Monitoring the woman and newborn during the first six hours postpartum Name of presenter: Prevention of Postpartum Hemorrhage Initiative (POPPHI) Project BASICS - PowerPoint PPT Presentation

Loading...

PPT – Monitoring the woman and newborn during the first six hours postpartum Name of presenter: Prevention of Postpartum Hemorrhage Initiative (POPPHI) Project BASICS PowerPoint presentation | free to download - id: 3de096-MWQ1N



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Monitoring the woman and newborn during the first six hours postpartum Name of presenter: Prevention of Postpartum Hemorrhage Initiative (POPPHI) Project BASICS

Description:

Monitoring the woman and newborn during the first six hours postpartum Name of presenter: Prevention of Postpartum Hemorrhage Initiative (POPPHI) Project – PowerPoint PPT presentation

Number of Views:219
Avg rating:3.0/5.0
Slides: 32
Provided by: pphpreven
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Monitoring the woman and newborn during the first six hours postpartum Name of presenter: Prevention of Postpartum Hemorrhage Initiative (POPPHI) Project BASICS


1
Monitoring the woman and newborn during the first
six hours postpartum Name of presenter
Prevention of Postpartum Hemorrhage Initiative
(POPPHI) ProjectBASICS
2
Objectives
  • By the end of this session, participants will be
    able to
  • Identify principles of care to follow when
    providing care to the woman and newborn during
    the first 6 hours after childbirth.
  • Describe how to integrate maternal and newborn
    care.
  • Monitor the woman and newborn during the first 6
    hours after childbirth.

3
Importance of monitoring the woman and newborn
during the first 6 hours
  • A large number of maternal and newborn deaths
    occur during the first few hours after the birth.
  • AMTSL will only prevent up to 60 of PPH cases.

4
Principles of care when monitoring the woman and
newborn during the first 6 hours postpartum (1)
  • Ensure the room is warm and that there are no
    drafts.
  • Monitor the woman and her newborn at the same
    time always remember to check the baby when you
    check the mother, and vice versa.
  • Document all findings, treatments, and care
    provided.
  • Keep the woman and the newborn in the delivery
    room for at least one hour and longer if their
    condition is not stable.
  • DO NOT discharge the woman or her newborn from
    the facility before at least 12 hours after
    birth.

5
Principles of care when monitoring the woman and
newborn during the first 6 hours postpartum (2)
  • Keep the woman and newborn together.
  • As far as possible, avoid leaving the woman and
    newborn alone.
  • Facilitate early initiation of infant feeding
  • Wherever possible, promote breastfeeding.
  • If the womans HIV status is positive and she
    chooses not to breastfeed, counsel about giving
    formula feeds safely.
  • Keep the baby in skin-to-skin contact with the
    mother to keep him/her warm.

6
Principles of care when monitoring the woman and
newborn during the first 6 hours postpartum (3)
  • Provide PMTCT interventions
  • Inform the woman and companion of danger signs in
    the woman and newborn and ask them to call for
    help immediately should they notice them.
  • Perform a basic, systematic examination of the
    woman and the newborn
  • At least once in the first 6 hours, but
    preferably at 1 hour and 6 hours after birth.
  • Once a day during their stay at the facility.
  • Before discharge from the facility.

7
Care for the woman after delivery of the placenta
(1)
  • Ensure the womans body, clothing, bedding, and
    environment are kept clean to prevent infection.
  • Ensure the woman has sanitary napkins or clean
    material to collect vaginal blood.
  • Encourage the woman to eat, drink, and rest.
  • Facilitate the infant feeding choice of the
    mother.
  • Encourage the woman to empty her bladder and
    ensure that she has passed urine.

7
8
Care for the woman after delivery of the placenta
(2)
  • Encourage the woman move around as much as she
    feels able.
  • If she experiences pain after delivery, provide
    paracetamol/acetaminophen to help relieve the
    discomfort.
  • Ask the womans companion to watch her and call
    for help if bleeding or pain increases, if mother
    feels dizzy or has severe headaches, visual
    disturbance or epigastric distress.
  • Provide additional care if the woman is infected
    with HIV.

8
9
Monitoring the woman during the first 6 hours
postpartum
Every 15 minutes for 2 hours, then Every 30
minutes for 1 hour, then Every hour for 3 hours
  • Blood pressure, pulse
  • Vaginal bleeding
  • Uterine contraction
  • Check the bladder (help the woman void if the
    bladder is full)
  • Breastfeeding
  • Psychological responses

Every hour for 6 hours
  • Temperature
  • Respiration

Every 4 hours
10
Maternal danger signs (1)
  • Danger Signs BP, pulse, vaginal bleeding, and
    uterus
  • Diastolic BP 90 mmHg
  • Systolic BP lt60 mmHg
  • Pulse gt110 beats/min
  • Pad soaked in less than 5 minutes
  • More than one sanitary napkin soaked in five
    minutes
  • Slow, continuous bleeding or a sudden increase in
    vaginal bleeding
  • Uterus is neither hard nor round
  • Genital laceration extending to the anus or
    rectum.

10
11
Maternal danger signs (2)
  • Danger Signs Temperature and Respiration
  • Temperature gt 38 C
  • Rapid breathing
  • Palmar or conjunctival pallor associated with 30
    respirations per minute or more (the woman is
    quickly fatigued or has rapid breathing at rest)
  • Danger Signs Bladder
  • The woman cannot void on her own and her bladder
    is distended and the woman is uncomfortable
  • Urinary incontinence

11
12
Maternal danger signs (3)
  • Danger Signs Breastfeeding
  • The baby is not taking the breast well
  • Breastfeeding has not yet been initiated
  • Danger Sign Bonding
  • Negative feelings about herself or the baby

12
13
Case study Ms. Kabongo
  • Ms. Kabongo gave birth at 120 pm. It is now 350
    pm. You assess Ms. Kabongo and find the
    following
  • BP 120/70, Pulse 88 beats/minute.
  • Uterus well-contracted vaginal bleeding lt 1
    sanitary pad since the last time you checked her
    30 minutes ago.
  • Bladder is distended and Ms. Kabongo cannot pass
    urine.
  • The newborn is breastfeeding well.
  • Ms. Kabongo looks very happy.
  • Q. Are there any danger signs?

13
14
Case study Ms. Kabongo
  • Answer
  • Danger sign Ms. Kabongos bladder is distended
    and she cannot pass urine.

15
Case study Ms. Mpo
  • Ms. Mpo gave birth at 300 pm. It is now 700 pm.
    You assess Ms. Mpo and find the following
  • BP 90/-, Pulse 120 beats/minute.
  • Uterus well-contracted Vaginal bleeding gt 7
    sanitary pads since the last time you checked her
    1 hour ago.
  • Ms. Mpo just passed urine.
  • The newborn is breastfeeding well.
  • Ms. Mpo has cold, clammy skin.
  • Q. Are there any danger signs?

16
Case study Ms. Mpo
  • Answer
  • Danger signs
  • BP 90/-, Pulse 120 beats/minute.
  • Vaginal bleeding gt 7 sanitary pads since the
    last time you checked her 30 minutes ago.
  • Ms. Mpo has cold, clammy skin.
  • Ms. Mpos bleeding is most likely due to a
    genital tear.

17
Case study Ms. Kabamba
  • Ms. Kabamba gave birth at home 4 hours ago. She
    came to the health center because she has been
    bleeding excessively. You find
  • Pulse 96 beats/minute BP 110/70 Respirations
    21/ minute Temperature 37 C. 
  • Her uterus is soft.
  • The sanitary cloths are soaked in blood she put
    this cloth there about one hour ago.
  • There are no vaginal or perineal tears.
  • Her conjunctivae are pale.
  • Her extremities are hot she is fully conscious
    and oriented.
  • She just passed a good amount of urine.
  • Q. Are there any danger signs?

18
Case study Ms. Kabamba
  • Answer
  • Danger signs
  • Her uterus is soft.
  • The sanitary cloths are soaked in blood she put
    this cloth there about one hour ago.
  • Her conjunctivae are pale.
  • Ms. Kabambas bleeding is most likely due to
    uterine atony.

19
Case study Ms. Tona
  • You assisted Ms. Tona during labor. You actively
    managed the third stage of labor. Thirty minutes
    after delivery of the placenta you notice that
    Ms. Tona has soaked 4 sanitary pads since you
    checked her 15 minutes ago. When you check her
    you find
  • Pulse 112 beats/minute BP 80/40 Respirations
    36/minute.
  • Her uterus is soft.
  • Temperature 36 C pale conjunctivae cold
    extremities.
  • Ms. Tona is very anxious.
  • You cant remember the last time she passed
    urine.
  • The newborn is breastfeeding well.
  • Q. Are there any danger signs?

20
Case study Ms. Tona
  • Answer
  • Danger signs
  • Soaked 4 sanitary pads in 15 minutes.
  • Pulse 112 beats/minute BP 80/40 Respirations
    36/minute. 
  • Her uterus is soft.
  • Temperature 36 C pale conjunctivae cold
    extremities. 
  • Ms. Tona is very anxious.
  • You cant remember the last time she passed
    urine.
  • Ms. Tonas bleeding is most likely due to uterine
    atony.

21
Monitoring of the newborn in the first six hours
  • Respiration
  • Color
  • Axillary temperature at least once and then by
    touching the extremities and the abdomen
  • (if extremities are not warm, check axillary
    temperature)
  • Make sure the cord is not bleeding
  • Ensure exclusive breastfeeding starting within 1
    hour

every 15 minutes for 2 hours, then every 30
minutes in the next 1 hour, then every hour
during the next 3 hours
Check anus at birth first stool within 24 hours
  • The first stool (meconium)
  • The first urine

First urine in 48 hours
22
Danger signs in the newborn (1)
  • Danger signs are primarily related to sepsis
    which is the leading cause of death. The first 5
    signs are the most important.
  • Poor sucking/not sucking
  • Lethargy/inactivity/moving only on stimulus
  • Fever/hypothermia
  • Respiratory difficulty (tachypnea/fast breathing
    gt 60/minute, grunting, nasal flaring, subcostal
    retractions)
  • Convulsions


23
Danger signs in the newborn (2)
  • 6. Persistent vomiting or green vomit /
    abdominal distention
  • 7. Umbilical Cord - Note danger signs related
    to severe infection will not be present in the
    first six hours of life. At this time look for
    bleeding if it is present, retie the cord.

24
Case study Baby Kabongo
  • Baby Kabongo was born at 920 am It is now 1150
    am. During routine monitoring, you find
  • The color of the palms, soles, lips, and tongue
    is pink.
  • Respiratory rate is 45/minute with no grunting or
    subcostal retraction.
  • Mother informs you that the baby breastfed for 10
    minutes.
  • Blood is oozing from the umbilicus.
  • Q. What steps should be taken?

25
Case study Baby Kabongo
  • Answer
  • Interpretation of the findings and actions
    needed
  • The only abnormality is blood oozing from the
    umbilical cord.
  • There are no real serious danger signs at this
    stage.
  • Action Retie the cord.
  • Counsel the mother.
  • Continue monitoring.

26
Case study Baby Mpo
  • Baby Mpo was born at 300 pm. Routine monitoring
    findings at 600 pm are
  • Respiratory rate 65/minute repeat count is
    70/minute.
  • Grunting.
  • Mother says that the baby sucked weakly when
    offered the breast.
  • Q. What do the findings indicate? What should be
    done?

27
Case study Baby Mpo
  • Answer
  • The baby has two danger signs breathing too fast
    and a weak suck.
  • The baby needs to be referred to the appropriate
    referral center after administration of the first
    doses of antibiotics details related to this
    will be discussed during the session on major
    infections.

28
28
29
Summary
  1. How often should the woman and baby be monitored
    during the first six hours after birth?
  2. What will you monitor in the woman?
  3. What will you monitor in the baby?
  4. How will you know if a woman is bleeding too much
    in the postpartum period?
  5. How will you know if the babys temperature is
    normal in the postnatal period?
  6. When should you examine the woman and newborn in
    the postnatal period?

29
30
Review session objectives
  • By the end of this session, participants will be
    able to
  • Identify principles of care to follow when
    providing care to the woman and newborn during
    the first 6 hours after childbirth.
  • Describe how to integrate maternal and newborn
    care.
  • Monitor the woman and newborn during the first 6
    hours after childbirth.

31
Learning activities
  • Please complete learning activities found in the
    Participants Notebook for Session 6.
  • You may work individually or in groups on the
    learning activities during breaks, in the
    evening, or in the clinical area when there are
    no clients.
  • You may correct your answers individually or with
    another participant or the facilitator.
  • See a facilitator if you have questions.
About PowerShow.com