Post natal care

DEFINITION   The puerperium is that period after delivery during which the pelvic organs return to their non-pregnant state. The period of the puerperium is usually stated as SIX WEEKS (6 weeks) although some of the organs may not have returned completely to their normal non pregnant state. In most women who are not breast feeding (and even in some women who are breast feeding) ovulation is reestablished during the period of the puerperium.

PHYSIOLOGICAL CHANGES IN THE PUERPERIUM 1. General 2. Cardiovascular system 3. Haematological change 4. Urological changes 5. Genital Tract -Breasts -Uterus -Lochia 6. Lactation

Assessment of Lochia

FUNDAL PALPATION

Routine Care In The Puerperium Recording of Vital Signs/Palpation of Abdomen Temperature - Slight rise under 38ºC noted in first 24 hours after delivery Pulse Blood Pressure State of uterus Respiratory Rate 2. Breast feeding / Care of breasts

3. Analgesia -Indications/drugs -Episiotomies/Lacerations -Operative deliveries -Caesarean sections etc. 4. Mobilisation 5. Involution of the uterus/Perineal care Lochia rubra Lochia serosa Lochia alba

6. Disorders of Micturition Emptying of the bladder Retention of urine   Emptying of the bladder Retention of urine In-continence of urine 7. Bowel function 8. Diet – Normal diet 9. Sleep disturbances/Depression -Ensure adequate rest during the day and good sheep at night Insomnia inspite of adequate measures- Sinister sign Watch out for depression and early puerperal psychosis and treat early.

10. Immunisations Anti-D 300mg should be given to the Rhesus D Negative who is not isoimmunized and who has an Rhd Positive baby soon after delivery. Other immunizations depend on local variations. 11. Physiotherapy/postnatal exercise should be encouraged where facilities are available and where possible. Contribute to good tone of abdominal wall muscles and to good vaginal function. 12. Contraceptive advice -Counseling and appropriate contraception before discharge where possible.

13. Discharge from Hospital Varies from place to place. After vaginal delivery, discharge home, if all is well, should be between 48 hours and 4 days after delivery. Time of discharge after operative deliveries usually varies also. Discharge home after caesarean section should be between 6-10 days post-operative.   14. Postpartum Follow-up Check up after delivery should be about 6 weeks after delivery -the end of the puerperal period Extent of check-up varies, but there is an ideal postpartum check up. Cervical Smear (Other Tests)