University:
Stanford University
Course:
PEDS 282 | Pregnancy, Birth, and Infancy
Academic year:

2023
Views:

371

Pages:

1
Author:

Pierre BERNARD

Postnatal Care Puerperium = delivery of placenta until 6th post natal week Early postnatal checks General emotion & physical wellbeing Infant feeding & care (encourage breast feeding if possible) Urinary & bowel function Lochia (vaginal discharge) may continue for upto 4-8 weeks Contraception plans HR, BP, Temp (for signs of haemorrhage, anaemia & sepsis) Abdominal examination (is uterus involuting? – should be non palpable by day 14) Perineum – check any wounds & stitches Late postnatal check 6 weeks post delivery. Review all the above Answer any queries for future pregnancy Check maternal Hb Discuss contraception Common Postnatal Problems Anaemia – 25-30%. Usually managed with oral iron supplements Bowel problems – constipation - 20%, can be due to narcotic analgesia, haemorrhoids – 20% Breast problems – 2/3 have some problem (nipple pain, engorgement, cracks, bleeding). Give advice on positioning baby. Abx if infected mastitis Episiotomy breakdown – ensure wound is clean & consider re-suture Incontinence – UTI common in 1st yr postnatal. 20% urinary stress incontinence at 3 months. 5% flatus & faecal incotinence linked to sphincter damage or perineal trauma Postnatal Blues – over 50%, starts day 2-4 lasts approx 7 days. Tearful, sleep disturbance, poor concentration, headaches etc. Reassure & support Postnatal depression – 10-25% in 1st year, onsets around week 3-4. Can threaten baby’s well-being. Support with counselling, psychotherapy & antidepressants Puerperal psychosis – 1/500. starts at day 3-7, peaks at 2 weeks. Can put both mother & baby at risk of suicide attempts. Admit to specialist unit. Puerperal pyrexia – temp over 38oC on any occasion in first 14 days post delivery/miscarriage. Usually due to UTI or genital infection. Should exclude DVT/PE. Take blood cultures if systemically unwell. Rx according to severity Superficial thrombophlebitis – 1%, painful, erythematous varicose vein. Rx support stockings & antiinflammatory drugs