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Postnatal

The document summarizes guidelines for conducting a postnatal assessment of a mother. It describes assessing the mother's physical health, including vaginal bleeding, uterine contraction, vital signs, and urinary output in the first 24 hours. It also involves assessing emotional well-being, perineal healing, breast health, and lochia at subsequent visits. The assessment examines the mother's history, breasts, abdomen, uterine fundus, lochia, perineum, and checks for signs of deep vein thrombosis. The goal is to identify any physical or mental health issues after childbirth.

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Madhu Bala
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© © All Rights Reserved
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Download as DOCX, PDF, TXT or read online on Scribd
480 views

Postnatal

The document summarizes guidelines for conducting a postnatal assessment of a mother. It describes assessing the mother's physical health, including vaginal bleeding, uterine contraction, vital signs, and urinary output in the first 24 hours. It also involves assessing emotional well-being, perineal healing, breast health, and lochia at subsequent visits. The assessment examines the mother's history, breasts, abdomen, uterine fundus, lochia, perineum, and checks for signs of deep vein thrombosis. The goal is to identify any physical or mental health issues after childbirth.

Uploaded by

Madhu Bala
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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POSTNATAL ASSESSMENT

Postpartum Period :

It is the period beginning immediately after the birth of a child and extending for
about six weeks. The World Health Organization (WHO) describes the postnatal
period as the most critical and yet the most neglected phase in the lives of
mothers and babies; most deaths occur during the postnatal period It is the
time after birth, a time in which the mother's body, including hormone levels and
uterus size, returns to a non pregnant state.

Physical Assessment :

 Physical Assessment is necessary to identify individual needs or potential


problems • Explain to pt purposes of the examination.
 obtain her consent.
 Record your findings and report results to the mother.
 Avoid exposure to body fluids.
 Teach pt as you assess

Assessment of the mother First 24 hours after birth

 All postpartum women should have regular assessment of vaginal


bleeding, uterine contraction, fundal height, temperature and heart rate
(pulse) routinely during the first 24 hours starting from the first hour after
birth.
 Blood pressure should be measured shortly after birth. If normal, the
second blood pressure measurement should be taken within six hours.
 Urine void should be documented within six hours

Beyond 24 hours after birth :

 At each subsequent postnatal contact, enquiries should continue to be


made about general well-being and assessments made regarding the
following: micturition and urinary incontinence, bowel function, healing of
any perineal wound, headache, fatigue, back pain, perineal pain and
perineal hygiene, breast pain, uterine tenderness and lochia.
 Breastfeeding progress should be assessed at each postnatal contact
 At each postnatal contact, women should be asked about their: –
emotional wellbeing, – what family and social support they have – and their
usual coping strategies for dealing with day-to-day matters.
 All women and their families/partners should be encouraged to tell their
health care professionals about any changes – in mood, – emotional state –
and behaviour that are outside of the woman’s normal pattern
 At 10–14 days after birth, all women should be asked about resolution of
mild, transitory postpartum depression (“maternal blues”).
 If symptoms have not resolved, the woman’s psychological well-being
should continue to be assessed for postnatal depression, and if symptoms
persist, evaluated.
 Women should be observed for any risks, signs and symptoms of domestic
abuse.
 Women should be told whom to contact for advice and management.
 All women should be asked about resumption of sexual intercourse and
possible dyspareunia as part of an assessment of overall well-being two to
six weeks after birth.
 If there are any issues of concern at any postnatal contact, the woman
should be managed and/or referred

Maternal history:

 Ask the mother , since she delivered, she is now ambulatory / not yet
ambulatory
 has passed her bowels / has not yet passed her bowels
 has no flatus / is experiencing some flatus
 has voided her bladder (when) / has not yet voided her bladder
 Abnormal Findings Bowel: Constipation, diarrhea, epigastric pain,
hemorrhoids Bladder: urinary retention, urgency, dysuria, incontinence

Postpartum assessment :

B: Breasts

U: Uterine fundus

B: Bladder function

B: Bowel function

L: Lochia

E: Episiotomy (Perineum)

H: Homan's sign (legs)

E: emotions

Assessment of Breasts :

 inspect for redness & engorgement.


 Palpate breasts to determine if they are soft or filling, warm, engorged or
tender.
 Teach to promote milk production & let down, and methods to prevent and
treat engorgement. Ensure proper bra fit
 Nipples should be soft, pliable, intact & everted
 Abnormal Findings (Breasts) • Redness, heat, pain, cracked, and fissured
nipples, inverted nipples, palpable mass, painful, bleeding, bruised,
blistered, cracked nipples

Abdomen :

On inspection of the abdomen: Check for presence of visible scars abdomen can:
• be distended : below / above the umbilicus. • move / does not move with
respiration

palpation of the abdomen:

 Ensure privacy and environment where the mother can lie on her back with
her head supported.
 Ensure bladder is empty & lay patient supine with legs flexed.
 The midwives hands should be clean and warm and help the woman
expose the abdomen.
 The midwife places the lower edge of her/his hand at the umbilical area
and gently palpates inwards towards the spine until the uterus fundus is
located.

Assessment of the uterine fundus. It should be firm, if not, massage prior


palpation & assess for any blood discharged during massage. Assess its location
and the degree of uterine contraction, any tenderness or pain should be noted •
Normal findings: normal size and shape, mobile, regular, firm, in the midline,
below the umbilicus & non tender

Uterine fundus :

 Abnormal findings: immobile, irregular, soft, tender, deviated away from the
midline or above the umbilicus after 24hrs
 Fundal height is measured in cm above or below the umbilicus
 Note: fundus is 2 cm below the level of the umbilicus immediately after
birth; fundus descends approximately 1 cm per day; by the 10th day the
fundus should no longer be palpated
 If fundus is deviated or elevated above level of umbilicus always rule out
DISTENDED BLADDER

Postpartum vaginal loss


 Lochia: is the vaginal loss following birth.
 As involution progresses, the vaginal loss reflects this, and it changes from
fresh blood loss to one that contains stale blood products (lanugo, vernix,
and debris from the unwanted products of conception)
 Lochia rubra: dark red (red) discharge; occurs the first 3 days.
 Lochia serosa: pink, serosangineous discharge; lasts 3-10 days
 Lochia alba : creamy or yellowish discharge (white); occurs after the Tenth
day and may last a weeks or two.
 When lochia subsides, uterus is considered closed; postpartal infection is
less likely.

Lochia:

 On examination, Note the: – amount, colour, consistency, odour & presence


of clots Note the amount is assessed in relation to TIME (scant, light,
moderate, heavy). It should be odourless, with no clots & gets less each
day.
 Also assess woman’s pad changing practices & her type of pad.
 Teach proper wiping & progression of lochia .
 Abnormal Findings (Lochia) – Heavy, foul odour, bright red bleeding, clots,
amount more than a period

Assessment of vaginal blood loss :

 Questions to ask: Is the blood loss more or less? Color and the amount of
blood loss(Lighter/ dark) Any concerns about the blood loss?
 Ask if she has passed any clots and when it occurred. (Clots are
associated with prolonged bleeding postpartum)
 Ask the mother to describe the size of vaginal loss in a sanitary pad,
frequency of changing the pad because of saturation level, comparison of
clots to familiar items e.g. : 50 rs coin, or a plum

URINARY TRACT :

 Risk for urinary tract infection is increased, if client was catheterized


during labor and delivery.
 May have bruising and swelling caused by trauma around the urinary
meatus.
 Increased bladder capacity, along with decreased sensitivity to pressure
leads to urinary retention.
 Diuresis occurs during the first 2 days after delivery. 5. Bladder distention
may displace the uterus, leading to a boggy uterus and increase risk for
atony.

Assessment of Episiotomy (Perineum) :


 Inspect with patient in Sims position.
 Lift buttock to expose perineum & anus .
 If present, assess episiotomy or laceration for REEDA. – Should have
minimal tenderness with gentle palpation, – No hardened areas or
hematomas.
 Assess knowledge, practice, & effectiveness of self peri- care.
 Educate about suture absorption .
 Advice on what might help perinial pain: use of salts, or savlon in bath
water to reduce pain and improve healing.
 Abnormal Findings (Perineum) – Pronounced edema, wound edges not
intact, signs of infection, marked discomfort

Assessment of perinial pain :

 Women feel brused around the vagina regardless the trauma in the first
few days after birth.
 In cases of actual perenial injury, a woman will experience pain for several
days until healing takes place
 Long term psychological and physiological trauma is also evident
 The midwife observes perinial area to ascertain progress of healing from
any trauma.
 Appropriate care immediately after birth or where suturing has taken
place can help reducing edema or bruising.
 Very important Qn: the midwife ask the mother whether she has any
discomfort in the perinial area regardless of any record of actual pernial
trauma.
 Clear information and reassurance are helpful where women have a poor
understanding of what happened and are anxious or embarrassed about
urinary, bowel or sexual functioning in the future
 If there is no pain in the perinial area, the midwife should not examine.
 For majority of the women, the perinial wound gradually becomes less
painful and should occur 7 to 10 days after birth

Homan’s sign test (to detect early DVT) • Assess for signs of DVTs, i.e.
asymmetric: size, color, or temperature. • Asses for signs of superficial
thrombophebitis (redness, warmth, tenderness, pain in that limb, darkening of
skin over or hardening of vein)

Vital signs and general health • Pulse rate, respiratory rate, body temperature,
any outward odour, skin condition and the woman’s overall color and complexion
as you listen to what the mother is saying. • If no history of hypertension, BP
should return to normal within 24 hours. chest • chest should be: clear, with good
air entry bilaterally, and no added breath sounds • Note the respiratory rate.

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