WEEK 2: POST NATAL CARE Flashcards
Define the following terms:
*Puerperium (Postnatal period)
*Postnatal care
Puerperium (Postnatal period) : the time from the delivery of the placenta till 6 weeks post-partum.
Postnatal care = care given to a woman after the birth of her child
State the 5 Objectives of Postnatal care.
*Prevent, detect and manage complications
*Support to mother and family in transition
*Promote and maintain wellbeing of mother and infant (education on danger signs, nutrition, rest, sleep, hygiene and supplements)
*Newborn care/rooming in and breastfeeding support
*Contraception and resumption of sexual activity
Discuss the physiology of the woman in post-partum.
- Involution of the uterus
-By 2wks it’s no longer palpable
-6/8wks to its non-pregnant state(1kg-60gm) - Decidua shedding after delivery results in a physiological vaginal discharge (lochia)
- Urinary pregnancy test will become negative in 2 to 4 weeks.
- Ovulation early as 25days
- Breastfeeding. Amenorrhea(prolactin)
- Striae fade
- Breast engorgement-tight cloth, avoid Stimulation/ice/analgesia
Describe the 3 types of lochia.
Lochia rubra: is the first discharge 1 to 4 days after birth, red in color.
Lochia serosa: occurs till the 10th day, brownish or pink in color,
Lochia alba: May last from 2nd week to 6th week. whitish or yellowish white in color.
When do most women will have return of their menses by?
Most will have return of their menses by 6wks
State the 2 features of good post-partum care.
Care by skilled provider
Integration of postpartum and newborn care
State the WHO on time of discharge.
*Timing of discharge: Uncomplicated vaginal delivery, discharge after 24hours.
*For uncomplicated Caesarean delivery, no recommendation. In practice 48-72hrs post-delivery.
Monitoring is done post-partum in order to manage complications which may arise e.g. PPH, puerperal sepsis.
State the 4 Number and timing of postnatal contacts.
- On day 3 (48–72 hours)
- Between days 7–14 after birth
- Six weeks after birth.
- Domiciliary visits in Botswana
More frequent visits if there are complications such as hypertension.
State the immediate postnatal care given to mother.
Vitals – Bp,Temp, pulse, resp
Palpate uterus – contracted
P.v bleeding
Early ambulation /diet/supplements
Adeq. pain management
Rhogam if Rh –ve/vaccines
Antibiotics in case of a repaired 4th degree perineal tear
D/C 24 HOURS-SVD
State the immediate postnatal care given to baby.
*Initiate b/feeding in 1st hr. Benefits of breastfeeding positioning
*Keep baby warm
*Tetracycline eye ointment
*Vit K
*Vaccines
State the 4 complications that may arise in post partum period.
- PPH:
sudden and profuse blood loss or persistent
increased blood loss, faintness, dizziness, palpitations/tachycardia.
- Pre-eclampsia/eclampsia:
headaches accompanied by one or more of the symptoms of visual disturbances, nausea, vomiting, epigastric or hypochondrial pain, feeling faint, convulsions (in the first few days after birth).
- Puerperal sepsis:
Fever, shivering, abdominal pain and/or offensive lochia.
- Thromboembolism:
Unilateral calf pain, redness or swelling
of calves, shortness of breath or chest pain.
State the examinations done at early postnatal visits (1-2 weeks)
General health/anaemia
Fever/headache
Breasts & nipple pain
Abd pain (endometritis, wound)
Bowel/blader function
Postpartum psychosis
Vitals and examine the patient
Lochia /odor (type & duration)
Vulva/perineum/fistula
Subinvolution of uterus
State the examinations done at 6 wks postpartum visit.
General health/adjustment
Mood
Vitals and examine the patient.
Breasts & nipples (engorgement, mastitis)
Abd. (wound/scar)
Outline Routine procedures 6weeks PNC.
Support and reassurance.
*Family planning
*Counselling
*Provision of a method
Available LARCS; DMPA, Implant (Implanon, jadelle), Copper IUCD.
Combined oral contraception.
Progesterone only pill
NB: WHO medical eligibility criteria (MEC), to see if method is suitable for a particular patient.
*Pap smear
*Routine medications
