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8/2/2019 Postnatal Palpation
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Postnatal Palpation/care
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Puerperium 6 week postnatal period
Begins immediately following the deliveryof the placenta and membranes
Ends with the return of fertility.
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Aims of the Postnatal Period.
Assist and help the womans recovery to
the pre-pregnant state. Assess and identify deviations from the
norm. Educate the woman about her own self
care and the care of the infant.
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Postnatal period.
Care Shared;
Midwife: Hospital/Community
Duty of care usually 10 days canextend to28days.
Obstetrician
GP
Health visitor
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The normal puerperium Uterine involution
Uterus return to its pre-pregnant size,position and tone.
The vagina, uterine ligaments andmuscles of the pelvic floor all revert back.
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Physiology of involution Haemostasis is achieved in 3 ways:
Ischaemia.Pressure-apposition of the uterus
forming a T- shaped cavity.Clotting mechanism.
Autolysis Phagocytosis
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LIVING LIGATURES
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Postnatal Risks. Haemorrhage.
Hypovolaemic Shock. Infection.
Postnatal depression
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Lochia.Lochia Rubra. (red)
Persists for approx. 3 days.
Decidua and blood from the placental site.
Initially sterile then the flora begins tocolonize by vaginal flora.
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Lochia serosa. (Pink-brown) Contains leukocytes, mucous, vaginal
epethelial cells, necrotic decidua, non-pathological bacteria.
May be blood stained for 3-4 weeks.
Characteristic sweetish odour.
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Lochia Alba (Yellow-white). Mostly serous fluid and leukocytes.
Plus some cervical mucous andorganisms.
(Coad et al 2001)
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Fundal Palpation. Palpate the uterus through the uterine wall
reduction in size approx. 1cm per day. Measure the height of the uterus.
Assess the position, and tone of theuterus.
Position= Central
Tone = Firm and well contracted.
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MEASURING THE
SYMPHYSIO
FUNDAL HEIGHT
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Subinvolution
Slow rate of involution.Factors to enhance
involution.
Uncomplicated
labour/birth.
Breast feeding.
Early ambulation.
Causes.
LSCS
Retained products ofconception.
Prolonged labour Multiple pregnancy.
Full bladder.
Secondary infection.
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Signs and Symtoms of Sub-involution.
Prolonged lochia rubra
Offensive lochia.Delayed involution
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LactationColostrum
Present from 16 weeks High in density low in volume.
Contains more protein,minerals and fatsoluble vitamins A&K than more maturemilk.Less lactose, fats and water soluble
vitamins than mature milk
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Mature breast milk Variable within and between women
Contents change from one feed toanother, over the course of a specific feed
and as the baby grows and develops. Feed consists of foremilk and hind milk.
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Problems with breast feeding.
May result from:
Mothers attitude. Problems with the breast/nipple.
Anatomical or systemic disorders affectingthe baby.
Poor breast feeding technique.
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Post natal examination
Performed at 6 weeks
By GP or obstetrician
Includes baby medical (2nd)
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Post-natal examinationMother
General condition Cessation of lochia
Menstruation resumed/ Vaginal discharge Urinary symptoms/ Bowels
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Physical examination Urine: Protein, Glucose,
B/P. Breasts
Abdomen
Uterus
Cervix
Cervical smear
Advise for future pregnancy/contraception