When performing an assessment on a mother who just delivered a healthy newborn the nurse should expect to note that the fundus is positioned at which location?
Next, use the chart on Examine the woman in labour or with ruptured membranes D2-D3 to assess the clinical situation and obstetrical history, and decide the stage of labour. Show
If an abnormal sign is identified, use the charts on Respond to obstetrical problems on admission D4-D5. Care for the woman according to the stage of labour D8-D13 and respond to problems during labour and delivery as on D14-D18. Use Give supportive care throughout labour D6-D7 to provide support and care throughout labour and delivery. Record findings continually on labour record and partograph N4-N6. Keep mother and baby in labour room for one hour after delivery and use charts Care of the mother and newborn within first hour of delivery placenta on D19. Next use Care of the mother after the first hour following delivery of placenta D20 to provide care until discharge. Use chart on D25 to provide Preventive measures and Advise on postpartum care D26-D28 to advise on care, danger signs, when to seek routine or emergency care, and family planning. Examine the mother for discharge using chart on D21. Do not discharge mother from the facility before 12 hours. If the mother is HIV-infected or adolescent, or has special needs, see G1-G11 H1-H4. If attending a delivery at the woman's home, see D29. D2. EXAMINE THE WOMAN IN LABOUR OR WITH RUPTURED MEMBRANESFirst do Rapid assessment and management B3-B7. Then use this chart to assess the woman's and fetal status and decide stage of labour. View in own window ASK, CHECK RECORDLOOK, LISTEN, FEELHistory of this labour:
D3. DECIDE STAGE OF LABOURView in own window ASK, CHECK RECORDLOOK, LISTEN, FEELSIGNSCLASSIFYMANAGE
D4-D5. RESPOND TO OBSTETRICAL PROBLEMS ON ADMISSIONUse this chart if abnormal findings on assessing pregnancy and fetal status D2-D3. View in own window SIGNSCLASSIFYTREAT AND ADVISE
D6-D7. GIVE SUPPORTIVE CARE THROUGHOUT LABOURUse this chart to provide a supportive, encouraging atmosphere for birth, respectful of the woman's wishes. Communication
Cleanliness
Mobility
Urination
Eating, drinking
Breathing technique
Pain and discomfort relief
Birth companion
D8. FIRST STAGE OF LABOUR: NOT IN ACTIVE LABOURUse this chart for care of the woman when NOT IN ACTIVE LABOUR, when cervix dilated 0-3 cm and contractions are weak, less than 2 in 10 minutes. View in own window MONITOR EVERY HOUR:MONITOR EVERY 4 HOURS:
View in own window ASSESS PROGRESS OF LABOURTREAT AND ADVISE, IF REQUIRED
D9. FIRST STAGE OF LABOUR: IN ACTIVE LABOURUse this chart when the woman is IN ACTIVE LABOUR, when cervix dilated 4 cm or more. View in own window MONITOR EVERY 30 MINUTES:MONITOR EVERY 4 HOURS:
View in own window ASSESS PROGRESS OF LABOURTREAT AND ADVISE, IF REQUIRED
D10-D11. SECOND STAGE OF LABOUR: DELIVER THE BABY AND GIVE IMMEDIATE NEWBORN CAREUse this chart when cervix dilated 10 cm or bulging thin perineum and head visible. View in own window MONITOR EVERY 5 MINUTES:
View in own window DELIVER THE BABYTREAT AND ADVISE IF REQUIRED
DO NOT bandage or bind the stump.
D12-D13. THIRD STAGE OF LABOUR: DELIVER THE PLACENTAUse this chart for care of the woman between birth of the baby and delivery of placenta. View in own window MONITOR MOTHER EVERY 5 MINUTES:MONITOR BABY EVERY 15 MINUTES:
View in own window DELIVER THE PLACENTATREAT AND ADVISE IF REQUIRED
DO NOT squeeze or push the uterus to deliver the placenta.
RESPOND TO PROBLEMS DURING LABOUR AND DELIVERYD14. IF FHR <120 OR >160bpmView in own window ASK, CHECK RECORDLOOK, LISTEN, FEELSIGNSCLASSIFYTREAT AND ADVISEIF FETAL HEART RATE (FHR) <120 OR >160 BEATS PER MINUTE
D15. IF PROLAPSED CORDThe cord is visible outside the vagina or can be felt in the vagina below the presenting part. View in own window ASK, CHECK RECORDLOOK, LISTEN, FEELSIGNSCLASSIFYTREAT
D16. IF BREECH PRESENTATIONView in own window LOOK, LISTEN, FEELSIGNSTREAT
DO NOT allow the woman to push until the cervix is fully dilated. Pushing too soon may cause the head to be trapped.Next: If stuck shoulders D17. IF STUCK SHOULDERS (SHOULDER DYSTOCIA)View in own window SIGNSTREAT
D18. IF MULTIPLE BIRTHSView in own window SIGNSTREAT
DO NOT give the mother oxytocin until after the birth of all babies.
D19. CARE OF THE MOTHER AND NEWBORN WITHIN FIRST HOUR OF DELIVERY OF PLACENTAUse this chart for woman and newborn during the first hour after complete delivery of placenta. View in own window MONITOR MOTHER EVERY 15 MINUTES:MONITOR BABY EVERY 15 MINUTES:
View in own window CARE OF MOTHER AND NEWBORNINTERVENTIONS, IF REQUIREDWOMAN
D20. CARE OF THE MOTHER ONE HOUR AFTER DELIVERY OF PLACENTAUse this chart for continuous care of the mother until discharge. See J10 for care of the baby. View in own window MONITOR MOTHER AT 2, 3 AND 4 HOURS, THEN EVERY 4 HOURS:
View in own window CARE OF MOTHERINTERVENTIONS, IF REQUIRED
D21. ASSESS THE MOTHER AFTER DELIVERYAfter an uncomplicated vaginal birth in a health facility, healthy mothers and newborns should receive care in the facility for at least 24 hours after birth. Use this chart to examine the mother the first time after delivery (at 1 hour after delivery or later) and for discharge. For examining the newborn use the chart on J2-J8. View in own window ASK, CHECK RECORDLOOK, LISTEN, FEELSIGNSCLASSIFYTREAT AND ADVISE
If no problems, go to page D25. D22-D24. RESPOND TO PROBLEMS IMMEDIATELY POSTPARTUMView in own window ASK, CHECK RECORDLOOK, LISTEN, FEELSIGNSCLASSIFYTREAT AND ADVISEIF VAGINAL BLEEDING
IF ELEVATED DIASTOLIC BLOOD PRESSURE View in own window ASK, CHECK RECORDLOOK, LISTEN, FEELSIGNSCLASSIFYTREAT AND ADVISE
View in own window ASK, CHECK RECORDLOOK, LISTEN, FEELSIGNSCLASSIFYTREAT AND ADVISEIF PALLOR ON SCREENING, CHECK FOR ANAEMIA
D25. GIVE PREVENTIVE MEASURESEnsure that all are given before discharge. View in own window ASSESS, CHECK RECORDSTREAT AND ADVISE
D26. ADVISE ON POSTPARTUM CAREAdvise on postpartum care and hygiene
Counsel on nutrition
Counsel on Substance Abuse
D27. COUNSEL ON BIRTH SPACING AND FAMILY PLANNINGCounsel on the importance of family planning
Method options for the non-breastfeeding womanView in own window Can be used immediately postpartumCondoms Lactational amenorrhoea method (LAM)
Method options for the breastfeeding womanView in own window Can be used immediately postpartumLactational amenorrhoea method (LAM) D28. ADVISE ON WHEN TO RETURNUse this chart for advising on postnatal care after delivery in health facility on D21 or E2. For newborn babies see the schedule on K14. Encourage woman to bring her partner or family member to at least one visit. Routine postnatal contactsView in own window FIRST CONTACT: within 24 hours after childbirth.SECOND CONTACT: on day 3 (48-72 hours)THIRD CONTACT: between day 7 and 14 after birth.FINAL POSTNATAL CONTACT (CLINIC VISIT): at 6 weeks after birth Follow-up visits for problemsView in own window If the problem was:Return in:Fever2 daysLower urinary tract infection2 daysPerineal infection or pain2 daysHypertension1 weekUrinary incontinence1 weekSevere anaemia2 weeksPostpartum blues2 weeksHIV-infected2 weeksModerate anaemia4 weeksIf treated in hospital for any complicationAccording to hospital instructions or according to national guidelines, but no later than in 2 weeks. Advise on danger signsAdvise to go to a hospital or health centre immediately, day or night, WITHOUT WAITING, if any of the following signs:
Go to health centre as soon as possible if any of the following signs:
Discuss how to prepare for an emergency in postpartum
D29. HOME DELIVERY BY SKILLED ATTENDANTUse these instructions if you are attending delivery at home. Preparation for home delivery
Delivery care
Immediate postpartum care of mother
Postnatal care of newborn
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