Page 217 - ترم ثاني كتاب تمريض صحة الام الكتروني

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newborn care, and self-care.

• High risk of infection secondary to episiotomy during delivery.
Planning and Implementations
• Apply two forceps on umbilical cord and cut in between.

• Carefully inspect vagina, perineum, and labia for lacerations and tears.
• Inspect vulva for bleeding, edema, and hematoma.

• Make sure that the uterus is well contracted. Flabbiness or enlargement
of the uterus indicates bleeding.
• Palpate the height of the fundus. Feeling the fundus above the umbilicus

may be due to presence of another fetus, blood clots, big placenta, or full
bladder.
• Avoid vigorous uterine massage because it may lead to irregular

contractions, and cause retained placental parts or membranes.
• Observe signs of placental separation.

• Evacuate the bladder by a catheter if the placenta is not separated within
20 minutes.
• The placenta is expelled by controlled cord traction and use of oxytocic

drugs. It is then received in the hands, and turned through a circle. This
method reduces blood loss and shortens the third stage.
• Examine the placenta and membranes for general appearance,

completeness, cord vessels, and weight.
• Estimate the average blood loss (200-600 ml).

• Clean and dry the vulva, buttocks and thighs and then apply a sterile
pad.
Evaluation (Expected Outcome)

• The placenta is expelled without difficulty.
• The physiological status of the woman remains normal.

Care of the newborn include:
1- Clearance of the air passages (nose, mouth, and pharynx) by a mucus cather or

suction pump.

2- Apgar score is determined 1 and 5 minutes after delivery of the infant

3- Aplastic clamp is applied 5cm from fetal abdomen to avoid umbilical hernia.

The cord is inspected for bleeding and painted with alcohol. The cord usually falls

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