Professional Documents
Culture Documents
Introduction
Every year there are an estimated 200 million
pregnancies in the world. Each of these
pregnancies is at risk for an adverse outcome for
the woman and her infant. While risk can not be
totally eliminated, they can be reduced through
effective, affordable, and acceptable maternity
care. To be most effective, health care should
begin early in pregnancy and continue at regular
intervals.
Outlines
Goals of antenatal care.
Signs of pregnancy.
Physical changes during pregnancy.
Assessment and physical examination.
history.
Physical assessment.
Laboratory data.
Ultrasound.
Signs of pregnancy
Presumptive (subjective )signs of pregnancy:
These signs are least indicative of pregnancy; they could easily indicate
other conditions. signs lead a woman to believe that she is pregnant
Amenorrhea.
Breast changes and tangling sensation.
Chlosma and linea nigra.
Abdominal enlargement & striae gravidarum.
Nausea & vomiting.
Frequent urination.
Fatigue
quickening :sensations of fetal movement in the abdomen. Firstly
felt by the patient at approximately 16 to 20 weeks.
.
6-8 weeks
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Definitions
It is a planned examination and observation
for the woman from conception till the birth .
Or
Antenatal care refers to the care that is given
to an expected mother from time conception
is confirmed until the beginning of labor
Objectives
Antenatal care support and encourage a
familys healthy psychological adjustment to
childbearing
FACTORS AFFECTING MOTHERS
UTILIZATION OF ANTENATAL CARE
Demographic and Biological Factors
Socioeconomic Factors
Psychosocial Factors
Health Services Factors
Environmental Factors
history.
Physical examination.
Laboratory data.
Psychological assessment.
Nutritional assessment.
History
Welcome the woman, and ensure a quite place
where she can express concerns and anxiety
without being overheard by other people.
Personal and social history:
This include: womans name, age, occupation,
address, and phone number. marital status,
duration of marriage, Religion , Nationality
and language, Housing and finance
Menstrual history:
A compete menstrual history is important to establish the
estimated date of delivery. It includes:
-
Obstetrical history:
This provides essential information about the previous
pregnancies that may alert the care provider to
possible problems in the present pregnancy. Which
includes:
Gravida, para, abortion, and living children.
Weight of infant at birth & length of gestation.
Labor experience, type of delivery, location of birth,
and type of anesthesia.
Maternal or infant complications.
Family history:
Family history provides valuable information about
the general health of the family, and it may reveal
information about patters of genetic or congenital
anomalies.
Including:
- D.M.
- Hypertension.
- Heart disease.
- Cancer.
- Anemia.
Physical examination
Physical examination is important to:
detect previously undiagnosed physical
problems that may affect the pregnancy
outcome.
and to establish baseline levels that will
guide the treatment of the expectant mother
and fetus throughout pregnancy.
General Examination
It should be started from the moment the pregnant
woman walks into the examination room.
Examine general appearance:
Observe the woman for stature or body build and
gait
The face is observed for skin color as pallor and
pigmentation as chloasma.
Observe the eyes for edema of the eyelids and
color of conjunctiva. Healthy eyes are bright and
clear.
Vital signs:
Blood pressure:
1. It is taken to ascertain normality and provide a
baseline reading for a comparison throughout the
pregnancy.
2. In late pregnancy, raised systolic pressure of 30 mm
Hg or raised diastolic pressure of 15 mm Hg above
the baseline values on at least two occasions of 6 or
more hours apart indicates toxemia.
Pulse:
The normal pulse rate = 60-90 BPM.
Tachycardia is associated with anxiety, hyperthyrodism,
or infection.
Respiratory rate:
The normal is 16-24 BPM.
Tachypnea may indicate respiratory infection,
or cardiac disease.
Temperature:
normal temperature during pregnancy is
36.2C to 37.6C.
Increased temperature suggests infection.
Cardiovascular system:
Venous congestion:
Which can develop into
varicosities, venous congestion
most commonly noted in the
legs, vulva, and rectum.
Edema:
Edema of the extremities or face
necessitates further assessment
for signs of pregnancy-induced
hypertension.
Musculoskeletal system
Posture and gait:
Body mechanics and changes
in posture and gait should be
addressed. Body mechanics
during pregnancy may
produce strain on the
muscles of the lower back
and legs.
Pelvic measurement:
The bony pelvis is evaluated early in the
pregnancy to determine whether the
diameters are adequate to permit vaginal
delivery.
Abdomen:
The size of the abdomen
is inspected for:
- the height of the fundus,
which determines the
period of the gestation.
- multiple pregnancy.
1-Inspection:
The nurse should look at the following:
Skin changes such as linea nigra, striae
gravidarum and scars of previous
operations.
The size of the abdomen is inspected
for:
* Height of the fundus, which determines
the period of gestation.
* Multiple pregnancy and polyhydramnios
will enlarge both the length and breadth of
the uterus.
* A large fetus increases only the length of
the uterus.
Calculations:
Neurological system
Deep tendon reflexes should be evaluated
because hyperreflexia is associated with
complications of pregnancy.
Skin
Pallor of the skin my indicate anemia.
Jaundice may indicate hepatic disease.
Chloasma and linea nigra related to
pregnancy.
Striae graviderum should be noted.
Nail beds should be pink with instant
capillary return.
Legs:
* Legs should be noted for edema.
* They should be observed for varicose veins
* The calf must be observed for reddened areas which
may be caused by phlebitis and white areas which
could be caused by deep vein thrombosis.
* Ask the woman to report tenderness during
examination.
* The legs should be observed for unequal length or
muscle wasting which may be an indication of
pelvic abnormalities.
Breast
Assess breast size, symmetry, condition of
nipple, and the presence of colostrum.
Gastrointestinal systems
Mouth:
The gum may be red, tender, edematous as a result
of the effects of increased estrogen. Observe the
mouth for:
Dryness or cyanosis of the lips.
Gingivitis of the gums.
Vaginal discharge:
* Ask the woman about any increase or
change of vaginal discharge.
Report to the obstetrician any mucoid loss
before the 37th week of pregnancy.
Vaginal bleeding:
* Vaginal bleeding at any time during
pregnancy should be reported to the
obstetrician to investigate its origin.
Laboratory data
Test
Purpose
Blood group
To detect anemia.
Rubella
To determine immunity
Urine analysis
Chlamydia
Glucose
Test
purpose
Stool analysis
(VDRL)
Hepatitis Baserface
antigen
*
-
Ultrasound
Is performed to:
estimate the gestational age.
Check amniotic fluid volume.
Check the position of the placenta.
Detect the multifetal pregnancy.
The position of the baby.
health education:
Follow up:
Advice the mother to follow up according
to the schedule of antenatal care that
mentioned before, advise the mother to
follow up immediately if any danger sings
appears, describe the important of follow up
to the mother.
Hygiene:
Daily all over wash is necessary because it is
stimulating, refreshing, and relaxing.
Warm shower or sponge baths is better than tub bath.
Hot bath should be avoided because they may cause
fatigue. &fainting
Regular washing for genital area, axilla, and breast
due to increased discharge and sweating.
Vaginal douches should avoided except in case of
excessive secretion or infection.
Breast care:
Wear firm, supportive bra with wide straps to spread
weight across the shoulder.
Wash breasts with clean tap water (no soap, because
that could be drying). Daily to remove the colostrum &
reduce the risk of infection.
It is not recommended to massage the breast, this may
stimulate oxytocin hormone secretion and possibly lead
to contraction.
advise the mother to be mentally prepared for breast
feeding
Dental care:
The teeth should be brushed carefully in the
morning and after every meal.
Encourage the woman the to see her dentist
regularly for routine examination &
cleaning.
Encourage the woman to snack on nutritious
foods, such as fresh fruit & vegetables to
avoid sugar coming in contact with the teeth.
A tooth can be extracted during pregnancy,
but local anesthesia is recommended.
Dressing:
Woman should avoid wearing tight cloths
such as belt or constricting bans on the legs,
because these could impede lower extremity
circulation.
Suggest wearing shoes with a moderate to
low heel to minimize pelvic tilt & possible
backache.
Loose, and light clothes are the most
comfortable.
Travel:
Many women have questions about travel
during pregnancy.
Early in normal pregnancy, there are no
restrictions.
Late in pregnancy, travel plans should take
into consideration the possibility of early
labor.
Sexual activity:
Sexual intercourse is allowed with
moderation, is absolutely safe and normal
unless specific problem exist such as:
vaginal bleeding or ruptured membrane.
If a woman has a history of abortion, she
should avoid sexual intercourse in the early
months of pregnancy.
Exercises:
Exercise should be simple. Walking is ideal,
but long period of walking should be
avoided.
The pregnant woman should avoid lifting
heavy weights such as: mattresses furniture,
as it may lead to abortion.
She should avoid long period of standing
because it predisposes her to varicose vein.
She should avoid setting with legs crossed
because it will impede circulation.
Purpose:
1. To develop a good posture.
2. To reduce constipation & insomnia.
3. To alleviate discomvortable, postural back
ache& fatigue.
4. To ensure good muscles tone& strength
pelvic supports.
5 To develop good breathing habits, ensure
good oxygen supply to the fetus.
6- to prevent circulatory stasis in lower
extremities, promote circulation, lessen the
possibility of venous thrombosis
Contraindications:
-Vaginal bleeding.
-Sever anemia.
-History of preterm labor,
-Extreme over or under weight.
-Hypertension, heart, lung, thyroid diseases
Sleep:
The pregnant woman should lie down to relax
or sleep for 1 or 2 hours during the afternoon.
At least 8 hours sleep should be obtained every
night & increased towards term, because the
highest level of growth hormone secretion
occurs at sleep.
Advise woman to use natural sedatives such as:
warm bath & glass of worm milk.
Hazards
Occupational hazards: lead, mercury, X ray
s& ethylene oxide.
Infection: rubella, toxoplasmosis,
syphilis.......................
Smoking & alcohol: increase risk for
pregnancy, prematurity, fetal death, mental
retardation & congenital anomalies.
Drugs: as sedative & analysis,
anticoagulant, antithyrodism, hormones&
antibiotics.
Immunization:
the nurse instructs the woman to receive
immunization against -tetanus to prevent the
risk for her and her fetus.
Also, it is important that every pregnant
mother should receive a tetanus vaccination
card with her first tetanus dose and keep it to
record subsequent doses
Diet:
-Daily requirement in pregnancy about
2500 calories.
- Women should be advised to eat more
vegetables, fruits, proteins, and vitamins
and to minimize their intake of fats.
Purpose:
*Growing fetus.
*Maintain mother health.
*Physical strength & vitality in labor.
*Successful lactation.
Heartburn
Causes:
- progesterone hormone relaxes the cardiac sphincter of the
stomach and allows reflex or bubbling back of gastric contents
into the esophagus.
- the pressure of the growing uterus on the stomach from about
30-40 weeks.
Management:
- avoid
lying flat.
- sleeping with more pillows and lying on the right side.
- small frequent meals.
- take antacids.
- taking baking soda in a glass of water is contraindicated because
of the possibility of retention of sodium and subsequent edema
Avoid fried ,spicy, and fatty food
Avoid citrus juices
Backache
Cause:
Backache may be due to muscular fatigue
and strain that accompany poor body
balance.
It may be due to increased lordosis during
pregnancy in an effort to balance the
body.
The pregnancy hormones sometimes
soften the ligaments to such a degree that
some support is needed.
Management:
- exercise.
- sit with knee slightly higher than the hips.
-The pregnant woman is reassured that once
birth has occurred, the ligaments will
return to their pre-pregnant strength.
Urinary frequency
Cause:
Occur due to the pressure of the growing
uterus on the bladder.
Management:
The problem will resolved when the uterus
rises into the abdomen after the 12th week.
Kegel exercises are some times recommended
to help maintain the bladder.
Varicosities
Causes:
- progesterone relaxes the smooth muscles of the veins
and result in sluggish circulation. The valves of the
dilated veins become inefficient & varicose veins
result.
- weight of the uterus partially compressed the veins
returning blood from the legs.
Management:
- lying flat on the bed with the feet elevated.
- moving the legs about is better than standing still.
Constipation
Causes:
- intestinal motility decreased during pregnancy as a
result of progesterone.
- iron supplementation.
Management:
- the food should have amount of fruit & green
vegetables which contain fibers.
- drinking a lot of water.
- exercise & walking.
- laxatives could prescribed by physician.
Major Disorders
Asthma
Cystic fibrosis
Hypertension/PIH/PET
Arrthymias
Valvular disease
Cardiomyopathy
Cyanotic heart disease
Pulmonary hypertension
Epilepsy
Multiple sclerosis
Intracranial hypertension
Benign cranial tumours.eg.
adenomas
Obstetric Cholestasis
DIABETES
Important issue in pregnancy
Major impacts on maternal and fetal health
Effects of diabetes on
pregnancy
Miscarriage
Fetal malformations
Cardiac
Neural tube
Caudal regressions
syndrome (200x)
IUGR
Macrosomia
Unexplained IUD
PET
Effects of pregnancy on
diabetes
Poorer control
Deterioration of renal
function
Deterioration of opthalmic
disease
Gestational DM
Polyuria
Increased oxygen demands
Polyhydramnios
Polycythaemia
Neonatal
hypoglycaemia
Risk of
cerebral palsy
Risk of unexplained
term stillbirth
Fetal effects
Macrosomia
Increased risks of birth injury/ shoulder
dystocia***
Major cause of obstetric litigation
LSCS recommended in DM where
macrosomia and EFW >4000g
Polyhdramnios
Fetal malpresentations and possible increased
risk preterm labour
Hyperinsulinaemia
Severe hypoglycaemia (risk of CP)
Polycythaemia
Thrombotic effects
Jaundice
Hypocalcaemia
Pre-Eclampsia
Definition
Hypertension and proteinuria with onset 20
weeks
Oedema in the face
PET/Eclampsia
95
Risk Factors:-Pre-Eclampsia
Primiparous
First pregnancy
Family history (1 in 3
risk if mother had PET)
Twins/multiples
Pregestational Diabetes
PET/Eclampsia
Essential hypertension
Renal disease
SLE
Antiphospholipid
syndrome
Age >40
Obesity
96
Epigastric pain
Hepatic congestion/liver capsule stretching
Eclampsia
Occurrence of fits
44% postpartum
38% antenatal)
ALWAYS GRAND MAL
PET/Eclampsia
98
Essential Hypertension
Pre-existing raised blood pressure
May be on treatment or just under
observation
May be known prior to pregnancy or
detected at booking as raised BP
Risks to Mum
Worsening of BP
Superimposed preeclampsia
Medical overintervention
Risks to Baby
Teratogenesis from
certain drugs (eg ACE
Inhib.)
IUGR
Pre-eclampsia
Hypoglycaemia if on
labetolol and
breastfeeding
Cardiac Disease
Pre-existing/congenital
Valvular disease
coarctation
Acquired
IHD
Aortic aneurysm
cardiomyopathy
ASTHMA
Commonest chronic medical illness to
complicate pregnancy
Up to 7% women of childbearing age
Often undiagnosed or undertreated
PIH/PET
PTL/birth
LBW
IUGR
Neonatal morbidity , hypoglycaemia, seizures, NNU
admission
EPILEPSY
About 0.5% women of
childbearing age
Most diagnosed (known)
prior to pregnancy
All seizure types may be
affected by pregnancy
Associated with risks
maternal death due to
aspiration
Any Questions?
Definition
Labor is the process by which contractions of the gravid
uterus expel the fetus.
A term pregnancy delivers between 37 and 42 weeks from the
last menstrual period (LMP).
Preterm labor is that occurring before 37 weeks of gestational
age.
Postdate pregnancy occurs after 42 weeks gestation and
requires careful monitoring.
Termination of pregnancy before 20 weeks of gestation is
defined as either spontaneous or elective abortion.
Definition
Primigravida - pregnant for first time
Multigravida - pregnant more than once
Viability - able to survive outside the womb
(24+ weeks gestation)
Nulliparous - never carried a pregnancy to
viability
Multiparous - has had two or more deliveries
that were carried to viability
Oxytocin effect
The hormone oxytocin stimulates and enhances labor
contractions. As the baby moves toward the vagina (birth
canal), pressure receptors within the cervix (muscular outlet
of uterus) send messages to the brain to produce oxytocin.
Oxytocin travels to the uterus through the bloodstream,
stimulating the muscles in the uterine wall to contract stronger
(increase of ideal normal value).
The contractions intensify increase until the baby is outside
the birth canal.
When the stimulus to the pressure receptors ends, oxytocin
production stops and labor contractions cease.
Factors
True labor
False labor
Contractions
timing
Irregular intervals,
not occurring close
together
Contraction
strength
Frequently weak,
not getting strong
with time
Contraction
discomfort
Start in the back and radiates around toward the front of the abdomen
Position changes
Contraction may
stop or slow down
with walking or
changing position
Effect of analgesia
Frequently
abolished by
sedation
Cervical change
No change
Passageway:
It consist of maternal pelvis and soft tissue
Bony pelvis: it is divided into:
- False pelvis: consist of the upper flared parts
of the two iliac crests
- True pelvis: the bony passageway through
which the fetus must travel, it made-up of
three planes:
Pelvic shape:
Passenger
a. Fetal skull: is the largest presenting part and least
compressible fetal structure, making it an important factor in
relation to labor and birth.
Bones 6 bones: S sphenoid, F frontal sinciput, E
ethmoid, O occuputal occiput, T temporal, P parietal
2x
Measu rement fetal head:
1. transverse diameter 9.25cm
- biparietal largest transverse
- bitemporal 8 cm
2. bimastoid 7cm smallest transverse
Passenger
Sutures intermembranous spaces that allow molding.
1.) Sagittal suture connects 2 parietal bones
2.) Coronal suture connect parietal & frontal bone
3.) Lambdoidal suture connects occipital & parietal
bone
Moldings: the overlapping of the sutures of the skull to
permit passage of the head to the pelvis
Passenger
Fontanels:
1.) Anterior fontanel bregma, diamond shape,
3 x 4 cm, (> 5 cm hydrocephalus), 12 18
months after birth- close
2.) Posterior fontanel or lambda triangular
shape, 1 x 1 cm.
closes 2 3 months after birth
Fetal skull
Fetal attitude
Is another important consideration related to
passenger.
It refers to the posturing (flexion or extension)
of the joints and the relationship of fetal parts
to one another.
Fetal Lie
The relationship of the long axis of the fetus
to the long axis of the mother. The lie is
longitudinal with a vertex or breech
presentation or otherwise transverse or
oblique, as with a shoulder presentation
Fetal Presentation
Presentation describes that part of the fetus that
is lowest in the pelvis inlet first three main
fetal presentation:
the cephalic( head): 95% of the term new born
the breech( pelvis): 3% of term births
the shoulder( scapula): 2% of term births.
The Powers
Forces generated by uterine musculature
Frequency, amplitude, and duration of
contractions
Observation, manual palpation
Contractions cause complete dilation and
effacement of the cervix.
Uterine contraction:
Uterine contraction is involuntary and there fore
cannot be controlled by the experiencing women.ut.
Cont. is intermittent and rhythmic with a period of
relaxation. Uterine cont.has three phases:
Increment: building up of the contraction
Acme: peak or highest intensity
Decrement: descent or relaxation of the uterine
muscle fibers
Maternal position:
Changing positions and moving around during birth offer
several benefits, it facilitate fetal descend and rotation
Squatting position enlarges the pelvic outlet by approximately
25% .
The use of upright or lateral position compared with supine or
lithotomy positions may:
reduce the duration of the second stage of labor
reduce the number of assisted deliveries( vacuum and forceps)
Maternal position:
Psychological responses:
The birth experience influence the woman's self
confidence, self esteem, and her view of life, her
relationships, and her children.
Factors influencing a positive birth experience include:
Maternal responses:
Increased heart rate by 10 to 18 bpm
Increased cardiac output by l 0 to 15% during the first stage
of labor and increased by 30 to 50% during the second stage
of labor
Increased blood pressure by 10 to 30 mm Hg during uterine
contractions in all labor stages
Increase in white blood cell count to 25,000 to 30,000
cells/mm3 perhaps as a result of tissue trauma
Increased respiratory rate along with greater oxygen
consumption related to the increase in metabolism
Maternal responses:
Fetal responses
1.
2.
3.
4.
5.
Stages of labor:
The first stage of labor begins with the onset of labor and
ends with complete (10 cm) dilatation of the cervix.
Duration of the first stage:
Stages of labor
(2) The second stage of labor begins when the
cervix becomes fully dilated and ends with the
complete birth of the infant. The second stage
normally lasts up to 1 hour. While one should
be concerned when the second stage extends
longer than 1 h (based on fetal morbidity and
mortality). Safety for the fetus may be assured
by thoughtful monitoring.
Stages of labor
(3) The third, or placental, stage of labor is the period
from birth of the infant to 1 h after delivery of the
placenta. The rapidity of separation and means of
recovery of the placenta determine the duration of
the third stage
(4) Fourth stage of labor: is 1 to 4 hours after birth,
time of maternal physiologic adjustment.
Cardinal movements of
labour/mechanisms of normal
labour
The process of labor and delivery is marked
by characteristic changes in fetal position or
cardinal movements in relation to the maternal
pelvis. These spontaneous adjustments are
made to effect efficient passage through the
pelvis as the fetus descends.
ADMISSION PROCEDURE
-One of the most critical diagnoses in obstetrics is the accurate diagnosis of
labour:
History
Physical examination:
Fundal height measurement
Uterine contraction (duration, frequency, intensity)
fetus (presentation, heart rate, size)
fetal membrane, vaginal bleeding & leakage
The fetal heart rate should be checked, especially at the end of a
contraction and immediately, thereafter, to identify pathological slowing
of the heart rate
Pain level
Laboratory studies:
CBC
Blood type and RH
UA (protein, glucose)
Syphillis, hepatitis B, HIV
Oral intake
- food should be withheld during active labour and
delivery
- in labour analgesics may be are administered
:gastric emptying time is prolonged
:not absorbed ,vomited, and aspiration
-sips of clear liquids, occasional ice chips, and lip
moisturizers are permitted
Intravenous fluids
-there is seldom any real need for such in the
normally pregnant at least until analgesia is
administered
Vaginal examination:
Uterine contraction
Abdominal palpitation Maneuvers
Postpartum Physiology
Postpartum period
Is the interval between the birth of the
newborn and the return of the reproductive
organs to their normal nonpregnant state
It lasts for 6 weeks, with some variation
among women.
Postdelivery Assessment
Greatest risk for postpartum complications
is during the first 24 hours after delivery
Identification of potential problems;
immediate intervention; reassessment
Assessment includes:
Condition of uterus
Amount of bleeding
Bladder & voiding
Vital Signs
Perineum
Room Ready
IV Pole
Admission Assessment
Vital Signs Equipment
Assessment
Assessment is immediately upon arrival to
the Unit
Complete Assessment
- VS
Vital Signs
Elevated Temperature
Normal finding for first 24 hours
Sign of Dehydration
Sign of Infection
Bradycardia
Normal Finding
Tachycardia
Infection
Hemorrhage
Pain
Anxiety
Post C/S
Additional Assessment:
Incision
Fluid Intake
Bladder & Bowel
Ambulation/Orthostatic Hypotention
Thrombophlebitis
Uterus
Involution:-is the return of the uterus to a
nonpregnant state after childbirth
Involution process begins immediately after
expulsion of the placenta with contraction
of uterine smooth muscles
Cont.
At the end of third stage of labor, the uterus is
in the midline, about 2cm below the level of
the umbilicus and weighs 1000g
By 24 hours postpartum the uterus is about
the same size it was at 20 gestational weeks
Cont
-The fundus descends about 1 to 2cm every 24
hours, and by the sixth postpartum day it is
located halfway between the symphysis pubis
and the umbilicus.
-The uterus lies in the true pelvis within 2 weeks
after childbirth.
Involutionoftheuterus.A,Immediatelyafterdeliveryof
theplacenta,thefundusismidlineandhalfwaybetweenthe
symphysispubisandtheumbilicus.B,About6to12hours
afterbirth,thefundusisattheleveloftheumbilicus.Itthen
descendsonefingerbreadth(approximately1cm)eachday.
Cont
Lochia
-It is the uterine discharge that occurs after birth.
Lochia is initially bright red changing later to a pinkish
red or reddish brown
-For the first 2 hours after birth the amount of lochia
should be about that of a heavy menstrual period,
after that time the lochial flow should steadily
decrease.
Cont
Cont
3-lochia alba:-it consists of leukocytes, decidua,
epithelial cells, mucus, and bacteria. it is yellow to
white in color.
Lochia alba may continue to drain for up to and beyond
6 weeks after childbirth.
The amount of lochia is usually increases with
ambulation, and breastfeeding.
Cont
Persistence of lochia rubra early in the
postpartum period suggests continued
bleeding as a result of retained fragments of
the placenta or membranes.
The another common source of vaginal
bleeding is vaginal or cervical laceration.
Suggestedguidelineforassessinglochiavolume.
BUBBLEHE Assessment
Complications
Hemorrhage Hgb < 9 requires Tx
atony- most common cause is full bladder
laceration bleeding with firm uterus
placenta fragments bleeding returns to rubra or foul odor
noted
Infection Temp above 100.4 F
urinary
mastitis
Thrombophlebitis pain and redness,
+Homan send for venous scan
pulmonary embolism sudden onset chest pain, SOB
Postpartum Depression/Psychosis
Postpartum depression- 15-25% - all ethnic groups
affected.
Cause unknown, may be related to hormones,
exhaustion, anger, chronic stress
S&S: starts first 4 wks and last several months,
fatigue, loss of self, suicide thoughts crying
TX: combination of psychotherapy, social, meds
Postpartum psychosis- rare, bipolar disorder or
major depression, frightening thoughts, delusions of
dead baby and hallucinations, need psychiatric Tx,
will not resolve itself
Nursing Care
Involution 6-7 weeks
Descent of uterus midline and descend 1cm/d
Lochia unique healing process
rubra 2-3 days - dark red with small clots
serosa 4-10 days pink to brownish
alba 1-6 weeks cream-white
Perineum if episiotomy, takes 3-6 weeks
summary
-Postpartum physiologic changes allow the woman