MATERNAL AND CHILD HEALTH

NURSING II
KRISHAN SORIANO, MSN
 LABOR and DELIVERY
• LABOR- process by which the product of
conception is expelled
• THEORIES of LABOR
• 1. Uterine Stretch or Myometrial irritability
• 2. Theory of Aging Placenta
• 3. Progesterone Deprivation Theory
• 4. Estrogen Theory
• 5. Oxytocin Theory
• 6. Fetal Hormone Theory
• 7. Prostaglandin Theory- most acceptable
 Premonitory Signs of labor
• 1. Lightening- descent of presenting part
• 2. Increase braxton-hicks contraction
• 3. Increase in maternal activity
• 4. Decrease in maternal weight by 2-3 lbs
• 5. Rupture of BOW
• 6. SHOW
• 7. Nesting
 Factors that affect labor
• 1. POWER
• A. Primary/ Involuntary- refers to UTERINE
CONTRACTIONS
• Monitor:
• DURATION- start to end
• INTERVAL- end to start
• FREQUENCY- start to start
• INTENSITY
 B E
A C D F

A-B= INCREMEN B- C= DECREMEN

A-C= DURATION C- D= INTERVAL
A-D= FREQUENCY
 B. SECONDARY/ VOLUNTARY
• = refers to the bearing down effort of the
mother
• =Causes:
• 1. pain related to uterine contraction
• 2. pressure by the presenting part against
bony pelvis as head progressively descends
• 2. PASSENGER
= Refers to :
a. FETUS ( assess the folllowing )
1. size- microsomia, macrosomia, AGA
2. Number- single or multiple
3. Presentation- part of the fetus that enters pelvic
inlet first
a. CEPHALIC
= Occiput- Vertex
= Chin - Mento
= Forehead- Brow
 Fetal head measurement
• ANTERO POSTERIOR DIAMETER
• 1. SUB OCCIPITOBREGMATIC-
• Smallest diameter ; occiput to anterior
fontanel; 9.5 cm
• 2. OCCIPITO FRONTAL- occiput to eyebrow; 12
cm
• 3. OCCIPITO MENTAL- occiput to chin; 13.5 cm
 TRANSVERSE
• 1. BIPARIETAL = largest diameter 9.25 CM

• 2. BITEMPORAL = 8 CM

• 3. BIMASTOID= smallest diameter; 7 CM

 B. Buttocks (sacrum)- BREECH
• 1. FRANK- hips flexed; legs up
• 2. COMPLETE- hips flexed; knees flexed
• 3. INCOMPLETE- hips flexed; 1 leg up and 1 leg
down
• 4. FOOTLING

• 3. SHOULDER
 TYPES OF MULTIPLE GESTATION
• 1. TWINNING
• A. MONOZYGOTIC/ IDENTICAL/MATERNAL= 1
ovum + 1 sperm
• 1 placenta, 1chorion, 2 cords, 1 sex
• B. DIZYGOTIC/ FRATERNAL/ UNIDENTICAL = 2
ovum + 2 sperms
• 2 placenta, 2 chorion, 2 cords, 1 or 2 sex
 3. CONJOINED- ( SIAMESE )
• = twins whose body parts are connected with
one another

• 4. DISJOINED = formerly conjoined twins

separated by surgery
 4. POSITION
• =refers to relationship of presenting part to the
quadrants of the pelvis
• Composed of:
• = maternal side- Left or Right
• = presenting part- Occiput, Mento, Sinciput, Sacrum,
Acromion
• = pelvic quadrant- front- ANTERIOR; back-
POSTERIOR; side- TRANSVERSE
• LOA- most common position
 5. LIE
• Refers to relationship between the long axis of
the mother and the long axis of the fetus
• TWO Types:
• 1. VERTICAL/ LONGITUDINAL
• 2. HORIZONTAL/ TRANSVERSE
• 3. DIAGONAL
 6. ATTITUDE
• = refers to relationship of body parts to one
another
• = degree of flexion
• Types:
• 1. Flexion- best attitude; chin to chest
• 2. Military- neither flex nor extended
• 3. Extension- poor attitude
 7. CONGENITAL DEFECTS
• A. HYDROCEPHALUS
• B. OMPHALOCELE
• C. GASTROSCHISIS
• D. MYELOMENINGOCELE
 3. PASSAGEWAY
• COMPONENTS
• 1. PELVIS
• A.TYPES:
• 1. GYNECOID- round: female; best type
• 2. ANTHROPOID- ape like, oval
• 3. PLATYPELLOID- flat
• 4. ANDROID- heart shaped; typical male
 2. Measurements
• A. Pelvic inlet
• 1. Antero- posterior
• A. Diagonal conjugate- distance between the
anterior surface of the sacral prominence and the
inferior margin of the symphysis pubis; 12.5 cm
• B. Obstetrical conjugate- meas between the anterior
surface of the sacral prominence and the posterior
border of the inferior margin of the symphysis;
subtract 1.5 or 2 cm from DC
 B. ISCHIAL TUBEROSITY
• Distance between the ischial tuberosities or
the transverse diameter of the outlet; 11 cm
is adequate
 2. UTERUS
= assess the following
1. Uterine contraction
2. Physiologic retraction ring
Rule out BANDL’S RING
3. CERVICAL DILATATION= degree of opening; 1cm
very narrow; 10 cm full
4. CERVICAL EFFACEMENT = thinning or softening
of the cervix; 100 % very thin;
10% very thick
 3. VAGINA
• = FREE FROM INFECTION especially
• HERPES SIMPLEX
• and preferably other infections
 4. PSYCHE
5. POSITION
DIFFERENCES BET. TRUE AND FALSE LABOR
1. Uterine contractions
2. Location of pain
3. Passage of show
4. Intensified by ambulation
5. CERVICAL DILATATION
 STAGES OF LABOR
• STAGE I is characterized by:
• 1. LATENT PHASE
• UC= every 5 to 10 mins, duration 20 to 30
secs.; mild
• CD = 0 to 3 cm
• ATTITUDE= excited, cooperative, talkative,
easily coached
 2. ACTIVE
• Characterized by:
• UC = 30 to 45 sec duration
• Occurs every 3 to 5 mins
• Intensity- moderate
• CD = 4 TO 7 cm
• ATTITUDE= passive, less cooperative, malar
flush begins, may hyperventilate
• Best time for anesthesia and analgesia
 Types of anesthesia
• 1. GENERAL- ( PENTOTHAL SODIUM )
• 2. REGIONAL
– A. EPIDURAL- relieves both abdominal and
perineal pain; monitor FHT and maternal BP
– B. CERVICAL- relieves abdominal pain but not
perineal pain; monitor FHT, and maternal BP
– C. PUDENDAL- relieves perineal pain but not
abdominal pain;
 3. TRANSITION
• CHARACTERIZED BY
• UC= 45 to 60 secs
• Occurs every 2 to 3 mins
• Intensity= moderate to severe
• CD= 8 to 10 cm
• ATTITUDE= no longer in control of self; with
urge to bear down; shouts; complains of
severe pain
 Second stage= stage of expulsion
• Characterized by:
• UC= 60 to 90 sec
• Occurs every two mins
• Intensity= very severe
• CD= 10 cm or more
• Bulging of the perineum
• CROWNING- hallmark of second stage
• Best time for Episiotomy
 Types
• 1. Median
• 2. Mediolateral
• Purposes:
• 1. Prevent laceration
• 2. widen the outlet
• 3. shorten the second stage of labor
 Mechanisms of labor
• Descent Flexion Internal rotation
• Extension External rotation Expulsion
• RITGENS MANEUVER
 NURSING ACTION
• 1. Monitor frequency, intensity, and patterns of
uterine contractions
• 2. Monitor FHT
• 3. Assess bloody show ( pink or blood streaked
mucus ), perineal bulging, membrane status
• 4. Periodic vaginal examinations
• 5. Monitor VS
• 6. Assess client’s ability to cope with contractions
• 7. Provide emotional support
 Third stage- placental expulsion
• TWO MECHANISMS
• 1. SHULTZE’S- central separation; fetal side presents;
inverted umbrella
• 2. DUNCAN’S- marginal separation; maternal side
presents; umbrella
• SIGNS of SEPARATION
• 1. Calkin’s – firm globular uterus- first sign
• 2. Sudden gush of blood
• 3. Lengthening of the cord
 Postpartum care
• Check for completeness of the placenta
• Check the BP
• Administer Oxytocin IM or IV
• a. Methylergonovine maleate
• b. Ethylergonovine maleate
• Keep uterus firm and contracted
• Estimate blood loss ( total 500 ml )
• If more than HEMORRHAGE
• Prepare for Episiorrhapy
 The first 1-2 hours postpartum. Priority
nursing actions include:
A.Assessment of:
Fundus- should be checked every 15 mins. For one hour then
every 30 mins. for the next 4 hours.
• Note: if non-contracted- massage;
• apply ice cap over the abdomen;
• administer oxytocin as prescribed.
• Involution of the uterus occurs between 4-6 weeks
caused :
• A. by the contraction of the uterus with the decrease in
size of individual myometrial cells and
• B. partly by autolytic processes in which some of the
protein material of the uterine wall is broken down into
simpler components which then are absorbed.
•By the 9th or the 10th day it can be compared with a grapefruit
•not only in size but also in consistency.

• Immediately after delivery, the weight of the

uterus is 1000gm; after a week- 500 gm; after 2
weeks- 100 gm, and after 4 weeks- 4weeks- 60
gm.
• Fundic ht immediately after birth- above
umbilicus; within 24 hrs- umbilical level; then,
• 1 cm below umbilicus/ day;
• by the 7th day at the symphysis pubis and on the
10th day no longer palpable.
 Lochia
1. . Composed of blood with a small amount of
mucus, decidual particles, cells from the
placental site, WBC, bacteria ( from the
vagina ).
Types:
Lochia rubra- first three days after delivery,
consist almost of entirely of blood with only
decidual particles and mucus, red in color
 Lochia serosa
• about the fourth day, leucocytes begin to
invade the area as they do any healing
surface, the flow becomes pink or brownish
in color

Lochia alba-
on the 9th day,
the amount of flow decreases and
becomes colorless or white.
 ,
.
 Perineum-
1. is tender, discolored and
edematous.Should be clean with
intact stitches. Check for laceration
manifested by trickling of blood
with the uterus firm and
contracted.
 Types of laceration:
– First degree- involve the vaginal
mucous membrane,and perineal skin
to the fourchette.
– Second degree- involve the vaginal
mucous membrane, perineal skin,
and perineal muscles
 – Third degree- involve the entire
perineum, perineal skin and muscles,
and external sphincter of the rectum.
– Fourth degree- involve the vaginal
mucous membrane, perineal skin and
muscles, rectal sphincter and rectal
mucusa.
• Management: Episiorraphy under local
anesthesia ( (Xylocaine )
•
 Bladder
1. should be emptied every 2 hours. A full
bladder is evidenced by a fundus in the right
side of the midline, dark red bleeding with
some clots, may delay uterine contraction
2. bladder mucosa shows varying degrees of
edema and hyperemia with decrease muscle
tone thus most women do not have the
sensation of having to void resulting to
urinary stasis and infection (( Cystitis )
 Vital signs
• Temperature- may have a slight increase on the
first 24 hours due to dehydration ( fluid and
blood). Any increase after the first day with boggy
uterus and abnormal discharge may mean
Puerperal sepsis

• Pulse- slightly lower than normal due to increased

amount of blood that returns to the circulatory
system following delivery of the placenta. Usually
the PR is 60-70 /min
• Blood Pressure- Increased in the blood volume
during the postpartal period raises the BP. The
slowing of the heart beat is a compensatory
mechanism to decrease the pressure in the
circulatory system. A reading above 140/ 90
mmHg needs further evaluation.
• B. Lactation/Breastfeeding- first 30 mins or
immediately following the delivery of the Baby.
Benefits:
• Bonding
• Facilitates release of colostrums
• Stimulates the pituitary to produce Prolactin and
Oxytocin
• For the newborn- Prevents physiologic jaundice
due to stimulation of gastrocolic reflex which
causes more expulsion of meconium
 POSTPARTUM DISCOMFORTS

Apply ice packs to the perineum during the first 24 hours

to reduce swelling after the first 24 hours, apply warmth
by sitz baths

B.
 Episiotomy

• Instruct the client to administer perineal care

after each voiding

• Encourage the use of an analgesic spray as

prescribed

• Administer analgesics as prescribed if

comfort measures are unsuccessful
 Breast discomfort
• The BEST PREVENTION TECHNIQUE IS TO EMPTY
THE BREST REGULARLY AND FREQUENTLY WITH
FEEDINGS.
• The 2nd is EXPRESSING A LITTLE MILK BEFORE
NURSING, MASSAGING THE BREASTS GENTLY OR
TAKING A WARM SHOWER BEFORE FEEDING MAY
HELP TO IMPROVE MILK FLOW.
• Placing as much of the areola as possible into
the neonate’s mouth is one method. Other
methods include changing position with each
nursing so that different areas of the nipples
receive the greatest stress from nursing and
avoiding breast engorgement, which make I
difficult for the neonate to grasp.
• In addition, nursing more frequently, so that
a ravenous neonate is not sucking vigorously
at the beginning of the feedings, AND
FEEDING ON DEMAND to prevent over
hunger is helpful.

• AIRDRYING THE NIPPLES AND EXPOSING

THEM TO THE LIGHT HAVE ALSO BEEN
RECOMMENDED.
• Warm Tea bags, which contain tannic acid also,
will sooth soreness.

• WEARING A SUPPORTIVE BRASSIERE DOES NOT

PREVENT BREAST ENGORGEMENT.

• APPLYING ICE and LANOLIN DOES NOT RELIEVE

BREAST ENGORGEMENT.
 INTERVENTION:
• Measures that help relieve nipple soreness in a
breast-feeding client include:

a) lubricating the nipples with a few drops of

expressed milk before feedings
b) applying ice compresses just before feedings,
c) letting the nipples air dry after feedings, and
d) avoiding the use of soap on the nipples.
 Specific nursing care for breast
Engorgement

1. Breastfeed frequently

2. Apply warm packs before feeding

3. Apply ice packs between feedings

 Specific Nursing Care for Cracked nipples

1. Expose nipples to air for 10 to 20 minutes

after feeding

2. Rotate the position of the baby for each

feeding

3. Be sure that the baby is latched on to the

areola, not just the nipple
• NOTE:

Do not use soap on the breasts, as it tends to

remove natural oils, which increases the
chance of cracked nipples
 Inverted Nipples
a) Push the areola tissues away from the nipples,
and

b) Then grasp the nipples to tease them out of the

tissue.

c) Using a Woolrich breast shield, which pushes the

nipples through openings in the shield, also can
help overcome inverted nipples
• The LATERAL HEEL (HEEL STICK) is
the best site because it prevents
damage to the posterior tibial nerve
and artery and plantar artery.
Rubin's Postpartum Phases of
Regeneration
POSTPARTUM
PSYCHOSOCIAL
ADAPTATION
 “TAKING IN” PHASE (DEPENDENT) First 3
Days

• During this time, food and sleep are a major focus

for the client. In addition, she works through the
birth experience to sort out reality from fantasy and
to clarify any misunderstandings.

• This phase lasts 1 to 3 days after birth.

• The primary concern is to meet her own needs.

• Takes place 1-2 days postpartum
• Mother is passive and dependent; concerned
with own needs.
• Verbalizes about the delivery experience.
• Sleep/food important.
• Mother focuses on her own primary needs, such
as sleep and food
• Important for the nurse to listen and to help the
mother interpret the events of delivery to make
them more meaningful
• Not an optimum time to teach the mother about
baby care
 “TAKING HOLD” PHASE
(DEPENDENT/INDEPENDENT)

• The client is concerned regarding

her need to resume control of all
facets of her life in a competent
manner. At this time, she is ready to
learn self-care and infant care skills.
• 3-10 days postpartum
• Mother strives for independence and begins to
reassert herself.
• Mood swings occur.
• May cry for no reason.
• Maximal stage of learning readiness.
• Mother requires reassurance that she can
perform tasks of motherhood.
• Begins to assume the tasks of mothering
• An optimum time to teach the mother about
baby care.
 “LETTING GO” PHASE (INTERDEPENCE)

• 10 to 6 weeks postpartum
• Realistic regarding role transition.
• Shows pattern of life-style that includes
the new baby but still focuses on entire
family as a unit.
 Accepts baby as separate person

• 10 to 6 weeks postpartum
• Realistic regarding role transition.
• Shows pattern of life-style that includes the
new baby but still focuses on entire family as
a unit.
• Accepts baby as separate person.
– Mother may feel deep loss over separation of the
baby from part of the body and may grieve over the
loss

– Mother may be caught in a dependent/independent

role, wanting to feel safe and secure yet wanting to
make decisions

– Teenage mothers need special consideration

because of the conflict taking place within them as
part of adolescence
 POSTPARTUM WARNING S/S TO REPORT
TO THE PHYSICIAN
• Increased bleeding, clots or passage of tissue.
• Bright red vaginal bleeding anytime after
birth.
• Pain greater than expected.
• Temperature elevation to 100.4º F.
• Feeling of full bladder accompanied by
inability to void.
• Enlarging hematoma.

• Feeling restless accompanied by pallor; cool, clammy

skin; rapid HR; dizziness; and visual disturbance.

• Pain, redness, and warmth accompanied by a firm

area in the calf.

• Difficulty breathing, rapid heart rate, chest pain,

cough, feeling of apprehension, pale, cold, or blue
skin color
COMPLICATIONS OF LABOR
 DYSTOCIA
• abnormal or difficult labor and delivery
– Uterine Inertia- sluggishness of contraction

• Causes:
• Inappropriate use of analgesic
• Pelvic bone contraction
• Poor fetal position
• Over distention- due to multiparity, multiple
gestation, polyhydramnios or macrosomia
 Types
1. Primary ( hypertonic ) uterine dysfunction-
2. Relaxation are inadequate and mild, therefore,
ineffective.
3. Since uterine muscle is in a state of greater than
normal tension, latent phase is prolonged.

Treatment:
Sedation with Diazepam, provision of comfort
measures like bedbath and restful environment
• Secondary ( hypotonic ) uterine dysfunction-
contractions have been good but gradually
became infrequent and poor of quality and
dilatation ceases.

Treatment:
a) Oxytocin administration or
b) amniotomy to augment

• Ambulation and Enema if BOW is intact

 Precipitate Delivery
Precipitate delivery- labor and delivery in less
than 2-3 hours after the onset of true labor
pains.
• Common in multiparity or following
administration or amniotomy.
• Possible complications include:
• Causes of Hemorrhage
– sudden release of pressure,
– extensive laceration,
– abruptio placenta.
3.Prolonged labor

4.Uterine rupture
- occurs when the uterus undergoes
more strain than it is capable of
sustaining.
 CAUSES
• Scar from a previous classic CS
• Unwise use of Oxytocin
• Faiulty presentation
• Prolonged labor
• Overdistention
 Signs and symptoms:
• Sudden,severe pain
• Hemorrhage
• Change in abdominal contour with two
abdominal swelling; the retracted uterus
and the extrauterine fetus

Treatment:
Hysterectomy
 UTERINE INVERSION
turning inside out of the uterus
• Causes:
• Insertion of placenta at the fundus, so that as as
fetus is rapidly expelled the fundus is pulled
down
• Strong fundal push when mother fails to bear
down effectively
• Attempts to deliver the placenta before
placental separation occurs.
• Treatment: Hysterectomy
 AMNIOTIC FLUID EMBOLISM
occurs when amniotic fluid enters the maternal
circulation causing cardiopulmonary failure

• Signs and symptoms: dramatic

• = woman in labor suddenly sits up and grasps her
chest because of sharp pain and inability to breathe
• =Turns pale and becomes bluish-gray color associated
with pulmonary embolism
• =Death may occur in few minutes
 TREATMENT
• Emergency CS
• CPR measures;
• IV;
• O2 inhalation
• Inform family and provide emotional
support
 PROLAPSE UMBILICAL CORD
• The umbilical cord is displaced, either
between the presenting post and the amnion
or protruding through the cervix.
• Cord Prolapse
• Fetal Position other than cephalic
presentations

• Prematurity:
Small fetus allows more space around
presenting part.
 Predisposing Factors
• Multiple fetal gestation

• FetoPelvic disproportion

• Abnormally long umbilical cord.

• Placenta Previa
• Intrauterine tumors that prevent the
presenting part from engaging

• Breech presentation, Transverse lie,

Unengaged presenting part,

• Twin gestation,

• Hydramnios

• Small fetus
• NOTE:
First discovered when there is variable
decelerated pattern

• FHR pattern variable: Decelerations with

contractions or between contraction or
fetal bradycardia present
• Persistent non reassuring fetal heart rate –
fetal distress

• Atrophy of the umbilical cord & cord

protruding from vagina

• Cord may be palpated in cervix/vagina

• Reflex constriction when cord is exposed to

air
 LATE SIGN
• Cool, moist skin

• Dystocia
 Cardinal Sign
• Rupture of Membrane spontaneously

• The cord may then present/visible @ the

vulva.

Note:
Do not attempt to push the cord into the
uterus.
 Confirmatory Test
• Amniotomy:

Rupture of Membranes
 Best Major Surgery

• Cesarian Section if the cervix

incompletely dilated.

• Fast vaginal delivery with forceps

 Disease Complication
• #1 Maternal & Fetal Infection
• Causing compression of the cord and
compromising fetal circulation

• OTHERS:
Prematurity,
Hypoxia,
Meconium aspiration,
Fetal death if delayed or undiagnosed
 Best Position

• Trendelenberg’s position or Knee Chest

position -which causes the presenting
part to fall back from the cord.
• Turn side to side helps elevate or shift to
fetal presenting toward diaphragm.
• Best Drug

Heparin IV

> to control intravascular

coagulation in the pulmonary
circulation
 Trial Labor

If a woman has borderline ( just

adequate) pelvic measurements, but fetal
positions and presentations are good,
labor maybe continued as long as with
progressive fetal descent and cervical
dilatation.
 Treatment

• Monitor FHT and uterine contraction

• Keep bladder empty to allow all

available space for descent

• Emotional support
 Labor and Delivery
• if uterine contractions occur before 38 weeks
gestation
• If no bleeding and cervical dilatation –
premature contractions can be stopped by
drugs:

• Ethyl alcohol ( Ethanol- IV )-blocks the release

of Oxytocin
• Side effects: N&V, mental confusion
• Vasodilan, Isoxelan, Duvadilan
• Ritodrine orally- muscle relaxant
• Bricanyl
• If with bleeding and progressive cervical
dilatation occurs premature delivery is
inevitable.

• Treatment may include:

• Administration of Steroid to the mother to help

in the maturation of surfactant .

• Pain medications are kept to a minimum

because analgesics are known to cause
respiratory depression.
POST PARTUM COMPLICATIONS
 HEMORRHAGE
• CAUSES OF LATE POSTPARTUM
HEMORRHAGE IS RETAINED PLACENTAL
FRAGMENTS.

• Uterine atony and vaginal & cervical

tears are associated with early
postpartum hemorrhage
• #2 Cause

• OVER-DISTENTION OF THE UTERUS from

more than (10) pounds,

• OTHERS ARE:
> 4000 gms neonate,
> excessive oxytocin use
> Polyhydramnios and Placental Disorders.
 SIGNS OF HEMORRHAGE
• Boggy uterus (does not respond to massage)

• A boggy uterus would be palpable above the

umbilicus and would be soft and poorly
contracted.

• Abnormal clots unusual pelvic discomfort or

headache
• Excessive or bright-red bleeding

• Signs of shock

• Early Hemorrhage starts on the first 24 hours,

or more than 500 ml of blood on the first 24 hrs
in a Normal spontaneous delivery.
 MANAGEMENT

• Fluid replacement
• Emergency lap
• Oxygen
• Vital signs
• Perineal pad count
• Psychological support
Massaging the lower abdomen
after delivery is done to maintain
a firm uterus, which will aid in the
clumping down of blood vessels in
the uterus, thereby preventing
any further bleeding
• “BOGGY UTERUS
• Uterine atony means that the uterus is not
firm or it is not contracting. The nurse should
gently massage the uterus which will contract
the uterus and make it firm. Clients who are
predisposed are usually MULTIPLE
GESTATION, POLYHYDRAMNIOS, PROLONGED
LABOR and LGA (LARGE GESTATIONAL AGE
fetus.
 THROMBOPLEBITIS

– Inflammation of the vein caused by a clot

• The positive Homan’s sign indicate is possibility

of thrombophlebitis or a deep venous
thrombosis that is present in the lower
extremities.
 CURATIVE
MANIFESTATION MANAGEMENT

Edematous Preventive Immobilize

extremities extremity
Fever with Analgesics
chills Anticoagulant
Pain and Thrombolytics
redness in
affected area
Positive
Homan’s sign
INFECTION
 PREDISPOSING MANIFESTATION MANAGEMENT
FACTORS

Fever Antibiotics
Rupture of Chills Oxytocin
membranes over 24 Poor appetite Analgesics
hours before delivery General body Maintain hygiene
Retained placental malaise Semi-fowlers
fragments Abdominal pain positions
Foul-smelling lochia Vital signs
Early ambulations
Assess lochia
 PREDISPOSING MANIFESTATION MANAGEMENT
FACTORS

Internal fetal Bright red blood is a

monitoring Puerperial infection is normal lochial finding
Vaginal infection an infection of the in the first 24 hours
genital tract. after delivery. Lochia
should never contain
Early signs and large clots, tissue
symptoms of puerperial fragments, or
infection include chills, membranes. A foul odor
fever, and flu-like may signal infection, as
symptoms. It can occur may absence of lochia.
up to one month after
delivery.
 MASTITIS
• ASSESSMENT:
Elevated temperature, chills, general aching,
malaise and localized pain
Engorgement, hardness and reddening of the
breasts
Nipple soreness and fissures
Inflammation of the breast as a result of
infection
Primarily seen in breastfeeding mothers 2 to 3
weeks after delivery but may occur at any time
during lactation
 NURSING IMPEMENTATION:

 Instruct the mother in good hand washing and breast

hygiene techniques
 Apply heat or cold to site as prescribed
 Maintain lactation in breastfeeding mothers
 Encourage manual expression of breast milk or use of
breast pump every 4 hours
 Encourage mother to support, breasts by wearing a
supportive bra
 Administer analgesics & antibiotics as prescribed
Postpartum Mood Disorders
 MOOD ASSESSMENT
DISORDERS

Postpartum blues Onset:

1-10 days postpartum lasting 2 weeks
or less

Fatigue

Weeping anxiety

Mood instability
Postpartum depression
Normal processes during Onset: 3-5 days lasting more than
postpartum include the
2 weeks
withdrawal of progesterone
and estrogen and lead to the Confusion
psychological response Fatigue
known as "the blues." Agitation
Postpartum depression is a Feeling of hopelessness and
psychiatric problem that shame “let down feeling”
occurs later in postpartum
Alterations in mood “roller
and is characterized by
more severe symptoms of coaster emotions”
inadequacy. Because the Appetite and sleep disturbance
client's behavior is normal,
notifying her physician and
conducting a home
assessment aren't
 Because the According to Rubin, dependence
client's behavior and passivity are typical during the
is normal, taking-in period, which may last up
notifying her to 3 days after delivery. A client
experiencing postpartum
physician and
depression demonstrates anxiety,
conducting a
confusion, or other signs and
home assessment symptoms consistently. Maternal
aren't necessary. role attainment occurs over 3 to 10
months. Attachment also is an
ongoing process that occurs
gradually.
 Onset: 3-5 days postpartum

Postpartum Symptoms of depression plus

psychosis delusions
Auditory hallucinations
Hyperactivity
 Milk Production
Expulsion of

Placenta
Decrease of
Estrogen
And
Progesterone

Prolactin will
Stimulate Causes the
Anterior Pit. The acinar Posterior smooth
Gland cells Pit.Gland Muscles in the
To To Is stimulated Lactiferous
Produce manufacture To produce Tubules
Prolactin Milk and store OXYTOCIN To contract
In the Resulting
Lactiferous Milk ejection/
tubules Let down
reflex
 Benefits of Breastfeeding
• To infants
Provides a nutritional complete food for the
young infant
Strengthens the infant’s immune system ,
preventing many infections
Safely rehydrates and provides essential
nutrients to a sick child, especially those
suffering from diarrheal diseases
Reduces the infant’s exposure to infection
To mother
Reduces a woman’s risk of excessive blood
loss after birth
Provides a natural method of delaying
pregnancies
Reduces the risk of ovarian and breast
cancers and osteoporosis
 General Principles in Breastfeeding
• Oxytocin causes uterus to contract and
uterine cramping maybe experienced

• Wash breast without using soaps

• With flat nipples, nipple- rolling is done

• Avoid medications and gas –forming foods

• Calories should be increased to 3,000 per day
or additional 500 calories per day and 1,000ml
of fluids
• Baby’s stool will be watery, frequent and light
yellow in color
• Start with the breast used on last feeding
• Stimulate rooting to start and finish each
session by burping the baby
 Schedule of Breastfeeding
• As soon as both mother and baby is stable

• Regular and sustained sucking at the breast is 8-10

times per day

• Gradually increase time of breastfeeding foe each

breast with subsequent feedings

• Baby will develop their own schedule of feeding

 Breastfeeding problems and immediate
intervention
• 1. Engorgement
• More frequent feedings and ice
• packs

• 2. Retracted Nipples
• Nipple –rolling
• wear breast-shield

• 3. Cracked nipple
• Lubricate nipple with Vit A and D
• Rotate feeding position
• expose nipple to air 10-20 mins after feeding

• 4. No milk or Inadequate supply

• increase frequency of feeding and make interval longer