Postnatal Care. This change in a most women's bodies is due to the laxity of the abdominal muscle wall. Therefore, the patient must be reassured that it will improve over time. These adjustments range from mild to marked. Analgesia, e.g. NURS 2000: Parent Child. Repeat the measurement of the pulse rate and blood pressure every 15 minutes for the 1. The patient should be shown how to observe: She should rub up the uterus and call you immediately. If the patient and her infant are both well, they are referred to their local mother-and-child health clinic for further follow-up. Looks like you’ve clipped this slide to already. If there is subinvolution of the uterus, an evacuation under general anaesthetic must be done. Also explain that her feelings are normal and are experienced by most mothers. The presence of pyrexia and punch tenderness in the renal angles indicate an upper renal tract infection and a diagnosis of acute pyelonephritis must be made. POSTNATAL CARE Care of the mother (and the newborn) after delivery is known as postnatal or post-partal care(Up to 6 Weeks) Broadly this care falls into two areas: care of the mother which is primarily the responsibility of the obstetrician; and care of the newborn, which is the combined responsibility of the obstetrician and paediatrician. Proper repair of vaginal and perineal lacerations. The importance of attending a healthy baby clinic at 6 weeks must be emphasised. Many of these deaths occurred in babies born too early and too small, babies with infections, or babies asphyxiated around the time of delivery. The patient has been referred to a mother-and-child health clinic for further care. The episiotomy wound or perineal or vaginal tears may be infected. A patient should only be discharged home after delivery if no abnormalities are found when the following examinations are performed: Rigors may occur. Routine postnatal care 2013–15 Care in first week Mother’s wellbeing Baby’s wellbeing and feeding See also POSTNATAL PERIOD – At every postnatal contact section at beginning of guideline Midwife will: Ensure Rh–D negative woman is offered Anti D immunoglobulin within 72 … by tepid sponging. The patient is then examined. The patient feels miserable and cries easily. Since postnatal care is mostly a counseling session, the key points should be kept in mind only for the period after giving birth. The postnatal visit is usually held 6 weeks after delivery. Throughout the UK, all newborn babies are screened using something called the blood spot test (it used to be known as the Guthrie test or Heel Prick test). Give the patient analgesia, e.g. No. They help you regain the strength of your abdominal muscles and help prevent lower back injury and other complications like abdominal organs from "drooping forward" due to lack of support. Intravenous cefuroxime (Zinacef) 750 mg 8-hourly. The main objectives here are: Prevent postpartum complications; Restore the mother to optimal health; Ensure problem-free breastfeeding The checklist will again be used during the day 3 to 6 visit to check that all the important tasks have been completed (i.e. Dysuria and difficulty in passing urine may lead to complete urinary retention, or retention with overflow incontinence. A postnatal examination was completed for the mother and infant. Topics which should be emphasised in patient education in the puerperium include: Patient education is an important and often neglected part of postnatal care. This remarkable decrease in size is the result of contraction and retraction of the uterine muscle. CARE…. A build-up of amino acids can lead to severe mental handicap. A blood transfusion must be given if the haemoglobin concentration is below 8 g/dl. A diuresis usually occurs on the second or third day of the puerperium. Only those changes which are important in the management of the normal puerperium will be described here: Marked changes occur during the puerperium with the production of milk. A patient who has had a normal pregnancy and delivery may be allowed to go home about 6 hours after the birth of her infant, provided: A patient should only be discharged home after delivery if no abnormalities are found when the following examinations are performed: It is important to arrange for suitable contraception before the patient is discharged home. Genital tract infection with or without retention of a piece of placenta or part of the membranes. Separation of an infected slough in a cervical or vaginal laceration. The blood pressure may also vary and may be slightly elevated in an otherwise healthy patient. You will be able to hear the patient, if she calls you. The management of the rest of the puerperium. Measure the haemoglobin concentration if the patient appears pale. Because it may be caused by serious complications of the puerperium. It should, however, be less than 140/90 mm Hg. Vagina: Immediately after delivery the vagina is large, smooth walled, oedematous and congested. Although the patient may be very distressed, all that is required is an explanation, reassurance, and a caring, sympathetic attitude and emotional support. In oedematous patients it may start immediately after delivery. She has a temperature of 39 °C, a pulse rate of 110 beats per minute and complains of a headache and lower abdominal pain. Admit patients with upper urinary tract infections to hospital. 3. A mother newly diagnosed with HIV and those that defaulted treatment and are known to have had a viral load lower than detectable should be commenced on TLD. Thrombophlebitis (superficial vein thrombosis). Antenatal care - ANTENATAL CARE Piyawadee Wuttikonsammakit,M.D. The puerperium starts when the placenta is delivered and lasts for 6 weeks (42 days). The Standards for maternal and neonatal care are part of the WHO Integrated Management of Pregnancy and Childbirth Care (IMPAC) Package, which provides guidance for countries to improve the health and survival of women and their newborn babies during pregnancy, childbirth and the postnatal period. The height of the uterine fundus in relation to the umbilicus. Constipation is common in the presence of an episiotomy or painful haemorrhoids. Her infant takes the breast well and sleeps well after each feed. This guideline covers the routine postnatal care women and their babies should receive for 6–8 weeks after the birth. Broad spectrum antibiotics, e.g. Ask the patient what she thinks is wrong with her. However, some organs may only return to their pre-pregnant state weeks or even months after the 6 weeks have elapsed (e.g. There is, nevertheless, a feeling of great relief and happiness. A patient is seen at a clinic on day 5 following a normal pregnancy, labour and delivery. The muscles that are exercised are those used to suddenly stop a stream of urine midway through micturition. Determine the height of the uterine fundus and assess whether any uterine tenderness is present. It is a condition that affects around 30 percent of moms after delivery, and will mostly occur due to changes in hormone levels and fatigue in the body. Very marked changes occur in the genital tract during the puerperium. Allowed to rest for as long as she needs to. It should again be remembered to ask her whether she has any questions she would like to ask. See our User Agreement and Privacy Policy. The Essential Postnatal Obstetric Care (EPOC) card with the mother and infant’s discharge information could now be completed. The important role of breastfeeding in lowering infant mortality in poor communities must be remembered. Infants of all HIV positive women should receive a dose of nevirapine at birth and then daily until 6 weeks of age. Antibiotics should not be given to a patient with puerperal pyrexia until she has been fully investigated. However, these are not reliable symptoms of upper urinary tract infection. By this time almost all the organ changes which occurred during pregnancy should have disappeared. A general examination, paying particular attention to the: An abdominal examination, paying particular attention to the state of contraction and tenderness of the uterus. A postnatal card needs to be completed for the mother on discharge as this is the only means of communication between the delivery site and the clinic where she will receive postnatal care. Women who are on ARV treatment should continue their TLD or FDC for life. These patients will have to be kept in hospital longer before discharge. Role of Physiotherapy in Antenatal and Post-natal care Dr. Venus Pagare (PT) MPT, KMC Mangalore SEHA Emirates Hospital Abu Dhabi, UAE Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. All maternity care providers should encourage breast-feeding. After delivery the uterus is about the size of a 20-week pregnancy. Assess whether the amount of vaginal bleeding is more than normal. The patient has any questions about herself, her infant, or her family. After the placenta has been delivered the patient needs to be: These two important steps may help prevent a postpartum haemorrhage. Reassure the patient if she has not passed a stool by day five. Ask about mood changes and problems with breathing and coughing. If an HIV positive woman is breastfeeding and not on ARV treatment, the daily nevirapine to the infant should be continued until a week after the last breastfeed. An abdominal examination is followed by a speculum examination to check whether the episiotomy, vulval or vaginal tears have healed. Following a prolonged first stage of labour due to an occipito-posterior position, a patient has a spontaneous vertex delivery. Breastfeeding has been satisfactorily established. Teach the patient the concept of ‘the mother as a monitor’. This quality standard forms part of a suite of maternity quality standards, of which antenatal care, intrapartum care and postnatal care will form the core pathway. This is a concept where the patient is made aware of the many ways in which she can monitor her own, as well as her fetus’ or infant’s wellbeing, during pregnancy, in labour, and in the puerperium. Postnatal depression is much commoner than is generally realised. 3. Advice about postnatal self-care, along with information about postnatal depression and "baby blues". The patient may become very ill or even die. It rapidly shrinks in size and rugae return by the third week. Therefore, patients who cannot be discharged safely at 6 hours will have to be transferred to a hospital. Often stress incontinence is worse initially but tends to improve with time and with pelvic floor exercises. This diagnosis is suggested by the general signs of infection and the uterine tenderness and offensive lochia. Assess whether vaginal bleeding appears more than normal. The patient complains of rigors (shivering) and lower abdominal pain and/or pain in the lower back over one or both the kidneys (the loins). Attention must be given to any specific reason why the patient is being followed up, e.g. Most maternal and infant deaths occur in the first month after birth: almost half of postnatal maternal deaths occur EUR/02/5035043 30062 ORIGINAL: ENGLISH UNEDITED E79235 ABSTRACT Much has changed in antenatal, perinatal and postpartum care in recent decades, and many of the changes have arisen from a questioning – and in Dysuria and frequency. The infant must accompany the patient to hospital. Family size and when she plans to have her next infant. Other organs never regain their pre-pregnant state (e.g. A cytology smear of the cervix should be taken if the patient is 30 years or older and has not previously had a normal cervical smear. You are the only staff member in the clinic. The average duration of red lochia is 24 days. Stress incontinence is common during the puerperium. At the first postnatal contact, women should be advised of the signs and symptoms of haemorrhage, infection, thromboembolism and pre-eclampsia/eclampsia and the appropriate action to take. Postnatal Care. They also help you regain a flat stomach. It The abdominal wall is flaccid (loose and wrinkled) and some separation (divarication) of the abdominal muscles occurs. Culture and sensitivity tests of the urine must be done if the facilities are available. Postnatal care session is a counseling and examination session which is needed for the new mother and infant, right after birth. Postnatal care should be a continuation of the care the woman has received through her pregnancy, labour and birth and take into account the woman’s individual needs and preferences. Women that defaulted treatment whose viral load was not suppressed or with an unknown viral load must be commenced on AZT, 3TC and TLD. During the first hour after the delivery of the placenta, provided that the above observations are normal, you should: Continuously assess whether the uterus is well contracted and that no excessive vaginal bleeding is present. Breakdown (dehiscence) of a Caesarean section wound of the uterus. Many patients are constipated as a result of decreased tone of the bowel during pregnancy, decreased food intake during labour and passing stool when nearly fully dilated or during the second stage of labour. You are called away and will have to leave the patient alone for a while. However, pelvic floor exercises must be explained to her as they will hasten improvement of her incontinence. During this period, the mother goes through a number of physical and emotional changes and thus requires rest, nutrition, and vaginal care. It includes advice given on breastfeeding, and the management of common and serious health problems in women and their babies after the birth. The management of the puerperium may be divided into three stages: The two main objectives of managing the first hour of the puerperium are: The correct management of the first 2 hours of the puerperium is most important as the risk of postpartum haemorrhage is greatest at this time. The patient should decide, with the guidance of a midwife or doctor, on an appropriate contraceptive method. A patient and her infant should only be discharged if they are both well and have been referred to the local mother-and-child health clinic, and the patient has received contraceptive counselling. This is the commonest cause. The platelet count is raised and the platelets become stickier from the fourth to tenth day after delivery. Careful examination after delivery to determine whether the placenta and membranes are complete. A patient with pre-eclampsia should be kept in hospital until her blood pressure has returned to normal or is well controlled with oral drugs. Puerperal pyrexia is a clinical sign and not a diagnosis. POSTNATAL CARE 93. This should preferably start before pregnancy and continue throughout the antenatal period and after pregnancy. The patient appears healthy with normal observations, and the involution of her uterus is satisfactory. The patient should not have been discharged home so early as she had a prolonged first stage of labour which places her at a higher risk of infection. Also ask about and discuss any other uncertainties which the patient may have. Offensive lochia is always abnormal. She has a temperature of 38.5 °C, tenderness over both kidneys (loins) and tenderness to percussion over both renal angles. She need not be worried about not having passed a stool as this is normal during the first few days of the puerperium. See our Privacy Policy and User Agreement for details. Personal hygiene, Clothing, Rest and ambulance, Diet, Care of bowel, Care of breast, Perineal care, Environmental hygiene, New born care; Family planning. Clipping is a handy way to collect important slides you want to go back to later. arrangements for the management of patients who remain hypertensive after delivery. Most term infants will need 1.5 ml NVP from birth to six weeks. A postnatal card needs to be completed for the mother on discharge as this is the only means of communication between the delivery site and the clinic where she will receive postnatal care. Post natal exercises can help your abdomen return to its original size. Unless the cause of the secondary postpartum haemorrhage is treated, the vaginal bleeding will continue. Offensive lochia must be reported immediately. It is important to remember that your body has simply changed, and not necessarily for the worse. No. The observations done on the mother and infant since delivery have been normal. Examine the calves for tenderness and swelling (evidence of deep vein thrombosis). acute appendicitis. It is important for the midwife or doctor to assess whether the puerperal patient has returned, as closely as possible, to normal health and activity. Intravenous cefuroxime (Zinacef) must be given, as this will lead to a rapid recovery and prevent serious complications. Contraception has been arranged to the patient’s satisfaction. Microscopy of a midstream or catheter specimen of urine usually shows large numbers of pus cells and bacteria. the ureters). Now customize the name of a clipboard to store your clips. The puerperium starts when the placenta is delivered and lasts for 6 weeks. The circumstances of the hospital or clinic where the patient was delivered. The full set of quality standards, including all the maternity quality standards, that should be considered when commissioning and providing high quality maternity services are listed in related NICE quality standards . The postpartum (or postnatal) period begins immediately after childbirth as the mother's body, including hormone levels and uterus size, returns to a non-pregnant state. Cystic fibro… By providing patient education and motivation. No public clipboards found for this slide. A patient returns to a clinic for a visit three days after a normal first pregnancy and delivery. CARE Retention of urine is common and may result from decreased tone of the bladder in pregnancy and oedema of the urethra following delivery. Of the 2.9 million newborn deaths that occurred in 2012, close to half of them occurred within the first 24 hours after birth. She should be told that if the uterine fundus rises or the uterus relaxes or if vaginal bleeding increases, she must: Whether the patient had a normal pregnancy and delivery. The EPOC card (Figure 12-1) for the day 7 visit could now be completed. Introduction pdf, 154kb The successful establishment of breastfeeding is one of the most important goals of patient care during the puerperium. There is no excessive postpartum blood loss and the patient is discharged home after 6 hours. Listen sympathetically to the patient’s complaints and reassure her that she is managing well as a mother. Take the chapter quiz before and after you read this chapter. Catheterisation is often required and this increases the risk of a urinary tract infection. Screening and treating asymptomatic bacteriuria at the antenatal clinic will reduce acute pyelonephritis during the puerperium. Also making available all appropriate choices to fulfill optimal potential, and providing all necessary support and preparation for a high-quality life after birth. The haemoglobin concentration must be measured. It most commonly tests for the following conditions: 1. The patient is able to attend her nearest clinic on day 3 to 6 after delivery (day 1) for postnatal care, or be visited at home by a midwife. Even though the patient may be more than seven days postpartum, the cervical os will have remained open (a finger can be passed through the cervix). The barcode of the laboratory request will be attached to the Road to Health booklet. She starts to cry and says that she should not have fallen pregnant. There is an immediate drop in weight of about 8 kg after delivery. The vaginal walls remain laxer than before and some degree of vaginal prolapse (cystocoele and/or rectocoele) is common after a vaginal delivery.