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