GOVERNMENT COLLEGE OF

NURSING, JODHPUR (RAJ.)

POST-NATAL ASSESSMENT

Subject-Obstetrics & Gynecology Specialty-II

SUBMITTED TO - SUBMITTED BY-

Mrs. JYOTIBALA JANGID HEMLATA BHANWARIA
NURSING LECTURER M.sc (N) Final year
GCON, Jodhpur GCON, Jodhpur
 POST-NATAL ASSESSMENT
INTRODUCTION
The postpartum period, which lasts for approximately 6 weeks following delivery, is a time of rapid physical
and emotional changes. The number of changes that occur and the magnitude of these changes make the post-
partum period a potentially dangerous time. Providing care to new mothers is normally a pleasant experience,
but it is also a challenging responsibility.

AIMS:
 Demonstrate understanding of the normal and expected postpartum changes.
 Conduct thorough assessments to identify signs and symptoms of problems before they become serious
complications. 
 Initiate appropriate interventions when problems do occur.
 Prevent problems by teaching the woman appropriate ways to care for herself and her newborn.

EQUIPMENTS:
SL.NO ARTICLES PURPOSES
.
1. A trolley consists of,TPR tray To check temperature, pulse and Respiration.
2. BP apparatus and stethoscope  To check blood pressure.
3. A sterile bin with,
 2 gauze pieces  To check milk secretion.
 1 spatula  To observe tongue.
 1 right hand autoclaved gloves/paper gloves.  To observe vagina and lochia.
4. Inch tape To check fundal height
5. Torch To observe eyes, ears, nose, mouth and genitals.
6. Weighing machine To check weight of the mother.
7. Kidney tray To collect waste.

ASSESSMENT
Before beginning postpartum assessment, the nurse should review the woman’s records to determine physical
or psychosocial problems that may have been identified during labour or delivery. This review will enable the
nurse to pay special attention to those areas most at risk.

Physiologic stability is assessed by monitoring vital signs, assessing the contraction of the uterus, determining
the amount and type of lochia and assessing the tissues of the perineum.

Post-partum assessment is performed according to institutional policy. In most facilities this includes
assessments every hour until 4 hours after delivery and then at 4-8 hours intervals until discharge.

PROCEDURE:
 Explain the procedure to the woman completely and clearly.
 Ask mother to empty the bladder.
 Provide privacy and assemble articles at bedside.
 Check anthropometric measurements.
 General appearance-Looks dull/good/fair.
 Check vital signs including temperature, pulse, respiration and blood pressure.
 Head to foot examination.
 Postpartum assessments: BUBBLE HE should be checked carefully to know the deviation from normal
and prevent complications.
 B-Breast
  U-Uterus
 B-Bowels
 B-Bladder
 L-Lochia
 E-Episiotomy
 H-Homan’s Sign
 E-Emotional status

HEAD TO FOOT EXAMINATION:

HEAD: Scalp-Dandruff/ lies

Hair distribution
Colour of hair
Any surgical scars

FACE: Fore head is normal / any abnormality

EYES: Eyebrows and eyelashes

Reaction to light
Discharges/haemorrhage/any other
Visual acquity

EARS: Lowset ears/any other abnormalities.

Discharges/wax

NOSE: Deviated nasal septum/any other abnormalities

Discharges / epistaxis

MOUTH: Colour of the lips and tongue

Dental carries/any other abnormalities
Thyroid/lymph node enlargement

CHEST: INSPECTION
Symmetrical/non-symmetrical in chest movements

Breast; Symmetry of breast

Primary and secondary areola development
Montgomery’s tubercles
Nipples erected/cracked

PALPATION
Clockwise and anticlockwise palpation to check the lumps or nodules in Breasts and for breast engorgement.
Colostrums secretion in both the breast.

PERCUSSION
Check for pleural effusion

AUSCULTATION
Respiratory sounds normal/abnormal
Usually no breast changes are evident immediately following delivery. The breast should be soft, with the
nipples erect and free of any sign of redness or other irritation. A thin yellow serous fluid may be visible on the
breast.

ABDOMEN: INSPECTION
Size and shape of the abdomen
Surgical scar previous/present
Umbilicus dimpled or flattened
Striae gravidae/linea albicans

PALPATION
Fundal height
Centralization of the uterus
Diastesis of recti
Any other abnormalities/enlargement of organs

PERCUSSION
Accumulation of fluid

AUSCULTATION
Bowel sounds

UTERUS:
 Examine the fundus by placing one hand above the symphysis pubis to support the lower uterine
segment and using the side of the other hand to locate the fundus. And measure the fundal height with
inch tape. Here, the fundal height decreases 1.25cm daily to get beyond the symphysis pubis and
become a pelvic organ at 6weeks of puerperal period.
 Immediately after delivery the fundus should be firm and in the midline at approximately the level of
the umbilicus.
 Following delivery, the uterine muscle must remain in a state of contraction to prevent hemorrhage. If
the uterus is not contracting adequately, the nurse can support the lower uterine segment and use gentle
massage to increase contraction of the uterine muscle fibers.

BOWELS
Most women do not have the urge to defecate for a few days following delivery, although some may do so. Loss
of abdominal tone contributes to Problems with constipation following child birth. Fear of pain or tissue
damage during the first defecation after delivery is also common. The nurse should identify specific concerns so
that any potential problems can be addressed.

BLADDER
The urinary bladder should be assessed for the presence of distention. When the bladder becomes distended,
inspection and palpation will reveal a bulge directly above the symphysis pubis. A distended bladder
is dangerous following delivery because it will interfere with normal contraction of the uterus. The woman
should void within 4-6 hours following delivery. This time is monitored closely. The volume of the initial
voiding is typically measuring and documented. Subsequent voiding should be measured if incomplete
emptying of the bladder is suspected. Any signs or symptoms of infection, such as pain or burning with
urination should be documented and reported.

GENITALIA:
Inspect for vulval edema, hematoma and lacerations.

LOCHIA
The amount and characteristics of the lochia are assessed each time the fundus is checked. Immediately after
delivery this drainage is red and contains blood, small clots and tissue fragments.

 In case of uterine atony increases blood loss. So, general condition should be checked by monitoring
vital signs.
 The amount of lochia described as scant, light, moderate or heavy. This is determined by assessing how
rapidly perineal pads are saturated. The nurse must be careful to look underneath the woman’s buttocks and back
to make sure that the drainage is not missing the pad and pooling in the bed linens.
 For the first 1-2 hours following delivery the flow is expected to be moderate, with one or two pads
being saturated in an hour. A heavier rate of flow than this is considered excessive.
 The nurse should maintain careful records of the number of pads saturated in an hour in order to
determine overall blood loss.
 When more detailed assessment is needed, the pads can be weighed to determine blood loss more
precisely. One gram of weight is approximately equivalent to 1ml of blood.
 Less than expected flow should also be viewed with caution to determine that the uterus is contracting
and clots are not forming within the uterus or vaginal canal.
 The amount of lochia diminishes gradually over time. Lochia changes colour and consistency as healing
of the endometrium takes place.

EPISIOTOMY:
The woman should be positioned in lithotomy position and good room light or flash light is needed to
visualize the stitches/suture line adequately.

REEDA should be observed,

R-Redness
E-Edema
E-Ecchymosis
D-Discharges
A-Approximation of suture line

RECTUM: Inspect for hemorrhoids.

EXTREMITIES:
 Any congenital abnormalities syndactyly/polydactyl
 Capillary refill

HOMAN’S Sign
 Problems related to venous stasis generally begin during the last few months of pregnancy when the
enlarged uterus restricts the return of blood to the heart. These problems are further aggravated by
pressure on the femoral veins during bearing down and use of stirrups during delivery. Impaired venous
return increases the risk of thrombus formation.
 The nurse inspects both the legs for any signs of superficial or deep vein thrombosis (DVT) formation,
such as pain in the calf muscle, warmth, redness or swelling.
 Both the legs are checked for the presence of Homan’s sign, which is an indicator of venous thrombosis. With
the woman lying in the supine position, the nurse supports the knee of one leg while dorsi flexing the
foot.
 Homan’s sign is considered positive when the woman reports pain, not just stretching sensation in the calf.

EMOTIONAL STATUS

Relationship with the newborn and family dynamics:

The early postpartum period is the ideal time for bonding between mother and newborn. The immediate family
should have the opportunity to spend time with each other and the newborn while their emotions and level of
excitement are high.
The nurse should provide privacy and encourage the family to interact with a minimum amount of interruption.
And the rooming-in or bonding should be developed between mother and the baby.

Self-care ability:
 The nurse must assess the woman’s ability to care for herself and her newborn.
 Documentation of procedure and informing the deviations from normal to the physicians.
 Education to the mother regarding personal hygiene, postnatal diet,postnatal exercise,breast feeding
techniques, immunization schedule and care of the newborn.
 Replace the articles.
CONCLUSION:
The postpartum period is a time of major adjustments. With short hospital stays the nurse must work efficiently
and effectively to complete all of the necessary assessments, teaching and other interventions that the new
mother requires.

BIBLIOGRAPHY:
1.Gloria Hoffmann Wold;“Contemporary maternity nursing”, Mosby
publications, Philadelphia,1997,page no.258-264. 
2. B.T Basavantappa;”Text book of midwifery and Reproductive healthnursing”, Jaypee publications, Newdelhi
,2006,page no. 381-397.