postpartal care

Manila Central University

College of Nursing and Midwifery

POSTPARTAL

OVERVIEWA. ESSENTIAL CONCEPTS B. GOALS OF POSTPARTAL CARE C. FACTORS AFFECTING THE POSTPARTAL EXPERIENCE D.NURSING RESPONSIBILITIES

Postpartum period

ESSENTIAL CONCEPTSPostpartum period

ESSENTIAL CONCEPTSPOSTPARTUM CARERefers to the medical and nursing care given to a patient from the time of delivery until her body returns to near it s nonpregnant state

Postpartum period

ESSENTIAL CONCEPTSPUERPERIUMIs the 6-week period after delivery Beginning w/ termination of labor and ending w/ the return of the reproductive organs to nonpregnant state A physical and psychological adjustment to the process of childbearingPostpartum period

ESSENTIAL CONCEPTSINVOLUTIONProgressive changes in the uterus after delivery Leading to its return to prepregnant state and conditionPostpartum period

ESSENTIAL CONCEPTSPOSTPARTAL PERIODSometimes referred as the fourth stage of pregnancy

Postpartum period

ESSENTIAL CONCEPTSOne aspect of care that commonly suffers w/ the trend toward earlier discharge is support in breast-feedingThe image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.

Postpartum period

GOALS OF POSTPARTAL CAREPostpartum period

GOALS OF POSTPARTAL CAREPromote normal involution and return to the nonpregnant state

Postpartum period

GOALS OF POSTPARTAL CAREPrevent or minimize postpartum complications

Postpartum period

GOALS OF POSTPARTAL CAREPromote comfort and healing of pelvic, perianal, and perineal tissues

Postpartum period

GOALS OF POSTPARTAL CAREAssist in restoration of normal body functions

Postpartum period

GOALS OF POSTPARTAL CAREIncrease understanding of physiologic and psychological changes

Postpartum period

GOALS OF POSTPARTAL CAREFacilitate newborn care and selfcare by the new mother

Postpartum period

GOALS OF POSTPARTAL CAREPromote newborn s successful integration into the family unit

Postpartum period

GOALS OF POSTPARTAL CARESupport parenting skills and parentinfant attachment

Postpartum period

GOALS OF POSTPARTAL CAREProvide effective discharge planning, including appropriate referral for homes care follow-up

Postpartum period

Factors affecting the postpartal experiencePostpartum period

Factors affecting the postpartal experienceNature of labor and delivery and birth outcome

Postpartum period

Factors affecting the postpartal experiencePreparation for labor and delivery and for parenting

Postpartum period

Factors affecting the postpartal experienceAbruptness of the transition to parenthood Family s individual and collective experiences with childbearing and childrearing Family members role expectationPostpartum period

Factors affecting the postpartal experienceSensitivity that increase the risk of postparum complications include:Preeclampsia or eclampsia DM Cardiac problems uterine overdistension Abruptio placenta or Placenta previa Precipitous or prolonged labor, difficult delivery, extended period of time spent in stirrupsPostpartum period

NURSING RESPONSIBILITIES

Postpartum period

NURSING RESPONSIBILITIESProvide sensitive professional care to the new parents, which includes:a. Accurate assessment of mother s physiologic and psychological status b. Anticipatory guidance and health teaching as neededPostpartum period

NURSING RESPONSIBILITIESFacilitate the family s bonding experience

Postpartum period

Physiological changes of Postpartum period

POSTPARTAL BIOPHYSICAL CHANGESA. REPRODUCTIVE SYSTEM B. ENDOCRINE SYSTEM C. CARDIOVASCULAR SYSTEM D. RESPIRATORY SYSTEM E. RENAL & URINARY SYSTEM F. GASTROINTESTINALSYSTEM G. MUSCULOSKELETAL SYSTEM H. INTEGUMENTARY SYSTEMPostpartum period

REPRODUCTIVE SYSTEM CHANGES REPRODUCTIVEUTERUS

SYSTEM PERINEUM LOCHIA CHANGES BREAST CERVIXPostpartum period

VAGINA

REPRODUCTIVE SYSTEM CHANGES:

UTERUSPostpartum period

REPRODUCTIVE SYSTEM CHANGESUterusContracts firmly Reducing its size by over ; remains this size for 2 days, then decreases in size (involution) Descends one finger breadth per dayPostpartum period

REPRODUCTIVE SYSTEM CHANGESUterus@ 10 to 14 days postpartum cannot be palpated abdominally Returns to nonpregnant state by 4 to 6 weeks postpartum

Postpartum period

REPRODUCTIVE SYSTEM CHANGESUterusSite of placental attachment require - 6 to 7 weeks to heal Endometrial regeneration require 6 weeks

Postpartum period


LOCHIAPostpartum period

REPRODUCTIVE SYSTEM CHANGESLochiaDischarge from uterus during the first 3 weeks ff. delivery

Postpartum period

Color Lochia rubra Lochia serosa Lochia alba Dark red

Days 1-3

Components Blood & cellular debris from decidua Mostly serum Some blood Tissue debris Leukocytes w/ decidua Epithelial cells Mucus

Pinkish brown Yellowish white

3-10

10-14

Postpartum period


CERVIXPostpartum period

REPRODUCTIVE SYSTEM CHANGESCervixBecomes thicker and firmer By end of first postpartal week 1 cm Complete cervical involution 3 to 4 months Cervical os From round to elongatedPostpartum period

dilated


VAGINAPostpartum period

REPRODUCTIVE SYSTEM CHANGESVaginaSmooth and swollen w/ poor tone after delivery RugaeAppear 3 to 4 weeks postpartum

Estrogen indexReturn in 6 to 10 weeksPostpartum period


PERINEUMPostpartum period

REPRODUCTIVE SYSTEM CHANGESPerineumAppear edematous & bruised after delivery Episiotomy or laceration may be present

Postpartum period


ABDOMENPostpartum period

REPRODUCTIVE SYSTEM CHANGESAbdomenRemain soft and flabby Striae remainBut take a silvery-white appearance

Postpartum period

REPRODUCTIVE SYSTEM CHANGESAbdomenDiastasis rectiSeparation of abdominal recti muscle May occur w/ poor muscle tone

Postpartum period


BREASTPostpartum period

REPRODUCTIVE SYSTEM CHANGESBreastRapid drop in estrogen & progesterone levels w/ increase in secretion of prolactin after delivery

Postpartum period

REPRODUCTIVE SYSTEM CHANGESBreastColostrumPresent @ time of delivery

Breast milkProduced by 3rd or 4th postpartum dayPostpartum period

REPRODUCTIVE SYSTEM CHANGESBreastBecoming larger & firmerAs lactation is established (primary engorgement w/ congestion subsiding in 1 or 2 days

Postpartum period

REPRODUCTIVE SYSTEM CHANGESBreastProlactin stimulates alveolar cells to produce milk

Postpartum period

REPRODUCTIVE SYSTEM CHANGESBreastSucking newbornsCauses oxytocin release &

contractility of myoepithelial cells to stimulate milk flow (let-down reflex)

Postpartum period

REPRODUCTIVE SYSTEM CHANGESBreastAverage amount of milk produced (24 hrs) increase over time:First week: 6 to 10 oz 1 to 4 weeks: 20 oz 1 oz = 34 ml After 4 weeks: 30 oz

680 ml 340 ml 204 to 1020 mlPostpartum period

ENDOCRINE SYSTEM CHANGESPostpartum period

ENDOCRINE SYSTEM CHANGESEstrogen & Progesterone levelDecrease rapidly after delivery

Postpartum period

ENDOCRINE SYSTEM CHANGESOvulation & return of menstruation influenced by:Lactating45% resume menstruation by 12 weeks 80% have one or more anovulatory cycles before the first ovulation

Postpartum period

ENDOCRINE SYSTEM CHANGESOvulation & return of menstruation influenced by:Nonlactating40% resume menstruation by 6 weeks after delivery65% by 12 weeks & 90% by 24 weeks

50% ovulate during first cycle

Postpartum period

ENDOCRINE SYSTEM CHANGESEstrogen & Progesterone levelRapid drop ff. delivery of placenta Responsible for ana. & physio. changes in puerperium

Postpartum period

ENDOCRINE SYSTEM CHANGESRequirements for rest and sleep increase significantly

Postpartum period

CARDIOVASCULAR SYSTEM CHANGES

Postpartum period

CARDIOVASCULAR SYSTEM CHANGESTransient bradycardia40 to 70 bpm Occurs 24 to 48 hrs after delivery May persist for first 6 to 8 days

Postpartum period

CARDIOVASCULAR SYSTEM CHANGESBlood volumeDecreases to nonpregnant levels by 2 weeks after delivery

Postpartum period

CARDIOVASCULAR SYSTEM CHANGESHematocrit levelRises by 3rd to 7th postpartum day

Postpartum period

CARDIOVASCULAR SYSTEM CHANGESLeukocytosis level20,00 to 25,000 WBC/mL Continues for several days after delivery to prevent infection

Postpartum period

CARDIOVASCULAR SYSTEM CHANGESBlood pressureRemains stable

PulseReturns to nonpregnant rate by 3 months postpartumPostpartum period

RESPIRATORY SYSTEM CHANGESPostpartum period

RESPIRATORY SYSTEM CHANGESPulmonary functions return to nonpregnant status by 6 months after delivery

Postpartum period

RENAL & URINARY SYSTEM CHANGESPostpartum period

RENAL & URINARY SYSTEM CHANGESOverdistension of bladderCommon due to: Bladder capacity Swelling Bruising of tissues around the urethra Diminished sensation to increased pressurePostpartum period

RENAL & URINARY SYSTEM CHANGESFull bladderDisplaces the uterus Can cause postpartum hemorrhage

Bladder distensionCan lead to urinary retention Decrease rapidly after deliveryPostpartum period

RENAL & URINARY SYSTEM CHANGESAdequate bladder emptyingGenerally resumes 5 to 7 days after tissue swelling and bruising resolve

Postpartum period

RENAL & URINARY SYSTEM CHANGESGlomerular filtration rateRemains elevated for 7 days after delivery

Postpartum period

RENAL & URINARY SYSTEM CHANGESDilated ureters & renal pelvisElevated to their nonpregnant state 6 to 10 weeks after delivery

Postpartum period

RENAL & URINARY SYSTEM CHANGESPuerperal diaphoresis & diuresisOccur w/in first 24 hrs after delivery

Postpartum period

GASTROINTESTINAL SYSTEM CHANGES

Postpartum period

GASTROINTESTINAL SYSTEM CHANGESHunger and thirstCommon after delivery

Postpartum period

GASTROINTESTINAL SYSTEM CHANGESGI motility & toneReturn to nonpregnant state w/in 2 weeks after delivery

Postpartum period

GASTROINTESTINAL SYSTEM CHANGESConstipationCommonly occurs during the early postpartum period

Postpartum period

GASTROINTESTINAL SYSTEM CHANGESPrepregnant weightReturns in 6 to 8 weeks If weight gain was in N range

Postpartum period

GASTROINTESTINAL SYSTEM CHANGESHemorrhoidsCommon problem in early postpartal period Due to pressure on the pelvic floor and straining during labor

Postpartum period

MUSCKULOSKELETAL SYSTEM CHANGES

Postpartum period

MUSCULOSKELETAL SYSTEM CHANGESAmbulate 4 to 8 hrs after deliveryEarly ambulation ( ENCOURAGED) to avoid:Complications Promote involution Improve emotional outlookPostpartum period

MUSCULOSKELETAL SYSTEM CHANGESPelvic articulationRelaxation and increased mobility Occurs 6 to 8 weeks after delivery

Postpartum period

INTEGUMENTARY SYSTEM CHANGES

Postpartum period

INTEGUMENTARY SYSTEM CHANGESMelaninDecrease gradually after delivery Causing decrease in hyperpigmentation

Postpartum period

INTEGUMENTARY SYSTEM CHANGESVisible vascular changesDisappear as estrogen levels decrease

Postpartum period

STUDY WELL

Psychological changes of Postpartum period

POSTPARTAL PSYCHOSOCIAL ADAPTATIONA. ESSENTIAL CONCEPTS B. TAKING-IN PERIOD C. TAKING-HOLD PERIOD D. LETTING-GO PERIOD E. POSTPARTUM DEPRESSIONPostpartum period

ESSENTIAL CONCEPTSEstrogen & Progesterone levelDecrease rapidly after delivery

Postpartum period


Postpartum period


Postpartum period

TAKINGTAKING-IN PERIODEstrogen & Progesterone levelDecrease rapidly after delivery

Postpartum period


Postpartum period


Postpartum period


Postpartum period

TAKINGTAKING-HOLD PERIODEstrogen & Progesterone levelDecrease rapidly after delivery

Postpartum period


Postpartum period


Postpartum period

LETTINGLETTING-GO PERIODEstrogen & Progesterone levelDecrease rapidly after delivery

Postpartum period


Postpartum period


Postpartum period

POSTPARTUM DEPRESSIONEstrogen & Progesterone levelDecrease rapidly after delivery

Postpartum period


Postpartum period


Postpartum period

Nursing Management of Normal PPP

Nursing Management of Normal PPPAssessment Nursing diagnoses Planning and Implementation Evaluation

Postpartum period

ASSESSMENTPostpartum period

NURSING DIAGNOSESPostpartum period

IMPLEMENTATIONPostpartum period

PLANNING AND

EVALUATIONPostpartum period

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References

Maternal & Child Health Nursing 5th edition, 2004 Adele Pillitteri

References

Essentials of Maternity Nursing The nurse and the child bearing family 2nd edition, 1987 Irene M. Bobak Margaret Duncan Jensen* very understandable

References

ReferencesMyles Textbook for Midwives 11th edition, 1989 V. Ruth Bennett Linda K. Brown

Williams Obstetrics 19th edition, 1993 F. Gary Cunning Paul C. McDonald Norman F. Gant Kenneth J. Leveno Lary G. Guilstrap III

References

STUDY WELL

postpartal care

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