Hormonal System
- Pregnancy hormones produced by placenta is no longer present.
- HCG in urine is negligible in 24 hours.
- By week 1, progestin, estrone, and estradiol are at prepregnancy levels.
Urinary System
- Pressure of the fetal head during childbirth may leave the bladder with a transient loss of tone.
- Assess the woman’s bladder frequently in the immediate postpartum
- Positive excessive diuresis on immediate postpartum to excrete the excess fluids (2000mL-3000mL).
- Urine tends to contain more nitrogen than normal probably as a result of the increased muscular activity during labor.
Circulatory System
- Reduced blood volume as a result of the blood loss associated with labor and excessive diuresis apparent on 2nd to 5th postpartum day. Blood volume returns to its prepregnant value by the 3rd to 4th week.
- There is elimination of uteroplacental circulation reducing the maternal vasculature bed by 10% to 15%. The loss of placental endocrine function removes the stimulus for vasodilation and mobilization of extravascular water stored during pregnancy are also physiologic changes that protect the woman from hypovolemic shock during this period.
- Immediately after birth, pulse rate, stroke volume, and cardiac output remain elevated for 30-60 minutes as a result of the return to the general circulation of blood that was shunted through the uteroplacental circulation throughout pregnancy.
Vital Signs: There may be a small, transient rise in both systolic blood pressure and diastolic blood pressure lasting up to 4 days after delivery. Respiratory functions return to non-pregnant levels by 6 months after delivery. PMI and ECG are normalized as a result of the lesser pressure on the diaphragm by the emptied uterus.
Blood Components:
- Hct and Hgb: Increased Hct by 3rd to 7th day postpartum due to decreased plasma volume during the first 72 hours and the increased RBC mass of pregnancy.
- WBC: There are normal leukocytes averaging about 12,000/mm3 during the first 10-12 days. Neutrophils are the most numerous.
- Coagulation Factors: Clotting factors and fibrinogen normally remain elevated in the immediate postpartum. This increases the risk for thromboembolism especially when combined with vessel damage and immobility.
Varicosities: Commonly occurs during pregnancy but varices rapidly empties immediately after childbirth.