POSTNATAL CARE

Postnatal care includes a systematic examination of the mother and the baby and appropriate advice was given to the mother during the postpartum period. The first postnatal examination is done and the advice is given on discharge of the patient from the hospital. This has already been discussed. The second routine postnatal examination is conducted at the end of 6th week postpartum.

Aims and Objectives:

·         To assess the health status of the mother. Medical disorders like diabetes, hypertension, thyroid disorders should be reassessed.

·         To detect and treat at the earliest any gynaecological condition arising out of obstetric legacy.

·         To note the progress of the baby including the immunization schedule for the infant.

·         To impart family planning guidance.

 Procedure:

• ·         Examination of the mother
• ·         Advice given to the mother
• ·         Examination of the baby and advice

Examination of the Mother:

 Routine examination includes recording weight, pallor, blood pressure and tone of the abdominal muscles and examination of the breast.

Pelvic examination should be done only when indicated. The following should be noted: A cervical smear may be taken for exfoliative cytological examination if this has not been done previously and insertion of the intrauterine contraceptive device may be done when desired.

Laboratory investigations (e.g. haemoglobin) depending on the clinical need may be advised.

Examination of the baby: This should be conducted by a paediatrician. In this respect, a well-attached baby clinic to the postpartum unit is an absolute necessity. The progress of the baby is evaluated and preventive or curative steps are to be taken. Immunization to the baby is started.

Advice is given:

(1) If the patient is in sound health she is allowed to do her usual duties.

(2) Postpartum exercises may be continued for another 4–6 weeks.

(3) Vaccination MMR, HepB,

(4) To evaluate the progress of the baby periodically and to continue breastfeeding for 6 months.

(5) Family planning counselling and guidance

Management of ailments: 

Additional investigation and appropriate therapy is given according to the abnormalities detected during the check-up. Management of some common gynaecological problems is given below. Some women need psychological support also.

 Irregular vaginal bleeding:

 It is not uncommon to encounter irregular or at times, heavy bleeding after 4–6 weeks following an  uneventful period after delivery. This is usually the first period especially in nonlactating women and simple assurance is enough. Persistence of bleeding dating back from childbirth is likely due to retained bits of conceptus and usually requires ultrasound examination followed by dilatation and curettage operation.

Leukorrhea

The profuse white discharge might be due to ill health, vaginitis, cervicitis or subinvolution. Improvement of the general health and specific therapy cure the condition.

Cervical ectopy (erosion)

Cervical ectopy met during this period without any symptom should not be treated surgically. Hormone-induced ectopy during pregnancy takes a longer time (about 12 weeks) to regress. Thus, asymptomatic ectopy should be examined again after 6 weeks and if it still persists, cauterization is to be considered.

 Backache:

 It is mostly due to sacroiliac or lumbosacral strain. Backache over the sacrum is likely due to pelvic pathology, but if it is over the lumbar region, it might be due to an orthopaedic condition and is often relieved by physiotherapy.

Retroversion seldom produces backache. If associated with subinvolution with symptoms, a pessary is inserted after correcting the position and is to be kept for about 2 months.

The slight degree of uterine descent with cystocele, stress incontinence and relaxed perineum are the common findings at this stage. These can be cured by effective pelvic floor exercise. 

Urinary and anal incontinence: The woman is examined for any sphincter injury. Perineal exercises are advised. Women with persistent symptom after 6 months need special investigations and surgical treatment

Bibliography 

This content is from various web sources and books