The document discusses postnatal assessment procedures for mothers and babies. It outlines the objectives, content, and steps of the assessment. Key points include: 1. Postnatal assessment examines the physical and mental health of the mother and baby's progress in the first 6 weeks after birth. It aims to detect issues, provide health education, and plan family planning. 2. The assessment involves examining the mother's physical health, vaginal bleeding, breastfeeding, perineum, and providing advice. It also involves examining the baby and noting their development. 3. Factors like socioeconomic status, access to healthcare, and health complications can influence a woman's postnatal care and outcomes for her and her baby.

1. POSTNATAL
ASSESSMENT
Prepared by:
Anju Bista
MSc Nursing 1st year(2021)

2. Objectives:
 At the end of this session participant will be able to
know about postnatal assessment.

3. Content.
 Introduction of postnatal assessment.
 Aims and objectives of postnatal assessment.
 Advantages of postnatal assessment
 Procedure of postnatal examination.

4. Postnatal period:
 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.

5. Contd…
 Mother should be provided three PNC visit.(WHO
Recommendation)
 1st PNC visit with in 24 hrs,
 2nd PNC visit on 3rd days.
 3rd PNC visit on the 7 to 14 day.
 4th visit on 6th weeks after delivery.

6. Postnatal Assessment:
 Postnatal assessment includes systematic
examination of mother and the baby and
appropriate advice given to the mother during
postnatal period.

7. Demographic health survey 2016.
 The percentage of women who received a postnatal care
(PNC) assessment within two days following delivery rose
from 45% in 2011 to 57% in 2016. 81% of women who
delivered in a health facility and 13% of women who
delivered elsewhere received PNC within two days of
delivery.
 However, there were significant socioeconomic disparities
in PNC utilization: 81% of women in the highest wealth
quintile had an early PNC visit compared to only 37%
among women in the lowest wealth quintile.(DHS,2016)

8. Aims and objectives:
 To assess the health status of the mother. Medical
disorder like diabetes, hypertension, and thyroid
disorders should be reassessed.
 To provide necessary health teaching to mother and
family.
 To detect and treat at the earliest any gynecological
condition arising out of obstetric legacy.

9. Contd…
 To note the progress of the baby including the
immunization schedule for the infant.
 To impart family planning guidance.
 To achieve healthy outcomes for both the mother
and the baby.

10. Advantages:
 It is an opportunity to detect and treat at the
earliest, any gynecological-medical disability,
either pre-existing or appearing after childbirth.
 The process of the baby can be judged and effective
therapy can be instituted for alignments if detected.
 Motivation and acceptance of family planning
methods can best be imparted during this period.

11. Procedure for postnatal assessment:
 Examination of the mother.
 Advice given to the mother.
 Examination of the baby and advices.

13. Examination of mother:
Equipment required:
 TPR tray.
 Screen.
 Bed pan.
 Tape measure.
 Equipment for urine test of protein and sugar.
 Weight machine.
 Sterile gloves.
 Kidney tray.
 Cotton balls.

14. Physical Assessment of mother
 Physical Assessment is necessary to identify
individual needs or potential problems.
 Explain to patient purposes of the examination.
 obtain her consent.
 Record your findings and report results to the
mother.
 Avoid exposure to body fluids.
 Teach patient as you assess – use every opportunity
since there is limited time.

15. 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.

16. 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.

17. Contd…
 At each postnatal contact, women should be asked
about their:
 emotional wellbeing,
 what family and social support they have
 their usual coping strategies for dealing with day-
to-day matters.

18. Contd…
 All women and their families/partners should be
encouraged to tell their health care professionals
about any changes
 in mood,
 emotional state
 behaviour that are outside of the woman’s normal
pattern.

19. Contd…
 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.

20. Contd…
 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.

21. Maternal history: restored function
 Ask the mother if 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.
 Breast problems.
 Vaginal bleeding or discharge .

22. Abnormal history Findings
 Constipation,
 diarrhea,
 epigastric pain,
 hemorrhoids
 urinary retention,
 urgency,
 dysuria,
 incontinence.
Bowel Bladder

23. Procedure for getting ready :
 Prepare the necessary equipment and brings on
bedside or right side of examiner.
 Screen the patient to maintain privacy.
 Explain the mother with polite language about
procedure.
 Ask mother to empty the bladder and bring
specimen of urine for sugar and protein test.

24. Contd…
 Wash the hands with soap and water thoroughly.
 Take weight, TPR,BP and test urine for sugar and
protein.
 Inspect the mother’s general appearance eg. Facial
expression, tiredness, happy, sad, stress as well as
any sign of pale e.g. anemic, yellowish
color(jaundice).cyanosis.

25. Contd…
 Assess the physical status of the mother in
systematic way from head to toe. During this
process, if any abnormalities is found .we should
tell her and suggest for improving them. During
examination process, interaction makes her to
confidence or encourage to tell her problem.

26. Systematic examination form head to toe
examination.

27. Physical examination:
 When you have finished taking women history,
perform a physical examination .be sure to record
all those findings.

35. 3. Assessment of Breasts:

36. Inspect.
• Inspect for size, redness, cracks, lesions &
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.

37. Contd…
 Ensure proper bra fit
 Nipples should be soft, pliable, intact & inverted .
 If mother is NOT breast feeding - DO NOT palpate
breasts or assess nipples

38. Normal
Findings
Of
Breast
One breast is slightly larger than other.
• If breastfeeding, breasts look lumpy or
irregular than usual.
• Veins larger and darker, more visible
beneath the skin.
• Regular with no dimpling, no visible
lumps, skin is smooth with no puckering,
no redness, no lesion sores or rashes.
• Tenderness and lumpiness in both breasts
during the menstrual cycle.
 Areolas larger and darker

39. Abnormal
Findings
(Breasts):
 Redness, heat, pain, cracked, and
fissured nipples, inverted nipples,
palpable mass, painful, bleeding,
bruised, blistered, cracked nipples.
 Changes in color of breast or nipple,
wrinkling, dimpling, thickening,
puckering.
 A nipple sink into breast.

40. 4. 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,

41. 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

42. 5.Assessment of the uterine
fundus:
 The mother should keep in dorsal recumbent or
supine position.
 Palpate abdomen from symphysis pubis and feel
the uterus.
 Press the abdomen just above the uterine fundus by
ulnar side of the hand.

43. Contd…
 Measure the length from symphysis pubis to the
fundus of uterus and record the fundal height in
centimeters.
 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

44. Contd…
 Normal findings: normal size( 12.5 cm )
 Should decrease by 1.25 cm daily. and shape,
mobile, regular, firm, in the midline, below the
umbilicus & non tender.

45. 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.

46. Contd…
 If fundus is deviated or elevated above level of
umbilicus always rule out DISTENDED
BLADDER.
 Once the midwife has completed the assessment,
she helps to dress and sit up.

47. 6. 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.

50. 8. Urinary tract :
1. May have bruising and swelling caused by trauma around
the urinary meatus.
2. Increased risk of urinary tract infection, if client was
catheterized during labor and delivery.
3. Check signs of UTI, including fever, urinary frequency
and/ or urgency, difficult or painful urination.
4. Infrequent or insufficient voiding (less than 200 ml)
discomfort,or foul smelling urine suggest infection and
decreased sensitivity to pressure leads to urinary
retention.
5. Bladder distention may displace the uterus, leading to a
boggy uterus and increase risk for atony.

51. Bowel examination
 Inspect the woman's abdomen for distention,
auscultation for bowel sounds in all four quadrants prior to
palpating the uterine fundus, and palpate for tenderness.
 Ask the patient about daily bowel movement or has passed
gas since giving birth. She must no become constipated.
 Explain that she should wipe from front to back after
voiding or defecating.
 Normal assessment findings are active bowel sounds,
passing gas, and a non-distended abdomen.

52. 9. 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.

54. Contd…
 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.

55. 10. Assessment of perinial pain
 Women feel bruised 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.

56. Contd…
 The midwife observes perineal 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.

57. Very important Questions
 Midwife should ask the mother whether she has
any discomfort in the perinial area regardless of
any record of actual perinial 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.

58. Maternal examination lower
extremities
 Assess for edema of leg,pain during sitting and
sleeping, any sign of sign of deep vein
thrombosis,varicose vein, thrombo-embolic sign
etc.
 The risk of developing blood
clots (thrombophlebitis) is increased for about 6 to
8 weeks after delivery.

59. Contd…
 Asses for signs of superficial thrombophebitis
(redness, warmth, tenderness, pain in that limb,
darkening of skin over or hardening of vein)
 Assess for signs of DVTs, i.e. asymmetric: size,
color, or temperature.
 DVT is the most common cause of maternal death
in the developed world.(devis& knuttinen,2017)

60. Homan’s sign to indicate DVT.
Technique:
 In performing this test the patient will need to actively
extend his knee.
 Once the knee is extended the examiner raises the
patient’s straight leg to 10 degrees, then passively and
abruptly dorsiflexes the foot and squeezes the calf with
the other hand.
 Deep calf pain and tenderness may indicate presence
of DVT.
 A positive Homan’s sign in the presence of other
clinical signs may be a quick indicator of DVT.

63. Give advice and health
teacing:
 General advice:
 If the patient is in sound health she is allowed
to do her usual duites.
 Postpartum exercise (kegal exercise) may be
continued for another 4-6 weeks.
 Infant vaccination.
 To evaluate the progress of the baby
periodically and to continue breastfeeding for 6
months.
 Family planning counseling and guidance.

64. References
 Margret Myles textbook for midwifery, 15th edition
 Datta,Dc.Text book of obstetrics.hiralal
knoar.jyapee.9th edition.2019.
 https://www.medicalnewstoday.com/articles/15370
4#diagnosis
 http://www.clinicalexam.com/pda/o_obs_pos
tnatal_history_exam.htm
 https://www.dhsprogram.com/pubs/pdf/fr336/fr336.
pdf