Postnatal Abdominal Examination

Abdominal Examination (Postnatal Period)

• Postpartum assessments are crucial, using the BUBBLE-HE framework (Breasts, Uterus, Bladder, Bowels, Lochia, episiotomy/incissions, Legs homans' sign, Emotions, Bonding).

• Breasts: Assess nipples (everted, flat, inverted), breast tissue (soft, firm, etc.), temperature, and color.

• Uterus: Note location (midline or deviated), tone (firm or boggy), and the last time the bladder was emptied. Document color, odor, and amount of urine. Assess for clots/free flow.

• Bladder: Document the last time the patient emptied their bladder (spontaneously or via catheter). Assess if palpable or nonpalpable.

• Bowels: Note the date/time of last bowel movement (BM), presence of flatus, and hunger.

• Lochia: Assess color, amount, and presence of clots. Document type (e.g., lochia rubra, serosa, alba).

• Incisions/Episiotomies: Examine for pain, varicosities, warmth, discoloration, pedal pulses, sensation, and movement.

• Legs (Homans' sign): Check for calf pain during dorsiflexion of the foot.

• Emotions & Bonding: Observe patient-family interaction, effects of exhaustion, interaction with infant, etc., and note unique characteristics of the situation (e.g., "taking in" phase).

Postnatal Abdominal Examination Definition

• Abdominal palpation during the immediate postpartum period helps assess uterine involution, prevents complications from a relaxed fundus, and checks for discharge after delivery.

Objectives of Postnatal Fundal Assessment

• Evaluate involution (the returning of the uterus to its pre-pregnancy size).
• Prevent the uterus from becoming boggy and soft.
• Determine the uterus's position and consistency.
• Prevent hemorrhage and shock.

Descent of the Fundus

• The uterus should be firm, well-contracted, and in the midline.
• Immediately after delivery, the fundus should be at or below the level of the umbilicus.
• The fundal level descends gradually at a rate of about 1 fingerbreadth daily.
• By the end of the first week, it's midway between the umbilicus and symphysis pubis.
• By the second week, it's behind the symphysis pubis.
• Thereafter, it becomes a pelvic organ.

Postpartum Uterine Massage

• Keep the non-dominant hand above the symphysis pubis and use the dominant hand to massage the fundus until it's firm.

Lochia

• Lochia is the uterine discharge after childbirth.
• It's usually alkaline, fleshy-smelling, and more copious than menstrual flow.
• It contains blood, fibrin, leucocytes, decidual tissue, vaginal cells, peptone, cholesterol, and numerous non-pathogenic bacteria

Types of Lochia

• Lochia Rubra: Reddish discharge, containing blood, shreds of decidua, and other products. It lasts approximately the first 3-7 days post-delivery.
• Lochia Serosa: Pink-yellow discharge, with less blood and more serum. It lasts approximately 7-14 days post-delivery.
• Lochia Alba: Creamy or white discharge, containing leukocytes and mucus. It's the final stage, lasting approximately 10-14 days post-delivery.

Lochia Assessment Tips (amount)

• Scant/light: 1-2 inch stain
• Moderate: approximately 2-4 inch stain
• Heavy: More than 4-inch stain or saturated pad in 1 hour

Postpartum Assessment Techniques

• Explain the procedure to reduce anxiety.

• Ensure privacy and ask the patient to empty their bladder if necessary.

• Gloves are necessary.

• Position the patient in a supine position with knees slightly flexed.

• Palpate the fundus using the flat part of the fingers of one hand, keeping the other hand above the symphysis pubis.

• Document fundus consistency and location (e.g., firm, 2 fingerbreadths above umbilicus).

• Record findings accurately in the patient's chart.

Perineal Care

• Ice packs (first 24 hours)
• Warm sitz baths
• Topical agents (e.g., Epifoam)
• Gentle wiping from front to back