Post Partum

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Abdominal examination during the post-natal period

(Fundal / lochial) assessment


Introduction:-
WHO describes the postnatal period as the most critical and yet the most
neglected phase in the lives of mothers and babies; most maternal and newborn deaths
occur during this period. Palpation of the uterus during the post-natal period forms part
of the daily post natal examination. It provides information about uterine involution by
assessing the height, position and tone of the uterus (not only but it’s important to
assess the lochia).
The (degree) of uterine involution will vary from woman to woman and progress
should be assessed (according) to the individual women. This is achieved by palpating
the uterus through the abdominal wall .

Definition:-

It is the tactile examination of the woman's abdomen (abdominal palpation)


during the immediate postpartum period to assess the uterine involution.

Objectives:-
1- To evaluate the involution process.
2- To determine the shape, position and consistency of the uterus.
3- To detect and locate any abnormalities (deviation from normal).4-
To prevent shock and hemorrhage.
6- To encourage muscle contraction of the uterus & reduce blood loss

-INVOLUTION OF THE UTERUS:


Involution refers to the changes that occur on the reproductive organs
particularly the uterus undergo after childbirth as they return to their non-pregnant size
& condition.

The endometrial is regenerated by the 10th day, except at the placental site,
where it takes 6 weeks.

1
Uterine involution processes:

Uterine involution begins immediately after delivery of placenta, when


uterine muscle fibers contact firmly around maternal blood vessels at the area
where the placenta was attached. This contraction controls bleeding from the area
left denuded when placenta separated, Moreover, the uterus becomes smaller as
the muscle fibers, which have been stretched for many months, contract &
gradually regain their former contour and size.

DECENT OF THE UTERINE FUNDUS


:
� At the end of the third stage of labor the uterus is in the midline,
approximately 2cm below the level of the umbilicus, with the funds resting
on the sacral promontory. Within few hours of delivery it rises to the level
of the umbilicus or slightly above it.Then descends 1 cm (fingerbreadth)
each day for about 10 days.

2
Uterine-Atony:

Is the failure of uterus to contract adequately following delivery. Contraction


of the uterine muscles during labor compresses the blood vessels and slows flow, which
helps prevent hemorrhage and facilitates coagulation. Therefore, a lack of uterine
muscle contraction can lead to an acute hemorrhage

Lochia;
lochia is a vaginal discharge after giving birth, containing blood, mucus, and
uterine tissue. Lochia discharge typically continues for four to eight weeks after
childbirth

There are three types of lochia:-

1. Lochia rubra :(or cruenta) is the first discharge, composed of


blood,shreds of fetal membranes, decidua, vernix caseosa, lanugo and membranes. It
is red in color because of the large amount of blood it contains. It lasts 1 to 4 days
2. 2-Lochia Serosa: is the term for lochia that has thinned and
turnedbrownish or pink in color. It contains
serous exudates, erythrocytes, leukocytes, cervical mucus and microorganisms.This
stage continues until around the tenth day after delivery.
3. Lochia Alba :(or purulent) is the name for lochia once it has
turned whitish or yellowish-white. It typically lasts from the second through the third
tosixth weeks after delivery

Uterine involution assessment

Equipments:

1- Disposable or sterile gloves.


2- Clean vaginal pad. 3- Rubber
sheet.3- Paper bage.

3
Techniques for assessing involution
Nursing action Rational
1-Introduce yourself and explain the procedure. - To reduce anxiety and elicitedcooperation.
2- Ask the mother to empty her bladder - A distended bladder displaces the uterus.
(if she had not voided recently.)
3- Keep privacy.
4- Wash hands. -To decrease spread of microorganisms
5- Place the mother in a supine position withher - This relaxes the abdominal muscles and
knees s lightly flexed. Ensure she is comfortable. permits accurate location of the fundus.
6- Expose the woman’s abdomen
7- Wear clean gloves, and lower the perinealpads -Gloves is recommended any time there is
to observe lochia as the fundus is possibility of coming into contact with body
palpated. fluid.
8- Place the non-dominant hand above thesymphysis - This supports and anchors the loweruterine
pubis. segment during palpation or
massage of the fundus.
9- Gently palpate the fundus using the flate - The larger surface provides more comfort
part of the fingers of the dominant hand.
10- Begin palpation at the umbilicus andpalpate
gently until the fundus is located.

10-Measure by finger breadth how far the


fundus from the umbilicus.
11- Determine its size, position (at the middle - The fundus should be firm in midline and
or displaced to either sides) and consistency approximately at the level of the umbilicus
(normally contracted and firm or boggy and
soft require massage).
12- If the fundus is difficult to locate or is soft or The non-dominant hand anchors the lower segment
boggy, keep the non- dominat hand above the of the uterus and prevents trauma while the uterus is
symphysis pubis and massage the fundus with the massaged.
dominant hand untile the fundus is firm.
The uterus contracts in response to tactile
stimulation; contraction is essential to control
excessive bleeding.
13- Put new perineal pad after performing - To promote comfort.
perineal care.
14- Recover the abdomen, assisting the woman to a
comfortable position.
15- Discuss the findings with the woman.
16- Document the consistency and location ofthe -This promotes accurate communication and
fundus. identifies deviations from the expected so that
-Consistency is recorded as “fundus firm”,“firm potential problems can be identified
with massage” or boggy early.

4
Checklist performance: - Assessing the uterine fundus & Lochia
Nursing action Done Not
Done
1-Introduce yourself and explain the procedure.
2- Ask the mother to empty her bladder (if she had not voided
recently).
3- Keep privacy.
4- Wash hands .
5- Place the mother in a supine position with her knees slightly
flexed. Ensure she is comfortable.
6- Expose the woman’s abdomen
7-Wear gloves, and lowers the perineal pads to observe lochia as the
fundus is palpated.
8- Place the non-dominant hand above the symphysis pubis.
9- Gently palpate the fundus using the flate part of the fingers of the
dominant hand.
10- Begin palpation at the umbilicus and palpate gently until the
fundus is located.
11- Note firmness and location of the fundus.
12- If the fundus is difficult to locate or is soft or boggy, keep the
non- dominant hand above the symphysis pubis and massage thefundus with
the dominant hand until the fundus is firm.
13- Make perineal care (if needed).
14- Recover the abdomen, assisting the woman to a comfortable
position.
15- Discuss the findings with the woman.
16- Document the consistency and location of the fundus.
-Consistency is recorded as “fundus firm”,
“firm with massage” or boggy>
- Fundal hieght is recorded in fingerbreadth above or
below the umbilicus.

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