Postpartum assessment

Question 1

What to assess in BUBBLEHE components?
Breast:
Up to _ day postnatally:
- soft
- c__ may be expressed
_ day postnatally:
- full, engorged
- Lactating breasts (filled with breast milk)

Uterus:
____ = the shrinking of the uterus to its prepregnancy height and size
- Palpate uterine fundal height & consistency
* firm (___=poorly contracted)
* daily involutes about __ finger-breadth below
umbilicus
* return to pre-pregnant size at the end of ___ (Begins immediately from the end of third stage of labour and continues for about 6 weeks or until the body has returned to a near pre-pregnant state.)
Possible causes of sub-involution:
(uterus is partially contracted only)
- retained __
- full bladder during __
- infection

Bladder
- Assess ability to __, bladder
__, urgency or ___ when voiding
- Bladder & urethra may be _ & bruising, traumatised with reduced sensitivity to fluid pressure

Bowel
- Bowel movements resume on Day 2 or 3 of post delivery

• Prone to constipation because:
• perineal discomfort
• pain & fear of diminished bowel __ during pregnancy + de__
• Presence of _ (common following normal vaginal delivery)

Lochia
-Note colour, odor (should be ), amount
1st 4 days: Lochia Rubra ()
Days 5 – 14: Lochia Serosa ()
Days 10 – 6 weeks: Lochia Alba ()
Amount estimated by:
weight (__) OR soak of pad (__)

episiostomy
* May be oedematous & bruised
* Healing progress of perineal laceration / episiotomy
* wound heals in about 2 to 3 weeks
* Assess level of perineal discomfort
* Observe for signs of complications e.g. infection, vulva haematoma

Homan sign
Assess for signs of __, __:
- Localised pain and redness
- Oedema
- Warm on palpation
- Tender

Emotion
* Preoccupied with birth events
* Short concentration span in first few days postnatal
* Labile emotions
* ‘Postnatal blue’ common on the 4th day in 80% of new mothers

Answer 1

Breast:
Up to 2nd day postnatally:
- soft
- colostrum may be expressed
3rd – 4th day postnatally:
- full, engorged
- Lactating breasts (filled with breast milk)

Uterus:
Involution = the shrinking of the uterus to its prepregnancy height and size
- Palpate uterine fundal height & consistency
* firm (not soft, boggy-poorly contracted)
* daily involutes about one finger-breadth below
umbilicus
* return to pre-pregnant size at the end of puerperium (Begins immediately from the end of third stage of labour and continues for about 6 weeks or until the body has returned to a near pre-pregnant state.)
Possible causes of sub-involution:
(uterus is partially contracted only)
- retained product of conception
- full bladder during labour
- infection

Bladder
- Assess ability to void, bladder
distention, urgency or burning
sensation when voiding
- Bladder & urethra may be edematous & bruising, traumatised with reduced sensitivity to fluid pressure

Bowel
- Bowel movements resume
on Day 2 or 3 of post delivery

• Prone to constipation because:
• perineal discomfort
• pain & fear of diminished bowel tone during pregnancy + dehydration
• Presence of haemorrhoids (common following normal vaginal delivery)

Lochia
-Note colour, odor (should be absent), amount
1st 4 days: Lochia Rubra (Red)
Days 5 – 14: Lochia Serosa (pink/brownish)
Days 10 – 6 weeks: Lochia Alba (White)
Amount estimated by:
weight (1gm=1ml) OR soak of pad (full soak ~100ml, partial ~30 ml)

episiostomy
* May be oedematous & bruised
* Healing progress of perineal laceration / episiotomy
* wound heals in about 2 to 3 weeks
* Assess level of perineal discomfort
* Observe for signs of complications e.g. infection, vulva haematoma

Homan sign
Assess for signs of thrombophlebitis, deep vein thrombosis (DVT):
- Localised pain and redness
- Oedema
- Warm on palpation
- Tender

Emotion
* Preoccupied with birth events
* Short concentration span in first few days postnatal
* Labile emotions
* ‘Postnatal blue’ common on the 4th day in 80% of new mothers