By sumanOn

An hour or two after delivery when the tone of the uterus is re-established as the uterus contracts again for expelling any remaining contents. These contractions are extended by breastfeeding, which stimulates the production of the oxytocin hormone.

The First Two postpartum hour is the critical time of initial recovery from the stress of labour and delivery, requiring close observation of the mother and New-born. In this period midwives need to evaluate the mother and new-born directly related to the intrapartum period.

Basic Evaluations are-

  • Evaluation of the Uterus
  • Inspection and Evaluation of the Perineum, Vagina and cervix
  • Evaluation of the Placenta membrane and Umbilical cord
  • Repair of Episiotomy and Laceration tear if any.

Action Points are-

  • The fourth stage of labour is the stage that starts with the delivery of the placenta and lasts up to two hours.
  • Mandatory to close Monitoring of Mothers and New-born in the fourth stage of Labour as well as in the Postnatal Period Women should be kept in the Labour room for 2 hours.
  • Check and record all maternal signs every 30 minutes for 2 hr just after the delivery.
  • Maternal signs Such as- Midwife Need to evaluate these soon After Delivery to prevent maternal and New-born Complication as well as Mortality.
  • Assess Bleeding. Bleeding PV – Normal/Excessive
  • If the mother is bleeding 500 ml in 5 minutes or 1 pad soaked in 5 min Shout for help and Identify the Cause of PPH and Start Management.
  • Assess Temperature-If the mother has temp 38°C (100.5°F) and any of these symptoms
    • Chills
    • Foul smelling Vaginal Discharge
    • Lower Abdominal Tenderness
    • Rupture of Membrane >18 hr during Labour
    • Labour Period was >24 hr
  • Administered Antibiotics – Metronidazole 400 mg IV, Gentamicin 80 Mg IM and Ampicillin 1Gm IV
  • Assess the blood pressure of the mother- If Mother has systolic BP >160 or diastolic >110 with >+3 proteinuria OR BP systolic >140 or diastolic >90 with proteinuria trace to +2 along with any of Symptoms such as-
    • Severe Headache
    • Blurred Vision 
    • Breathing Difficulty
    • Epigastric Pain
    • Oliguria Or Convulsion
  • Midwives need to administer the first dose of inj. magnesium sulphate (Mgso4) and refer immediately to FRU/Higher centre OR give full dose (loading and then maintenance) if at FRU.
  • Assess Pulse of the mother (for one min).
  • Breast condition (soft/engorged).
  • Uterine Tone Soft-S Contracted-C Tender-T.
  • Episiotomy/Tear (healthy infected).
  • Pulse, blood pressure, tone of the uterus (well retracted) and any abnormal vaginal bleeding are to be watched at least 1 hour after delivery. When fully satisfied that the general condition is good, pulse and blood pressure are steady, the uterus is well retracted and there is no abnormal vaginal bleeding, the patient is sent to the ward.
  • Check and record all New-born signs every 30 minutes as per the case sheet Checklist.
  • Resp rate (per min) Give baby antibiotics if antibiotics were given to mother, or if baby has any of: Breathing too fast (>60/min) or too slow (38°C) Excessive crying.
  • Temp ( C/ F) Started skin-to-skin contact (if mother and baby are well) and KMC in pre-term and low-birth-weight babies.
  • Breastfeeding/ Suckling (yes/no) Started breastfeeding. Explain that colostrum feeding is important for the baby.
  • Activity (good/ lethargy) and muscles tone.
  • Umbilical stump (dry/bleeding).
  • Jaundice (yes/no).
  • Passed urine and stool ? (yes/no).
  • Explain the danger signs and confirm mother/companion will call for help if danger signs are present.
  • Clinical diagnosis, if any condition present: Normal Infection Jaundice Hypothermia Convulsions Death and Others.
  • Refer baby to NBSU/SNCU/FRU/higher centre if: Ÿ Any of the above (antibiotics indications) Ÿ Baby looks yellow, pale or bluish.
  • Arrange special care/monitoring for the baby if any of the following is present: c Preterm baby c Birth weight.
  • Give if mother is HIV +ve – If mother has received >24 weeks of ART, give syrup Nevirapine to baby for 6 weeks.
  • Explain the Duration of stay frequency importance of Post Natal Monitoring in PNC Ward.

Look for the danger signs-

Mother has any of:

  • Excessive bleeding
  • Severe abdominal pain
  • Severe headache or visual disturbance
  • Breathing difficulty
  • Fever or chills
  • Difficulty emptying the bladder
  • Foul-smelling vaginal discharge

Baby has any of:

  • Fast/difficulty breathing 
  • Fever 
  • Unusually cold
  • Stops feeding well
  • Less activity than normal
  • Whole body becomes yellow

Conclusion-

The first 2 hours after delivery (Stage 4 of Labor) is very critical for maternal health and may cause complications such as – PPH, Episiotomy hematoma, bleeding from undiagnosed tears etc. Similarly, the newborn may develop breathing difficulties, feeding difficulties, hypoglycaemia, hypocalcaemia, convulsions etc. These conditions are life-threatening and need immediate attention.

Beyond 2 hours of delivery, it is important to monitor the mother and baby for the above complications as well as other severe morbidities such as breast engorgement, urinary retention, fever, puerperal sepsis, sub-involutions etc. in mother and jaundice, failure to pass urine and stool, feeding/respiratory difficulties etc. in the new-borns. The mother and new-born should be discharged only after ensuring that they are free of any morbidities.

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