This document outlines the procedures for monitoring a patient's postpartum recovery, including performing regular checks to monitor vital signs, breast and uterine exams, urinary output, bowel activity, lochia, and extremities for signs of thrombophlebitis according to the specified schedule. The objectives are to ensure the patient's physical recovery is progressing normally by inspecting for issues like breast engorgement, uterine position and firmness, bladder distention, bowel regularity, and abnormal bleeding or swelling.
A prolonged second stage of labor is known to be associated with increased risk of certain maternal complications, such as infection, urinary retention, hematoma, and ruptured sutures in the early postpartum period.
A prolonged second stage of labor is known to be associated with increased risk of certain maternal complications, such as infection, urinary retention, hematoma, and ruptured sutures in the early postpartum period.
Amniotic sac. A thin-walled sac that surrounds the fetus during pregnancy. The sac is filled with liquid made by the fetus (amniotic fluid) and the membrane that covers the fetal side of the placenta (amnion). This protects the fetus from injury.
The ability of the fetus to successfully negotiate the pelvis during labor involves changes in the position of its head during its passage in labor. The mechanisms of labor, also known as the cardinal movements, are described in relation to a vertex presentation, as is the case in 95% of all pregnancies.
complcations of third stage of labour, includes PPH, Inversion of uterus, retained placenta, placenta accreta, increta, percreta, amniotic fluid embolism
Management of cases with Vaginal Breech Delivery.
Dr Manavita Mahajan is a renowned Gynaecologist and is a Sr. Consultant at FRMI, Gurgaon. You can contact her at www.drmanavitamahajan.in
Newborn Birth Injuries: The Untold Story
Introduction:
As a result of the birth process some injuries occur that may be minor, whereas other may be more serious. Despite skilled midwifery and obstetric care in developed, birth trauma still occurs.
Definition:
An impairment of the infants body function or structure due to adverse influences that occur at birth.
Risk factors:
Primi parity,
Small maternal stature
Prolonged or usually rapid labor
Malpresentation of the fetus
Use of mid forceps or vaccum extraction
Fetal macrosomia or large fetal head
Classification:
Based on areas involved:
1. trauma to skin and superficial tissues
2. muscle trauma
3. nerve trauma
4. fractures
PREVENTION OF BIRTH INJURIES
- To prevent or to detect early intrauterine fetal asphyxia.
- To avoid premature delivery.
- To avoid traumatic vaginal delivery.
- To extend the use of caesarean section in abnormal & complicated presentation more liberally.
- Improve the level of doctor and nurses
THANK YOU.
Amniotic sac. A thin-walled sac that surrounds the fetus during pregnancy. The sac is filled with liquid made by the fetus (amniotic fluid) and the membrane that covers the fetal side of the placenta (amnion). This protects the fetus from injury.
The ability of the fetus to successfully negotiate the pelvis during labor involves changes in the position of its head during its passage in labor. The mechanisms of labor, also known as the cardinal movements, are described in relation to a vertex presentation, as is the case in 95% of all pregnancies.
complcations of third stage of labour, includes PPH, Inversion of uterus, retained placenta, placenta accreta, increta, percreta, amniotic fluid embolism
Management of cases with Vaginal Breech Delivery.
Dr Manavita Mahajan is a renowned Gynaecologist and is a Sr. Consultant at FRMI, Gurgaon. You can contact her at www.drmanavitamahajan.in
Newborn Birth Injuries: The Untold Story
Introduction:
As a result of the birth process some injuries occur that may be minor, whereas other may be more serious. Despite skilled midwifery and obstetric care in developed, birth trauma still occurs.
Definition:
An impairment of the infants body function or structure due to adverse influences that occur at birth.
Risk factors:
Primi parity,
Small maternal stature
Prolonged or usually rapid labor
Malpresentation of the fetus
Use of mid forceps or vaccum extraction
Fetal macrosomia or large fetal head
Classification:
Based on areas involved:
1. trauma to skin and superficial tissues
2. muscle trauma
3. nerve trauma
4. fractures
PREVENTION OF BIRTH INJURIES
- To prevent or to detect early intrauterine fetal asphyxia.
- To avoid premature delivery.
- To avoid traumatic vaginal delivery.
- To extend the use of caesarean section in abnormal & complicated presentation more liberally.
- Improve the level of doctor and nurses
THANK YOU.
In general, the standard physical exam typically includes: Vital signs: blood pressure, breathing rate, pulse rate, temperature, height, and weight. Vision acuity: testing the sharpness or clarity of vision from a distance. Head, eyes, ears, nose and throat exam: inspection, palpation, and testing, as appropriate.
2. At the completion of this presentation, you will be able to: Perform postpartum checks according to protocol Monitor vital signs and blood pressure Inspect and palpate the breasts Palpate the fundus and bladder Monitor urinary output Monitor bowel activity Monitor lochia Inspect the perineum Monitor extremities for thrombophlebitis Objectives
3. You will need: Hand-washing station. Gloves. Oral glass, electronic or tympanic thermometer. Stethoscope. Doppler ultrasound stethoscope or probe.
4. Conductive jelly. Watch with sweep second hand. Sphygmomanometer with assorted cuffs; or continuous non-invasive blood pressure monitoring device. Maternity pads.
5. Postpartum Check Frequency of postpartum checks according to protocol: First hour: every 15 minutes Second hour: every 30 minutes First 24 hours: every four hours After 24 hours: every 8 hours
6. Vital Signs and Blood Pressure Wash hands and explain the procedure to the patient To make sure the client is as comfortable as possible, make sure the patient has voided. Take vital signs and make sure they are within normal limits when compared to the baseline. Take vital signs before hands-on procedures; the discomfort of palpating the fundus could reflect in an elevated blood pressure or pulse.
7. Inspect and Palpate the Breasts Raise the head of the bed Ask the patient lower her gown so that her breasts can be examined Visually inspect and palpate each breast noting: Soft, filling or firm Engorged, reddened, or painful Nipples: erectility, possible cracks and redness
8. Palpate the Fundus The fundus should be palpated until the 10th day postpartum. Since patients are usually discharged sooner, patients should be instructed in self-examination so that she can be alert to sudden changes in the uterus. Lower the head of the bed so that the abdomen will be relaxed. Position the ring finger directly over the umbilicus so that the small finger is the closest to the client’s head.
9. Palpate the Fundus Using the ring finger as a fulcrum, roll the hand back and forth gently and note the fundus in relationship to the umbilicus. Note: Fundal consistency and tone Fundal position – in relationship to the midline. Displacement to the left or right could be caused by a distended bladder. Fundal height – measured in finger breadths from the umbilicus.
10. Palpate the Bladder During fundal palpation Bladder palpability Bladder distention could displace the uterus Impeding involution Impeding the control of bleeding.
11. Monitor Urinary Output Voiding pattern and amounts voided: Is it at least 30ml/hr? Distention: Is a distended bladder displacing the uterus? Pain: Is voiding painful, burning or itching? S/S of what?
12. Monitor Bowel Activity Bowel movements: When was her last BM? Normal, diarrhea or constipation? Hemorrhoids: Are there hemorrhoids present? Is there active bleeding Bowel sounds: auscultate all four quadrants: Especially C/S patients; why? Normo-, hyper- or hypoactive?
13. Monitor Lochia Detach the peripad from the front to the back to minimize the risk of contaminating the vagina with rectal discharge. Note: Type and amount – rubra (dark and red); serosa (serous or brown) Four to eight saturated pads per 24 hours is normal. Presence of odor – could indicate infection Presents of clots – could indicate retained placental tissue or inadequate uterine contraction.
14. Instruct the client to assume a side-lying (Sims) position. If a laceration or episiotomy repair is present, instruct the client to flex the top leg to minimize the strain on the repair. Gently separate the buttocks and inspect the perineum for: Episiotomy, lacerations and hemorrhoids Bruising, hematoma, edema, discharge, approximation Inspect the Perinuem
15. Monitor Extremities for Thrombophlebits Homan’s sign (calf pain from passive dorsiflexion of foot) Redness, tenderness or warmth
16. References Bradshaw, M. J., & Lowenstein, A. J. (2007). Innovative teaching strategies in nursing (4 ed.). Sudbury, MA: Jones and Bartlett Publishers. Mattson, S., & Smith, J. E. (Eds.). (2004). Core curriculum for maternal-newborn nursing (3 ed.). St. Louis, MO: Elsevier-Saunders. McEwen, M., & Wills, E. M. (2007). Theoretical Basis for Nursing (2 ed.). Philadelphia, Pennsylvania: Lippincott Williams & Wilkins. National League for Nursing Accrediting Commission. (2008). 2008 Edition NLNAC Accreditation Manual. New York City. NY: Author. Simpson, K. R., & Creehan, P. A. (2008). Perinatal nursing (3 ed.). Philadelphia, PA: Association of Women’s Health, Obstetric and Neonatal Nurses. Smith, S. F., Duell, D. J., & Martin, B. C. (2000). Clinical nursing skills: basic to advanced skills (5 ed.). Upper Saddle River, NJ: Prentice-Hall, Inc.. Swearingen, P. L., & Howard, C. A. (Eds.). (1996). Photo atlas of nursing procedures (3 ed.). Menlo Park, CA: Addison-Wesley Nursing. Wendt, A., Kenny, L., & Stasko, J. (Eds.). (2008). 2008 Detailed test plan for the NCLEX-PN examination-Item writer/item reviewer/nurse educator version. Chicago, IL: National Council of States Boards of Nursing.