Maternity Nursing Q 49
In a gravido-cardiac mother, the first 2 hours postpartum (4th stage of labor and delivery) particularly in a cesarean section is a critical period because at this stage
A. There is a fluid shift from the placental circulation to the maternal circulation which can overload the compromised heart.
B. The maternal heart is already weak and the mother can die.
C. The delivery process is strenuous to the mother.
D. The mother is tired and weak which can distress the heart.
Correct Answer: A. There is a fluid shift from the placental circulation to the maternal circulation which can overload the compromised heart.
During the pregnancy, there is an increase in maternal blood volume to accommodate the need of the fetus. When the baby and placenta have been delivered, there is a fluid shift back to the maternal circulation as part of physiologic adaptation during the postpartum period. In a cesarean section, the fluid shift occurs faster because the placenta is taken out right after the baby is delivered giving it less time for the fluid shift to gradually occur.
Option B: Heart rate increases in a linear fashion during pregnancy by 10 to 20 bpm over baseline and returns to pre-pregnant levels in 6 weeks postpartum. There is ventricular remodeling during pregnancy and left ventricular wall thickness and mass increase by 28% to 52% above pre-pregnancy values. Cardiac contractility and ventricular ejection fraction don’t undergo any significant change during the entire peripartum period.
Option C: There is generalized physical fatigue immediately after delivery. The pulse rate may be elevated a few hours after the childbirth, due to excitement or pain, and usually normalizes on the second day. The blood pressure could be elevated due to pain or excitement but is generally in the normal range
Option D: Cardiac output increases throughout pregnancy. However, in the immediate postpartum period, following delivery, there is an increase in circulating blood volume from the contraction of the uterus and an increase in preload from the relief of inferior vena cava obstruction, leading to an increase in stroke volume and heart rate leading to a 60 to 80% rise in cardiac output, which rapidly declines to pre-labor values in 1 to 2 hours following delivery and to pre-pregnancy values in two weeks postpartum.