Background

This educational package designed to assist students in developing expertise

and in depth understanding, in how to assess a woman in postpartum period
.it will help students to understand the client as a holistic individual. In
addition, develop skill and competence to function as an independent nurse,
midwifery practitioner. It will further enable the student to function as
educator, manager and researcher in postpartum assessment.
Objectives

By the end of this course, the student will be able to use problem based
learning and acquired knowledge skills and competence in postpartum
assessment: the student should know

- What is the postnatal period?

- Physiological changes that occur during postpartum period
- How to Assess postnatal women by (babbler)in first day and in subsequent
visit
- Minor discomforts and complication of pueperium
- Management of mothers during pueperium
- Education for postnatal women
- Schedule for postnatal visit according to WHO
- To know how to analyses postnatal problem according to problem based
learning.

Background
Postpartum period, is period start immediately after delivery of the
placenta until six weeks later .during this period the anatomical and
physiological change during pregnancy retern to non pregnant stat (Anna et
al 2010).the health care provider should frequently assess women , because
there allot of complication may occur during this time (Kebalepile T 2001).
Most postpartum women stay in hospitals for first postpartum hours.
were is majority of women stay two days after vaginal delivery, and three to
four after cesarean section. While the women in hospital, the nurse assess
blood loss, signs of infection, abnormal blood pressure, contraction of the
uterus, vital signs and if any abnormality present, treat early before discharge
to home. Moreover, health care provider should counsel a mother for family
planning, personal hygiene, breastfeeding, nutrition, and care of the baby
(Abd El-Razek A. 2013). The Mother also advice to come back with her
baby for assessment and examination at six weeks to be sure the return of the
reproductive organs to pre-pregnancy state. Maternal mortality rate is a good
indicator for the quality of health care provided during pregnancy and
postpartum period (Sarah V (2008)). 80 % of maternal deaths can be
avoidable if there is good assessment and intervention (WHO.1998).maternal
death occurs in first 24 hours, the most common cause is hemorrhage, and it
it account 34% in Africa. Sepsis is 10%. In sub Saharan Africa, 1.16 million
babies die in first 28 days after delivery. These deaths may occur before health
services start the care (Warren C, et al. 2002).However, most of the health
care in both developed and developing countries focused on pregnancy,
childbirth, neglected post partum care. (Thi L, pasandarnorn W, Rauyajin O
2003). Post partum services; consider neglected issue in health system in most
developing countries (Alfred O 2005) (Yu, C.Eileen, R.Lorraine, O.2006).
However; there is a lot of problem may present during postpartum period,
according to (WHO 2012); PPH is the major cause of maternal death in the
world, 88% in the first fourth hours after delivery and this need carful
assessment and treatment. So During first hour's caregiver assess uterus to be
sure it well contracted and no any signs of bleeding. Worldwide eclampsia is
the third cause of maternal death and common during first days of
postpartum period. ()
In study done in Egypt hypertensive is second leading cause of maternal
death; most serious symptoms reported in post partum period (Egypt
ministry of health 2005).
Post partum assessment
PPA; done by using acromyon (bubble -he).breasts, uterus size and
consistency, bladder distention, bowel elimination, lochia, episiotomy,
emotional response, and Homans' sign (Mary Jo. Hovey. 2007). There is
immediate nursing postpartum assessment and subsequent.
Immediate nursing postpartum assessment:
The nurses assess postpartum women for uterine tenderness, color,
amount, and odor of lochia. Monitor vital signs every 4 hours for signs of
infection. Assess knowledge and skill of perineal hygiene; teach proper
technique and assist, if necessary. Provide for adequate rest periods. Increase
fluid intake to meet recommendations. Have to positing in High Fowler's
position to promote drainage. Administer antibiotics and analgesics, as
ordered. Explain benefit of perineal washing or sitz baths and hand washing.
Encourage minimal separation from the infant and continuation of breast-
feeding, as possible .Observe for signs of septic shock: tachycardia more than
120 beats per minute, hypotension, tachypnea, and decreased urine output.

The subsequent nursing assessment: The nurses should check the firmness
of the funds at regular intervals. Then Perform fundal massage if the uterus is
boggy, inspect perineum for bleeding (color, amount and Oder of lochia,
count number of pads that are saturated in each period).assess vital signs
twice daily. Assess bowel and bladder elimination. Then evaluate interaction
between mothers, baby and family .assess Brest for encouragement and
abnormalities. More ever inspect legs for signs of thromboembolic and assess
human's sings and incisions for infection by (REEDA) redness, edema,
Ecchymosis, discharge and approximation or cleanness o the skin edges.
Lesley If the patient is Rh negative, evaluate her need for RhO(D) immune
globulin (RhoGAM). If indicated, administer the RhoGAM within 72 hours of
delivery (Sandra M et al (2006)).