post partum care & complications
TRANSCRIPT
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POSTPARTUM CARE& COMPLICATIONS
Dr. Baran Palanimuthu , MDDepartment Of Obstetrics & Gynaecology
Sultan Abdul Halim General Hospital
Sg.Petani
Kedah Darul Aman
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The postpartum period
(puerperium) is from the
end of labour until the
genital tract has returned to
normal. It usually last for
42 days.
INTRODUCTION
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The Aims of Postpartum Care:
Support mother and family
Prevention, early diagnosis and treatment of
complications
Referral
counselling
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The Aims of Postpartum Care:
Support of breastfeeding
Educate on nutrition, and supplementation
Counselling contraception and the resumption of
sexual activity
Immunization of infant
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Is to increase the awareness of warning
signal and appropriate intervention at all
level.
About 2/3 of the maternal deaths occur
during the postnatal period
RATIONALE
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NEEDS OF WOMEN AND NEWBORN
1.Information/counselling on:
Herself-Health
Self care
Sexual life
Nutrition
Contraception
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NEEDS OF NEWBORN
Information/counselling
Care of the baby
*Special Needs referto Neonatal Care
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NEEDS OF NEWBORN
Information/counselling
Breastfeeding
*Special Needs refer to Neonatal Care
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Postpartum care: What to expect after a vaginal
delivery
Vaginal soreness
- Keep the wound clean-Rinse the perineum after using the toilet.
- Sit down carefully. If sitting is uncomfortable, sit on a pillow or padded ring.
Vaginal discharge
- Lochia after delivery. Expect a bright red, heavy flow of blood for first fewdays.-Will gradually taper off- changing from pink or brown to yellow or white.
- To reduce the risk of infection, use sanitary napkins rather than tampons.
Contractions- Few days after delivery- contractions often resemble menstrual cramps , help
prevent excessive bleeding by compressing the blood vessels in the uterus.
- Carefull when a fever rise or abdomen is tender to the touch
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Hemorrhoids and bowel movements
- Foods high in fiber and drink plenty of water.
- RX: e.g Bisacodyl
- Fecal incontinence due to long labor. Frequent Kegel exercise
Sore breasts and leaking milk
- Known as engorgement- Nurse baby (Practise good lactation method)
- Apply cold washcloths or ice packs on breasts
Mood changes
- Mood swings, irritability, sadness and anxiety are common
- Share feelings, and ask your partner, loved ones or friends for help
Urination problems
- Watch out for s/sx of UTI
- Pregnancy stretch connective tissue @ base bladder cause nerve + muscle damageto bladder or urethra. Problem-Dysuria,Urgency,frequency usually improves within 3months.
- Adviced for Kegelsexcercise
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Postpartum care: What to expect after a C-
section
Treat C-section incision with care:
- It takes about four to 6 weeks for a C-section incision to heal
- Have a good posture -stand and walk & sudden movements-coughing, sneezing
/laughing.
- Complete medications-especially antibiotics
- Empty bladder frequently -reduce risk of UTI
Look for signs of infection
- The incision is red, swollen or leaking discharge
- Fever > 38 degree celcius
- Increasing pain around incision
- OTHERS = Vaginal Delivery
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Post Partum Complications
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Post Partum Haemorrhage (PPH)
Defination:
- Excessive bleeding after childbirth; traditionally defined as a loss of 500 ml
or more after a vaginal birth and 1000 ml or more after a cesarean birth
- Primary Haemorrhage:
Bleeding 24 hours but within puerperium
Causes are:
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1.Uterine Atony
- The most common cause:- Uterus fail to contract following the delivery of placenta
Predisposing conditions:- Multiparity
- Prolonged labour
- Conditions overdistends uterus-> Multiplepregnancy,macrosomia,polyhidramnios ,hydrops fetalis
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2.Retained Placenta
Occurs when only part of placenta been seperated
Bleeding continues @ seperation site because uterus
unable to contract down due to retained placenta
Sometimes only small part of placenta retained butenough to cause PPH
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3.Genital Tract Laceration
Commonly follows assisted deliveries: e.gForceps/Ventouse
Arises when inappropriate application of instruments/excessive force used to deliver the baby.
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4.Abruptio Placenta
Occurs because
1.Patient may gone into DIVC on account consumtivecoagulopathy
2.Extravasation of blood within the myometrium(Couveleire uterus)cause uterine atony
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6.Acute inversion of the uterus
Uterus is pulled inside out & fundus of the uterus
presented @ the introitus.
Often occurs when there is excessive traction used to
deliver the placenta when it has not yet seperated fromthe fundus of uterus
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Puerperal Infections
Reproductive tract associated with childbirth Metritis, perineal or cesarean wound
Causes of metritis Cesarean - Prolonged labor
PROM - Multiple vaginal exams
Scalp electrodes - Internal uterine monitor
OB trauma - Instrument assisted birth
Manual removal of placenta
Prexisting infection
Compromised health status
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Puerperal Infections:Metritis
Assessment
Abd/Uterine pain
Foul smelling
vaginal dischargeFever 101-104 F
Chills
Malaise30% increase in
WBC
Interventions
CBC
Cultures
Hygiene
Abscess is drained
IV antibiotics
Antipyretics
ICU hospitalization
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Overdistention of the Bladder
Cause Unable to empty bladder due to trauma or anesthesia
Assessment Distended bladder
Displaced uterus, increased vaginal bleeding, boggy uterus,backache, restless
Intervention Encourage voiding
Perineal ice packs Pour water over perineum
Aseptic straight catheter X 1
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Urinary Tract Infections
Cause Retention of urine
Bacteria from catheterization
Cystitis Assessment Intervention
Increase fluids >> Void frequently
Empty bladder >> Urine culture and
antibiotics Prevention
Hygiene
Void q 2-4 hrs
Increase acidit in urine
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Urinary Tract Infections
Pyelonephritis Assessment
UTI signs >> High fever
Chills >> Flank pain
N&V >> Acutely ill Management
IV antibiotics >> Increase fluids
Antipyretics >> AnalgesicFollow-up culture in 2 weeks
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Mastitis Infection of breast tissue
Causes Bacteria enters through cracks in nipple
Milk stasis
Poor hand washing
Breast not dry or wet breast pad
Incorrect placement of baby causes sore nipples
Assessment Fever > 101 F and chills, acutely ill
Flu-like symptoms, malasia, headache
Painful, warm, red area of breast
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Mastitis
Intervention Bed rest - Increase fluids Supportive bra - Antibiotics Analgesic
Breast feed frequently Warm compress before feeding Cold packs between feedings Drain abscess
Prevention Early feedings and frequent feedings Change babys feeding positions Massage clogged duct Empty breast at each feeding
Nipple care
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Thromboembolic Disorders
Blood clot formed from impeded blood flow Causes Hypercoagulability of blood Venous stasis
Injury to epithelium of vessels Increased risk Prevention Avoid dehydration Avoid trauma to legs in stirrups Early postpartum ambulation Leg exercises to support venous return No smoking Antiembolism stockings
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Thromboembolic Disorders
Superficial thrombophelbitis 3 to 4thday after delivery
Assessment
Tenderness >> Localized heat
Swelling >> RednessNo or low fever
Intervention
Elevate leg >> Bed rest
Local moist heat >> Analgesia
Support hose Little risk of pulmonary embolism
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Thromboembolic Disorders
Deep vein thrombosis Intervention
Bed rest >> Elevate leg
Analgesia >> Antibiotics
Anticoagulant therapy
IV heparin
Coumadin for 2 to 6 months
Monitor for pulmonary embolism
Antiembolism stockings after symptoms:
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Every visit to HC
Mother
Examination of
vital signs
breast
abdomen
Perineum
These should be recorded in the Rekod KesihatanIbu KIK/1(a)/96 and KIK/1(b)/96 .
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Every visit to HC
Mother
Health and well-being.
Symptoms of abnormal lochia,
Chest pain,
Difficulty in breathing,
Redness and inflammation of lower limbs
Calf swelling and tenderness.
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Ask Mother about Baby:
Health and well-being.
Feeding
Bowel opening
Passed urine
Other concerns.
Every visit
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Assessment On Baby
body weight body temperature eyes, skin
umbilical cord.
If the mother accompanies her baby in the ward, thepostnatal care should be continued for the mother bythe hospital staff as scheduled.
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CHECK LIST TO IDENTIFY HIGH RISKS
Senarai semak bagi mengesan factor risiko semasa postnatal digunakan oleh anggota jururawat/ pegawai
perubatan ketika menjalankan jagaan postnatal.
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Resumption of sexual activity post natally
Some Studies shown
By eight weeks postpartum 71% of respondentshad resumed intercourse, and by ten weeks 90%
of the women who had partners had resumedintercourse (Glazener 1997).
Another factor that influences sexual behaviorpost partum is pain related to perineal damage
and sutures, caused by vaginal tears andepisiotomies (Glazener 1997).
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Resumption of sexual activity cont..
Mother and her partner should decide together Sexual intercourse may be resumed after mothers
vaginal bleeding has stopped and stitches arehealed (usually within 4- 6 weeks)
Be aware that sex first few times following birthmay be painful Advised for lubricants andcomfortable positioning.
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COPING WITH DEATHS
GRIEF:
Emotional and somatic responses felt by an
individual on the death of another individual.
More intense if the death occurs in a person who is
closely related.
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NORMAL GRIEF REACTION
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MORTALITY BEREAVEMENT
Maternal Death
Stillbirth
Neonatal death
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