Prenatal GENERAL GUIDELINES
- Identify the patient & check for ID band
- Orient the mother/ patient to health care unit
- Check for high risk consent
- Provide comfortable position as per the advice (left lateral/check for order)
- Initial assessment regular assessment includes, vital sign, electronic fetal
- heart rate, and pain
- Monitor FHS & vital signs of mother
Intra natal
- Refer the prenatal guidelines.
- Keep ready for oxygenation, suction, emergency equipment and LSCS
- Administer tocolytics and analgesics, oxytocin and prostaglandins as per the order
- Monitor & document the cervical dilation.
- Close monitor FHS, vital signs and contractions
- Assist the patient for psychological, physical support whenever required.
- Assist the obstetrician for labor as per the instruction
- Encourage for bearing down efforts during 2nd stage of labor
Postnatal
- Refer the prenatal Intra natal guidelines.
- After the delivery identify the baby with ID band with UHID no of mother and take foot print.
- Initiate breast feeding within half an hour (for natural delivery), one hour (For LSCS).
- Watch for post partal bleeding and arrange necessarily as per the Instruction by the doctor
- Assess for bleeding or clots
- Monitor vitals- hypovolemia (administer IV fluid as per order)
- Administer Inj. Oxytocin as per the order
- Inform the doctor and check for NPO order for the preparation for surgical intervention
- Prepare for blood transfusion and monitor hemodynamic stability.
- Educate about self-episiotomy care, Breast feeding techniques, positions
- Provide emotional & psychological support to patient & family with information about symptoms of psychosis and special care of baby and mother by the family.
The participates in prenatal advices as
- Health education regarding: Diet rich in Iron, proteins, calcium & fiber;
- Personal hygiene, Oral hygiene, care of bowels,
- Rest, Exercise.
- No smoking and alcohol.
- Abstinence from sex – I & III trimester.
- Drugs – Only with Doctor’s prescription.
- Watch for warning signs: swelling of feet, head ache, blurring of vision, fits, bleeding or discharge per vagina.
- Child care – Exclusive breast feeding for 6 months, Immunization as per schedule, nutrition, child rearing.
- Family planning
Participates in education and counselling of mothers in collaboration with doctors on the following specific health protection aspectsas
- Anemia – Fe, Folic acid, protein.
- Other nutritional deficiency – Protein, Vit-A, D, Iodine
- Toxemia of pregnancy – Check BP, Weight, Urine Albumin regularly, Antioxidants.
- Tetanus – Two doses of TT Vaccine
- Syphilis – VDRL test at early and late pregnancy (congenital syphilis is preventable).
- German measles – congenital malformation – prevention by administering Rubella vaccine. Before vaccination it is advisable to rule out pregnancy and effective contraception be maintained for 8 weeks.
Rh Status
- If women are Rh –ve and husband Rh +ve, she is kept under surveillance.
- If baby is Rh +ve the Rh anti D immunoglobulin is again given within 72 hours of delivery.
- Same should be done after abortion.
- The blood is examined again at 28 weeks and 34 to 36 weeks for Antibodies. Rh anti D
- immunoglobulin should be given at 28 weeks of gestation to prevent sensitization in first pregnancy
- HIV infection – prenatal screening. Infected women may choose abortion, informed decision on breast feeding.
- Genetic counseling.
- Mental preparation to undergo labour process and motherhood, breastfeeding, child care.
- Family planning sensitization, education.