (not decreased) after delivery; the woman being afebrile 24 hours after childbirth; having puerperal bradycardia (40 to 50 beats/minute), which is common after childbirth; blood pressure showing a transient increase of approximately 5% over the first few days after birth; pulse, along with stroke volume and cardiac output, staying elevated for the first hour (not 4 hours) after birth; and orthostatic hypotension possibly developing in the first 48 hours (not the first hour) after delivery because of splanchnic engorgement.

On the second day postdelivery, the client reports feeling dizzy when she stands up. What is the probable reason for the client's dizziness? Orthostatic hypotension Subinvoluted uterus Decreased estrogen levels Decreased progesterone levels

Orthostatic hypotension

Which factor is responsible for postpartal diuresis? Increased estrogen Increased prolactin Decreased diaphoresis Decreased venous pressure

Postpartal diuresis is common during the first 2 to 3 days after delivery. It occurs due to decreased venous pressure in the lower extremities. Diuresis removes excess tissue fluid accumulated during pregnancy. Estrogen levels decrease after delivery resulting in diuresis. Prolactin levels increase after delivery increasing lactation. Profuse diaphoresis may occur, especially at night, for the first 2 or 3 days after birth, but it does not affect the urinary system.

Which physiologic change causes a postpartum increase in circulating blood volume? Promotion of vasodilation Reduction in plasma volume Reduction of kidney function Mobilization of extravascular fluid

Three physiologic changes occur postpartum to protect the client by increasing circulating blood volume during puerperium. Mobilization of extravascular fluid to intravascular space increases the circulating blood volume postpartum. The placenta, which has the capability to release vasodilation-stimulating hormones, acts as an endocrine organ during pregnancy. In postpartum clients the stimulus for vasodilation is removed. Reduction in plasma volume results because of diuresis during immediate puerperium. This does not account for the increase in circulating blood volume. Postpartum hormonal changes result in reduced kidney function, which includes decreased water reabsorption, resulting in diuresis. Hence, this does not cause an increase in circulating blood volume.

What are the symptoms of carpal tunnel syndrome? Tingling of fingers Increased urination Increased sweating Numbness of fingers Yellow-colored sputum

Tingling of fingers Numbness of fingers Carpal tunnel syndrome occurs because of compression of the median nerve. Tingling and numbness of the fingers are symptoms of carpal tunnel syndrome. Increased urination, sweating, and yellow-colored sputum are not symptoms of carpal tunnel syndrome. Increased urination may occur due to many reasons, including decreased estrogen levels. Increased sweating is a general finding after delivery. Yellow-colored sputum is a symptom of infection.

Which description of postpartum restoration or healing times is accurate? The cervix shortens, becomes firm, and returns to form within a month postpartum. Vaginal rugae reappear within 3 to 4 weeks. Most episiotomies heal within a week. Hemorrhoids usually decrease in size within 2 weeks of childbirth.

Vaginal rugae reappear within 3 to 4 weeks.

The breasts of a bottle-feeding woman are engorged. The nurse should tell her to what? Wear a snug, supportive bra. Allow warm water to soothe the breasts during a shower. Express milk from breasts occasionally to relieve discomfort. Place absorbent pads with plastic liners into her bra to absorb leakage.

Wear a snug, supportive bra.

The nurse is caring for a postpartum client with type I diabetes. The client reports dizziness on the first day postdelivery, in spite of taking the regular medication. What should the nurse do in this situation? Administer insulin to the client. Assess for symptoms of hemorrhage. Assess the client's blood glucose levels. Refer the client for a computed tomography scan.

Postpartum clients may have low blood glucose levels in the immediate puerperal period. This client is diabetic and has taken the medications on schedule following the delivery, which indicates the client is likely to develop hypoglycemia. Therefore, the nurse should assess the blood glucose levels of the client. Administration of insulin may worsen the client's condition and the nurse would not administer any medication without first checking the client's glucose levels. The client would have severe vaginal bleeding in case of a hemorrhage, but not necessarily dizziness. Dizziness does not necessarily indicate a brain pathology, so the nurse would not refer the client for a computed tomography scan.

The nurse is assisting a client who is experiencing postpartum hemorrhage. Which are the risk factors of postpartum hemorrhage? Overdistension of uterus Administration of exogenous oxytocin Reduction in levels of oxytocin released Expulsion of placental tissue from the uterus Vasodilatation of intramyometrial blood vessels Eugene off target

Postpartum hemostasis is attained by the contraction of uterine muscles and also by the compression of intramyometrial blood vessels. The release of oxytocin and increased sensitivity of the uterus to oxytocin stimulate uterine contractions. Hence, a decrease in oxytocin levels may result in postpartum hemorrhage. Vasodilatation of intramyometrial blood vessels will also contribute to the development of hemorrhage. Only when accompanied by other causes might overdistention of the uterus lead to hemorrhage. Administration of exogenous oxytocin reduces the risk of postpartum hemorrhage. Expulsion of placental tissue is a normal response during labor.

postpartum client reports severe headaches. When reviewing the client's medical record, the nurse finds that the client's blood pressure was 150/100 mm Hg and 160/90 mm Hg on the second and third postpartum days, respectively. Which condition may be responsible for these alterations in blood pressure? Bradycardia Preeclampsia Hypovolemia Hyponatremia

Preeclampsia An increase in blood pressure after delivery that is greater than 140/90 mm Hg on more than two or three occasions, and at least 6 hours apart, may indicate preeclampsia. Preeclampsia may cause postpartum headache in the client. A decrease in the heart rate to 40 to 50 beats/minute indicates bradycardia. Hypovolemia is characterized by low or decreasing blood pressure. Hyponatremia is a decrease in sodium levels, which occurs 3 to 6 months postpartum. Increased blood pressure does not indicate the presence of hyponatremia.

Which complication should the nurse assess before planning care for the client who has undergone a forceps-assisted delivery? Decreased vaginal secretions Decreased urinary frequency Presence of vaginal lacerations Increased pelvic muscles tone

Presence of vaginal lacerations

Which changes might the nurse observe in a client after delivery? Increased pulse rate Decreased temperature Increased cardiac output Increased blood pressure Decreased respiratory rate

Pulse rate and cardiac output are elevated for the first hour after childbirth. Increased pulse rate may indicate hypovolemia, as a result of hemorrhage. Blood pressure shows a transient increase after delivery, due to excessive use of vasopressor or oxytocic medications. Temperature can increase after delivery as a result of dehydrating effects of labor during the first 24 hours. The respiratory rate, which is slightly increased during pregnancy, should be within the woman's normal range soon after delivery.

Upon reviewing the medical history of a postpartum client with type 1 diabetes, the nurse finds that the client is insulin dependent. Which intervention would help in management of blood sugar levels in the client? Reduce the dose of insulin. Change the type of insulin. Stop the insulin administration. Change the route of administration.

Reduce the dose of insulin. Immediately postpartum, there will be a rapid decrease in the levels of placental enzyme insulinase, which results in a reversal of the diabetogenic effects of pregnancy. Hence, clients with type 1 diabetes require low doses of insulin for several days after childbirth. Reducing the dose is more beneficial than changing the type of insulin to manage the blood glucose levels. Administration of insulin should not be stopped, because it may result in hyperglycemia. Insulin injections are generally given subcutaneously. Changing the route of administration to either intravenous injection or intramuscular injection may cause severe hypoglycemia.

Which postpartum changes are observed in the integumentary system of a postpartum woman? Decreased rate of hair turnover Regression of palmar erythema Regression of spider angiomas (nevi) Regression of hyperpigmentation of areolae Disappearance of striae gravidarum on breast

Regression of palmar erythema Regression of spider angiomas (nevi) Regression of hyperpigmentation of areolae

The nurse is caring for a client who underwent a cesarean section. Upon checking the medical history, the nurse finds that epidural opioid medication was administered to the client. What complication of epidural opioid administration should the nurse look for in the client? Puerperal sepsis Puerperal bradycardia Respiratory depression Orthostatic hypotension

Respiratory depression

What statement by a newly delivered woman who is not planning to breastfeed indicates that she knows what to expect about her menstrual activity after childbirth? "My first menstrual cycle will be lighter than normal and then will get heavier every month thereafter." "My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles." "I will not have a menstrual cycle for 6 months after childbirth." "My first menstrual cycle will be heavier than normal and then will be light for several months after."

Stating that the first menstrual cycle will be heavier than normal and will return to her prepregnant volume within three or four cycles is an accurate statement and indicates her understanding of her expected menstrual activity. Most women experience a heavier than normal flow during the first menstrual cycle, which occurs by 3 months after childbirth if the woman isn't lactating. She can expect her first menstrual cycle to be heavier than normal, and the volume of her subsequent cycles to return to prepregnant levels within three or four cycles.

The nurse is caring for a postpartum patient who had a normal vaginal delivery. The nurse tells the patient, "This will help you prevent uterine prolapse in later stages of life." Which instruction from the primary health care provider (PHP) is the nurse most likely explaining to the patient? "Avoid climbing of the stairs." "Maintain a high-protein diet." "Do Kegel exercises every day." "Avoid sleeping in the prone position."

"Do Kegel exercises every day." Vaginal deliveries cause the pelvic muscles and ligaments to stretch and weaken. Kegel exercises help strengthen the pelvic floor muscles and thereby can prevent uterine complications, such as prolapse. The physical activity of climbing stairs may delay the process of healing from an episiotomy so it is usually avoided, but avoiding stairs does not prevent uterine prolapse. A diet high in protein is necessary to build muscle strength, but it cannot prevent uterine prolapse. Because the patient has already undergone delivery, sleeping in the prone position does not cause any harm.

A pregnant woman who is at 32 weeks gestation asks the nurse when she will start menstruating after delivery. What question should the nurse ask before responding to the client's question? "Will you be breastfeeding your child after delivery?" "Do you plan to opt for elective caesarean delivery?" "Do you plan to conceive again immediately after delivery?" "What form of contraception do you plan to use following the delivery?"

"Will you be breastfeeding your child after delivery?"

The nurse is teaching a first time mother who has delivered twins about postpartum changes. What information should the nurse include in the teaching? "You will have difficulty expelling milk." "You will have excess vaginal bleeding for a week." "You may have painful uterine spasms while breastfeeding." "You will have whitish vaginal discharge from the third day onwards."

"You may have painful uterine spasms while breastfeeding."

While examining the postpartum patient, the nurse finds that her fundus is located halfway between the umbilicus and the symphysis pubis. When would the nurse estimate about the time of the patient's delivery? 6 days ago. 12 hours ago. 24 hours ago. 6 weeks ago.

6 days ago. The fundus descends gradually from the time of childbirth and returns to its normal nonpregnant state. By the sixth day after childbirth it can be located halfway between the umbilicus and the symphysis pubis. The fundus rises to approximately 1 cm above the umbilicus within 12 hours of childbirth. Within 24 hours the fundus descends 1 to 2 cm, and the size of the uterus is same as during 20 weeks' gestation. By the sixth week, the uterus returns to its normal nonpregnant state.

The nurse is caring for a postpartum client. Which change in the respiratory system does the nurse consider to be normal? Rise in PaCO 2 levels Increased costal angle Increased intraabdominal pressure Increased pressure on the diaphragm

A decrease in progesterone levels due to the loss of the placenta causes a rise in PaCO 2 levels in a postpartum client. The costal angle that was increased during pregnancy may not completely return to the prepregnancy state. After delivery, intraabdominal pressure decreases to allow greater excursion of the diaphragm. This helps determine the degree of muscle deterioration in neuromuscular and respiratory diseases. Pressure on the diaphragm decreases; hence the pulmonary flow reduces, and chest wall compliance increases.

What changes take place in the integumentary system postpartum? Fingernails become brittle in consistency and strength. For the first 3 months after birth, women often report no hair loss when they brush or comb their hair. Vascular abnormalities such as spider angiomas (nevi) and palmar erythema persist indefinitely in all women. Striae gravidarum (stretch marks) on the breasts, abdomen, and thighs may fade but usually do not disappear completely. The abundance of fine hair seen during pregnancy usually disappears after giving birth; any coarse or bristly hair that appears during pregnancy usually remains. Melasma (chloasma or "mask of pregnancy") includes hyperpigmentation of the areolae and linea nigra and some women will have permanent darker pigmentation of those areas.

Striae gravidarum (stretch marks) on the breasts, abdomen, and thighs may fade but usually do not disappear completely. The abundance of fine hair seen during pregnancy usually disappears after giving birth; any coarse or bristly hair that appears during pregnancy usually remains. Melasma (chloasma or "mask of pregnancy") includes hyperpigmentation of the areolae and linea nigra and some women will have permanent darker pigmentation of those areas. The changes that take place in the integumentary system postpartum include striae gravidarum (stretch marks) on the breasts, abdomen, and thighs may fade but usually do not disappear completely; the abundance of fine hair seen during pregnancy usually disappears after giving birth; any coarse or bristly hair that appears during pregnancy usually remains; and melasma (chloasma or "mask of pregnancy") including hyperpigmentation of the areolae and linea nigra, and some women will have permanent darker pigmentation of those areas. Fingernails return to their prepregnancy state (do not become brittle) in consistency and strength; for the first 3 months after birth, women report hair loss (not no hair loss) when they brush or comb their hair; and vascular abnormalities such as spider angiomas (nevi) and palmar erythema persist indefinitely in some (not all) women.

The nurse is conducting a pelvic examination of a postpartum client in the sixth week following delivery. The nurse finds that the client has a palpable uterus and an infection due to retention of placental fragments. Which condition is likely to be found in the client? Hemostasis Dyspareunia Subinvolution Carpal tunnel syndrome

Subinvolution The uterus should not be palpable after 2 weeks following delivery and will return to its prepregnant location by 6 weeks after childbirth. A palpable uterus 6 weeks after delivery indicates subinvolution. The failure of the uterus to return to its prepregnant state is known as subinvolution. Subinvolution may occur due to retention of placental fragments after labor. Localized dryness and coital discomfort is observed in dyspareunia, which occurs due to estrogen deficiency. Postpartum hemostasis occurs because of the compression of intramyometrial blood vessels as the uterine muscles contract. Compression of the median nerve causes carpal tunnel syndrome.

The nurse is caring for a client who had twins. Following delivery, the client reports uterine cramping while breastfeeding. What action should the nurse take in this situation? Tell the client it may subside within 3 to 7 days. Notify the primary health care provider immediately. Instruct the client to perform Kegel exercises regularly. Instruct the client to stop breastfeeding for 2 to 3 hours.

Tell the client it may subside within 3 to 7 days.

What assessment finding does the nurse expect to find in a postpartum patient 12 hours after childbirth? The fundus is approximately 1 cm above the umbilicus. The palpation of the uterus is not possible abdominally. The uterus is about the same size as it was at 20 weeks' gestation. The fundus is located midway between the umbilicus and the symphysis pubis.

The fundus can rise to approximately 1 cm above the umbilicus within 12 hours after childbirth. By the sixth postpartum day the fundus is normally located halfway between the umbilicus and the symphysis pubis. At the end of the third stage of labor, the uterus is in the midline, approximately 2 cm below the level of the umbilicus with the fundus resting on the sacral promontory. The uterus is about the same size as it was at 20 weeks' gestation at 24 hours post-birth, not 12 hours after birth.

Maternal physiologic changes in the puerperium enable the woman to cope with the blood loss that normally occurs during birth by increasing her circulating blood volume. What are the maternal physiologic changes? Mobilization of extravascular water stored during pregnancy. Loss of placental endocrine function, which removes the stimulus for vasodilation. The plasma volume is replenished as extravascular fluid returns to the intravascular space. Elimination of uteroplacental circulation, which reduces the size of the maternal vascular bed by 10% to 15%. The average blood loss for a vaginal birth of a single fetus ranges from 300 to 500 ml (10% of blood volume).

The maternal physiologic changes that occur include mobilization of extravascular water stored during pregnancy; loss of placental endocrine function, which removes the stimulus for vasodilation; and elimination of uteroplacental circulation, which reduces the size of the maternal vascular bed by 10% to 15%. The plasma volume being replenished as extravascular fluid returns to the intravascular space, and the average blood loss for a vaginal birth of a single fetus ranging from 300 to 500 ml (10% of blood volume) are statements about those changes, but are not the actual maternal changes that occur.