SECTION 3: MANAGEMENT OF THE PUERPERIUM

1. The puerperium

1.1 The period from delivery for about two hours is a dangerous time. It is during this time that many serious complications could occur. The mother needs to be very closely observed in the delivery room. Observation includes blood pressure, pulse, uterine contractions and the amount of vaginal bleeding. Special attention is directed to the uterine fundal height and bladder distension.

1.2 Micturition and defecation postpartum women are encouraged to void within 2 - 4 hours after delivery.In the presence of dysuria increase oral fluid intake. If unable to void use nursing measures like hot water compresses, acupuncture etc. If still unable to void, then an indwelling catheter is inserted. Uninary antibiotics are also indicated. Catheter can be kept for 1-2 days. Postpartum patient should be encouraged to eat more vegetables, ambulate early and resume activities in order to prevent constipation.

1.3 Uterine involution and lochia. Uterine involution is observed with hand measurement of the fundal height. The fundal height reduces by around 1-2cm every day.

Observe the color, smell, amount of lochia. Foul smell or odor indicates infection..

1.4 Perineum. Inspect the perineum daily looking for swelling, induration and discharge. Swab the perineum 2-3 times per day. Hot-wet compress with 50% magnesium sulfate alleviates perineal edema. If the wound is infected, remove suturesencourage drainage. Change antibiotics. Keep the perineum clean and dry.

1.5 Breast Feeding. Breast distension: use hot-went compresses between breastfeeding: breast-feed frequently: empty breasts emptying frequently. Galactagogue: In the event of reduced secretion galatogogues can be used. Good, healthy and balanced diet helps to provide more secretion.

The easiest way to stop breastfeeding, there are certain situations where breast feeding has to be stopped. Commonly this follows demise of the neonate.

CAbergolin is the drug of choice for breast suppression.

Cracked nipple: if symptoms are mild continue breast-feeding. If pain and tenderness is more with engorgement of the breast, then stop feeding. Acute mastitis is an indication for antibiotics.

1.6 Diet Give liquid, bland and semisolid diet within 1 hour after natural delivery, then continue with normal diet. Ensure that the food is rich in nutrition, at the right temperature and enough.

1.7 Mood swings. Observe for changes in maternal mood. Help to alleviate discomfort of the body, providing spiritual care, encouragement, and comfort.

2. Puerperium health care

2.1 Patient has got to get back to daily activities. To regain muscle tone it will be good to indulge in post natal Aerobics.

2.2 Family planning: To start to use contraceptives from the 42nd day.

Principle of contraception: to use a barrier method if breast-feeding. Contraceptive drugs if not breastfeeding.

2.3 Postpartum examination: Postpartum postpartum visit and health examination.3 postpartum visits （3rd, 14th, 28th days postpartum）.

Visit:

（1）To understand the maternal diet, sleep, urine and uterus.

（2）Check the breasts/breastfeeding.

（3）Observation of uterine involution and lochia.

（4）Observation of perineal wound, abdominal incision and general condition.

The 42nd day visit will include systemic examination and gynecological examination. The former includes measurement of blood pressure and pulse, regular test of blood and urine .The latter includes the observation of pelvic genital recovery.

（刘琼 李华）