Puerperium Period Research Articles

RELATIONSHIP BETWEEN EMERGENCY OBSTETRIC HYSTERECTOMY AND MATERNAL AGE

Removal of the uterus at the time of delivery or within the puerperium period is known as emergency obstetric hysterectomy. Obstetric hysterectomy is a lifesaving procedure performed in cases of uncontrolled uterine haemorrhage in placenta previa, placenta accrete, or uterine atony. Being one of the important factors in uterine morbidity, maternal age has also a role in emergency obstetric hysterectomy. The present study was performed to identify the relation between maternal age and emergency obstetric hysterectomy. The study was conducted in tertiary care centres and medical colleges of Gujarat from May 2010 to January 2020. Data was collected from 169663 patients who delivered during the study period, 291 patients underwent emergency obstetric hysterectomy were studied for the objectives of the study. 58.07% (169 out of 291) patients in the study were more than 35 years of age. The study found a statistically signicant relationship between the maternal age and incidence rate. Summary: The incidence rate of emergency obstetric hysterectomy increases with the maternal age.

Active pharmacovigilance of the seasonal trivalent influenza vaccine produced by Instituto Butantan: A prospective cohort study of five target groups

Active pharmacovigilance studies are pivotal to better characterize vaccine safety. These are multicenter prospective cohort studies to evaluate the safety of the 2017 and 2018 seasonal trivalent influenza vaccines (TIVs) manufactured by Instituto Butantan, by means of active pharmacovigilance practices. Elderly, children, healthcare workers, pregnant women, and women in the puerperium period were invited to participate in the study during the 2017 and 2018 Brazilian national seasonal influenza vaccination campaigns. Following immunization, participants were observed for 30 minutes and they received a participant card to register adverse events information. All safety information registered were checked at a clinical site visit 14 days after immunization and by a telephone contact 42 days after immunization for unsolicited Adverse Events (AE) and Guillain-Barré Syndrome (GBS). A total of 942 volunteers participated in the two studies: 305 elderly, 109 children, 108 pregnant women, 32 women in the postpartum period, and 388 health workers. Overall, the median number of AR per participant ranged from 1 to 4. The lowest median number of AR per participant was observed among healthcare workers (1 AR per participant) and the highest among pregnant women (4 AR per participant). Overall, local pain (46.6%) was the most frequent solicited local AR. The most frequent systemic ARs were: headache (22.5%) followed by fatigue (16.0%), and malaise (11.0%). The majority of solicited ARs (96%) were mild, Grades 1 or 2), only 3% were Grade 3, and 1% was Grade 4. No serious AEs, including Guillain-Barré Syndrome, were reported up to 42 days postvaccination. The results from the two studies confirmed that the 2017 and 2018 seasonal trivalent influenza vaccines produced by Instituto Butantan were safe and that active pharmacovigilance studies should be considered, when it is feasible, as an important initiative to monitor vaccine safety in the post-marketing period.

The beneficial effects of fractional CO2 laser treatment on perineal changes during puerperium and breastfeeding period: a multicentric study.

Childbirth is a great change in woman life because of hormonal, physical and psychological alterations that are associated with this process. Dyspareunia and perineal pain are commonly reported symptoms in the postpartum period, mainly due to perineal trauma, lacerations, episiotomy, and forceps or vacuum use at delivery. Among non-pharmacological treatment, a new trend is gaining popularity, which is the energy-based therapy, including fractional micro-ablative CO2 laser. We conducted a multicentric retrospective study to assess the efficacy and the possible side effects of CO2 laser treatment on transient vulvovaginal atrophy and perineal postpartum pain related to puerperium and breastfeeding period. All patients were submitted to 3 or 4 sessions of CO2 laser treatment. As per protocol, an initial, intermediate (after 2 sessions) and final (3months after the last cycle) evaluation of the symptoms were made, using a VAS (Visual Analogue Scale 0-10). We also compared this group of patients with a control group with no treatment. At the final evaluation, patients showed a significant improvement for dyspareunia (VAS from 7.95 to 3.14, p < 0.0001). A significant improvement was also registered in pain at the vaginal orifice (VAS from 6.94 to 2.05, p = 0.0001), dryness (VAS from 6.6 to 2.9, p = 0.0022), itching (VAS from 4.5 to 1.16, p = 0.0053), heat (VAS from 3 to 0, p = 0.0119) and burning (VAS from 5.5 to 1.6, p = 0.0013) if compared with the control group. Quality of life for the women during the breastfeeding and puerperium is important and training is mandatory to avoid side effects in order to improve the CO2 laser performance.

Analysis of Maternal Deaths in Suburban of Dakar, Senegal

Objective: Maternal mortality remains a major concern in developing countries. This survey aims to suggest strategic plans that would help decrease maternal and perinatal mortality in the suburbs. It is a descriptive study that shows the different causes of maternal deaths during pregnancy and puerperium period. Methods: It is a retrospective descriptive study done between January 1st 2016 and the 31st of December 2018. We have collected information on all deaths due to mortality issues in Five (5) maternity clinics around Dakar. The record shows that teach centre have an average of 4000 deliveries per year. The data collected from the hospital records were inputted using Sphinx software (version 5). These data were analysed using Epi Info software (version 3.5). After analysing these data, recommendations were made to minimize the different causes of maternal deaths. Results: We recorded 154 maternal deaths out of 32,420 live births. The direct causes of maternal deaths were a result of preeclampsia and its complications (31.2%), postpartum haemorrhage (24.7%), abruption placentae (20.8%) and obstructed labour (7.8%). The indirect causes were mainly sickle cell disease (1.3%), heart disease (1.3%) and gynaecological cancers (1.3%). Maternal deaths were also associated with fetal loss in 47.4% of 153 maternal deaths, need for blood transfusion 59% while none of the reference structures in the suburbs of Dakar has a blood bank; with a need for admission in intensive care unit was noted as 40%. Conclusion: Thus, preeclampsia and its complications are the leading cause of maternal deaths in suburban settings. Timely availability of resuscitation units and liable blood products could drastically reduce maternal deaths from direct obstetric complications.

FACTORS THAT INTERFERE IN THE QUALITY OF LIFE RELATED TO THE HEALTH OF WOMEN IN THE POSTPARTUM PERIOD IN NORTHEASTERN BRAZIL

ABSTRACT Objective to analyze the sociodemographic, obstetric, type of delivery and professional factors that provided care that can influence the quality of life related to women's health in the immediate puerperium period. Method cross-sectional, correlational study conducted in a reference maternity hospital, with 272 women in the immediate puerperium period hospitalized in the rooming-in accommodation. A sociodemographic, clinical and obstetric questionnaire and the Short Form Health Survey-36 scale were used to assess health-related quality of life. Results regarding age, there was a significant association in the domains functional capacity and general status, with better scores for ages up to 29 years. Regarding education, significance was observed in the functional capacity domain with better scores for 9 to 11 years of schooling. The analysis of obstetric complications showed statistical significance in the general health status domain p&lt;0.05. By correlating the type of delivery and the attending professional, the mean scores showed that the domains limitation due to physical aspects, pain, vitality, social aspects, limitations due emotional aspects and mental health presented higher means for normal delivery performed by nurses, with statistical significance in the domains: pain (p&lt;0.05), vitality (p&lt;0.05) and mental health (p=0.05). Conclusion these analyzed factors interfere in the quality of life of women in the postpartum period. Thus, considering these questions provides complementary information to the use of the Short Form Health Survey-36, highlighting areas that need greater attention and that can be worked on even in prenatal care.

Relationship between patient ethnicity and prevalence of anemia during pregnancy and the puerperium period and compliance with healthcare recommendations - implications for targeted health policy

BackgroundAnemia is common during pregnancy and the puerperium. The association of ethnicity as well as other characteristics with anemia and compliance with healthcare recommendations has not been studied sufficiently and needs to be explored in order to implement a targeted health policy. We examined the association between ethnicity and the risk for prenatal and puerperium anemia and the compliance with healthcare recommendations. This effort aims to guide reforms in policies and practices that will assist in decreasing anemia prevalence in Israel.MethodsThis study was a secondary analysis of a prospective cohort study database including 1558 women who delivered vaginally at Emek Medical Center. Anemia was assessed before delivery by obtaining a complete blood count (CBC). After delivery, CBCs were taken in cases of postpartum hemorrhage, symptoms consistent with anemia, prenatal anemia or other clinical indications. The study population was divided according to their ethnicity (Jews and Arabs).The primary outcomes were anemia before delivery, anemia in the immediate postpartum and 6 weeks postpartum, and compliance with healthcare recommendations, which was defined as the rate of women who performed a routine CBC test 6-weeks-postpartum.ResultsThe rates of anemia before delivery and in the puerperium period were similar between Jews and Arabs (before delivery: 88 (11%) versus 98 (14%); 6 weeks postpartum: 55 (21%) vs 68 (28%), respectively;p > 0.05). Iron supplementation was high in both groups during pregnancy (~ 90%) and lower during the postpartum for Jews compared to Arabs (72% vs 83%,respectively; P < .0001). Only one third of the patients performed a CBC 6-weeks-postpartum regardless of ethnicity.ConclusionOverall compliance with health recommendation was high during pregnancy but low postpartum and was reflected in anemia persistence regardless of ethnicity.Because of the adverse long term impact of anemia on patient’s health, new policies need to be developed to improve patient’s compliance postpartum. A possible strategy is to combine the follow-up of the mother with the one of the newborn in the family health stations (Tipat Halav) and the community clinics similarly to the close follow-up during pregnancy. Additional methods may include active summoning for CBC test and assuring iron supplement consumption.

THE DIFFERENCES IN HEALTH EDUCATION ON HAZARD SIGNS IN POSTPARTUM USING THE MEDIA FLIP CHART AND LEAFLETS ON KNOWLEDGE OF POSTPARTUM MOTHERS IN AURA SYIFA HOSPITAL KEDIRI

Most maternal deaths occur during the puerperium period so that health workers should be more careful in handling postpartum mothers. There were 8 of the 10 (80%) normal primiparous postpartum mothers in the Aura Syifa Hospital Puerperal Room who did not know about the danger signs during the puerperium. Providing information and health education regarding danger signs during puerperium is one of the efforts in dealing with this. Health education is carried out using the media of leaflets, booklets, flipcharts, and audiovisuals. The purpose of this study was to determine the differences in health education about danger signs during puerperium using flip chart and leaflet media on knowledge of postpartum mothers in Aura Syifa Hospital Kediri. This study used a Pre-Experimental research design with research design using posttest design. The sampling technique used is simple random sampling. The number of samples in this study were 32 respondents who were in accordance with the inclusion and exclusion criteria which were divided into 2 groups. The Data was collected using questionnaires and data were analyzed using the Mann Whitney U-Test statistical test with a significance value of 0.05. The results of the study shows ρ value of 0.002 &lt;0.05, which means that there is a significant difference in health education about danger signs during puerperium using flip chart media and leaflets on knowledge of postpartum mothers. Thus it is known that flip chart media is more effective than leaflet media in health education on the knowledge of postpartum mothers about danger signs during the puerperium.

Puerperium Döneminde Gerçekleşen Venöz Sinüs Trombozu Olgusu

Venöz sinus trombozu nadir görülen derin komadan izole baş ağrılarına kadar farklı şekilde semptom verebilen bir durumdur.Fakat %60 vakanın gebe ve lohusalık döneminde artan pıhtılaşma faktörlerine bağlı olarak bu dönemlerde görüldüğü saptanmıştır.Olgumuzda eylemde ikiz gebelik nedeniyle C/S abdominale ile doğum yapan hastamızın postpartum 12.gününde geçirdiği tonik kloniknöbeti sonrası yapılan intrakranial görüntülemede venöz sinus trombozu tespit edilmiştir.Erken tanı konulmadığı takdirde morbiditeve mortalitenin yüksek olduğu bu durumda hastanın tanı sonrası 5gün yoğun bakım 5 gün serviste tedavisi gerçekleştirilmiştir. Bizgebelikte ve puerperium döneminde görülme ihtimali artan venöz sinus trombozu olgumuzu sizle paylaşarak sadece izole baş ağrısıile bile klinik olarak prezente olabilen morbidite ve mortalitesi yüksek olan durum hakkında farkındalığı arttırmak istedik.

Pregnancy outcome in systemic lupus erythematosus patients: a monocentric cohort analysis.

SLE is an autoimmune disease, mainly affecting women of childbearing age, with possible impact on pregnancy. In this study, we evaluated pregnancy outcomes in all pregnant patients affected by SLE, followed in the context of a rheumatology/gynaecology multi-disciplinary team. Since 2008, we evaluated 70 consecutive pregnancies occurring in 50 SLE patients referring to the Lupus Clinic of Sapienza University of Rome; as controls we evaluated 100 consecutive pregnancies in 100 women without autoimmune diseases. By comparing SLE patients and controls, we did not find differences in terms of pregnancy outcomes, except for the occurrence of small for gestational age, which was significantly higher in the SLE group (22.8% vs 11%, P=0.003). Small for gestational age was associated with the positivity for anti-dsDNA, anti-Sm and anti-RNP (P=0.009, P=0.02, P=0.002, respectively). A disease flare was reported in 28 pregnancies (40%) and in 31 puerperium periods (44.3%). Flare during pregnancy was associated with anti-SSA (P=0.02), while puerperium relapse with previous MMF treatment (P=0.01) and haematological flare during pregnancy (P=0.03). The present study confirms how pre-gestational counselling and a multi-disciplinary approach could result in positive pregnancy outcomes for SLE patients. The high percentage of disease relapse justifies even more the need for multi-disciplinary management.

Cerebral Venous Sinus Thrombosis in Women: Subgroup Analysis of the VENOST Study.

Background Early diagnosis of cerebral venous sinus thrombosis (CVST) associated with reproductive health-related risk factors (RHRF) including pregnancy, puerperium, and oral contraceptive (OC) use can prevent severe neurological sequelae; thus, the symptoms must be documented in detail for each group. Methods Out of 1144 patients with CVST, a total of 777 women were enrolled from a multicenter for the study of cerebral venous sinus thrombosis (VENOST). Demographic, biochemical, clinical, and radiological aspects were compared for 324 cases with RHRF and 453 cases without RHRF. Results The mean age of the RHRF (-) group (43.2 ± 13 years) was significantly higher than of the RHRF (+) group (34 ± 9 years). A previous history of deep venous thrombosis (3%), isolated cavernous sinus involvement (1%), cranial neuropathy (13%), comorbid malignancy (7%), and its disability scores after 12 months (9%) were significantly higher in the RHRF (-) group. The RHRF (+) group consisted of 44% cases of puerperium, 33% cases of OC users and 23% of pregnant women. The mean age was found to be higher in OC users (38 ± 9 years). A previous history of deep venous thrombosis was slightly higher in the pregnancy subgroup (4%). Epileptic seizures were more common in the puerperium group (44%). Conclusion The results of our study indicate that the risk of CSVT increases parallel to age, OC use, and puerperium period. In addition, when considering the frequency of findings and symptoms, epileptic seizures in the puerperium subgroup of the RHRF (+) group and malignancies in the RHRF (-) group may accompany the CSVT. In daily practice, predicting these risks for the CSVT and early recognition of the symptoms will provide significant benefits to patients.

Expulsion rate of intrauterine device: mediate vs. immediate puerperium period

Objective:To evaluate the rate of expulsion of intrauterine device (IUD) inserted during the immediate and mediate puerperium. To evaluate whether the type of delivery is a predictor of expulsion of the IUD when inserted in the puerperium period.Material and Methods:This was a prospective observational study. Patients whose IUD (TCU-380 copper) was placed during the puerperal period were divided in two groups according to the time of placement: immediate and mediate puerperium. The decision regarding the time of IUD insertion was made in a non-randomized manner. Analysis was performed using chi-square, Mann-Whitney U, and Spearman’s correlation tests and logistic regression analysis.Results:The total rate of IUD expulsions was 28.8% (49/170). There was no significant association between the occurrence of expulsion and the timing of IUD insertion (immediate vs mediate puerperium; 26.6% vs 34.78%, p=0.296). Among patients experiencing expulsion, 79.6% (39/49) underwent insertion after vaginal delivery and 20.4% (10/49) during cesarean section (CS). The type of delivery was a significant predictor for IUD expulsion (p<0.0001). Vaginal delivery was fourfold more likely to be associated with IUD expulsion inserted in the puerperal period than CS (odds ratio: 4.23, 95% confidence interval: 1.94-9.25). There was no significant correlation between the period between IUD insertion and the diagnosis of expulsion in regard to number of pregnancies (r=-0.160, p=0.271) or gestational age at delivery (r=-0.058, p=0.939).Conclusion:Vaginal delivery was the most prevalent type of delivery in patients who underwent IUD insertion during the immediate and mediate puerperium. The risk of IUD expulsion after vaginal delivery was greater than CS.

Purpura fulminans complicating puerperal sepsis: A case report.

Reports of purpura fulminans (PF) complicating pregnancy and the puerperium period are limited in the existing literature. The present study reports a case of puerperal sepsis with multiple organ dysfunction causing disseminated intravascular coagulation (DIC) and PF. Written informed consent for this study was obtained from the patient. A 30-year-old P3L3 woman presented eight days postpartum, following an uneventful vaginal delivery, with high-grade fever, loose stools and cough for three days, and bluish discoloration of the right ankle which rapidly progressed to involve the limbs, abdomen, and perineum.

SUTIKASRAVA (LOCHIA) IN AYURVEDA – AN OBSERVATIONAL STUDY

Ayurveda gives importance to the care of mother and her baby at every phase of her life under antenatal care and post-natal care. A post-natal period comes just after the expulsion of placenta up to 6 weeks thus defined as Puerperium and duration called as Puerperium period. Lochia is a vaginal discharge for the first fortnight during puerperium. The discharge originates from the uterine body, cervix and vagina. It is a cleansing discharge which stays for ten or twelve days after delivery in common practice. Lochia is of 3 types Lochia Rubra, Lochia Serosa and Lochia Aba. In Ayurveda the term Sutika can be used only after the expulsion of placenta. Sutika is more prone to diseases due to aggravation of Doshas. Also, she is more prone to infections which is called as Lochial Infection. A 45 patient’s observational data collected from Ayurveda College for the study.

Ultrasonographic examination of postpartum uterine involution in sows

Physiological uterine involution during the puerperium period is essential for sow reproductive health. Uterine involution in sows has mainly been described using macroscopic and histological examination after slaughter. The aim of this study, therefore, was to describe the continuous regression of uterine diameter from day 2–14 after parturition and on the day before weaning using ultrasonography in sows housed in a free farrowing system and in farrowing crates. Diameter of three uterine cross-sections was measured at 24 -hs intervals in 46 sows housed in a free farrowing system in Switzerland and 49 sows housed in farrowing crates in Germany. Overall, there was continuous regression of uterine diameter during the lactation period in both groups. Median diameter of the uterus decreased from 32.4 mm (min: 18.6 mm, max: 52.3 mm) on day 2–9.0 mm (min: 7.6 mm, max: 12.7 mm) on the day before weaning (on average 30 days p.p.) in sows housed in free farrowing systems. Median diameter of the uterus of sows in farrowing crates decreased from 38.5 mm on day 2 (min: 21.6 mm, max: 56.3 mm) to 10.1 mm (min: 8.8 mm, max: 13.6 mm) the day before weaning (on average 29 days p.p.). Interestingly, parity, obstetrical intervention and administration of oxytocin was not associated with the decrease of uterine diameter during the study period. In summary, the ultrasonic examination is a suitable method to evaluate diameter of the uterus during the puerperium period in sows and to describe uterine involution in vivo.

Personal and Family Resources Related to Depressive and Anxiety Symptoms in Women during Puerperium.

Introduction: This study investigated the relationship between personal and family resources (i.e., social support, family functioning, self-efficacy in care, sense of coherence and perceived burden of care) and depressive and anxiety symptoms in women during the puerperium, adjusting for stressors. Methods: This is a quantitative research design, carried out through a descriptive, cross-sectional correlation study. This study includes 212 women over the age of 19 who gave birth from March to September 2019 in Maternal and Child Hospital of Jaén (Spain). Women were selected during the immediate postpartum period. The variables analysed were postpartum depressive symptoms (Edinburgh scale), anxiety symptoms (STAI state anxiety questionnaire), perceived social support (Duke-UNC-11), family functioning (family APGAR), self-efficacy in care (Lawton), sense of coherence (SOC-13), perceived burden (Caregiver Strain Index) and stressful life events (Holmes and Rahe). The main analysis consisted of a multiple linear regression. Results: The regression model of depressive symptoms found a positive association with perceived burden (β = 0.230, p = 0.015) and negative associations with self-efficacy in care (β = −0.348, p < 0.001), social support (β = −0.161, p < 0.001) and sense of coherence (β = −0.081, p = 0.001). The regression model of anxiety symptoms obtained a positive association with perceived burden (β = 1.052, p < 0.001) and negative associations with self-efficacy in care (β = −0.329, p = 0.041), social support (β = −0.234, p = 0.001) and sense of coherence (β = −0.262, p < 0.001). Discussion: Firstly, depressive and anxiety symptoms in the puerperium period may be more prevalent than in other periods of a woman’s life. Secondly, perceived social support, self-efficacy in caring for the newborn and sense of coherence may be protective factors for depressive and anxiety symptoms in the puerperium period. Finally, perceived burden in caring for the newborn may be a risk factor for these symptoms.

Bilateral corpus callosum and corona radiata infarction due to cerebral venous sinus thrombosis presenting as headache and acute reversible aphasia: a rare case report

BackgroundCerebral venous sinus thrombosis (CVST), a rare cause of cerebral infarction, is often unrecognized at initial presentation. We report the case of a patient with bilateral corpus callosum and corona radiata infarction due to cerebral venous sinus thrombosis presenting as headache and acute reversible aphasia.Case presentationA 30-year-old female patient presented with headache, vomiting, and motor aphasia. She was 20 days post-partum and had a lower than normal food intake following a normal vaginal delivery. Brain magnetic resonance images revealed a bilateral corpus callosum and corona radiata infarction. MR venography (MRV) and digital subtraction angiography (DSA) images showed a signal void in the anterior aspect of the superior sagittal sinus and inferior sagittal sinus, ophthalmic vein expansion, and the reversed direction of venous flow. In addition, images showed non-visualization of the left transverse sinus. The left slender sigmoid sinus and small internal jugular vein were also noted. The diagnosis of cerebral venous thrombosis was considered based on the above findings. The patient was managed with anticoagulation therapy, and recovered substantially after treatment.ConclusionsBilateral corpus callosum and corona radiata infarction is very rare. However, for patients who clinically show cranial hypertension and neurological deficits during the puerperium period, the possibility of CVST should be considered. Furthermore, DSA plays an important role in the diagnosis of CVST, and should be routinely checked. Early diagnosis is crucial for the patient suffering from CVST.

THE Sutika Katishoola Nidan Panchaka and Chiktsa Sutra (Treatment Principles) According to Ayurveda – A review

Post-natal Low Back Pain (LBP) and pelvic pain are common problems in the postpartum period. Acharya Charaka and all other classics have given a definite period for specific dietetic management of Sutika which can be considered as normal period of puerperium. Changes in lead to Ati Aptarparpana, exhaustion of mother during Sutika-kala. Which causes Vata Vriddhi which is responsible for Vata vyadhis like Low-Backache in women. In Ayurveda, Kashyap Samhita mentions 74 Sutika diseases which includes Sutika Katishula as a Sutika Diseases. Proper Nidana Panchaka of Sutika Katishoola is not given in the texts but as it happens due to Vataprakopa thus scattered data has been put under heading.

Study on knowledge about postnatal care among mothers in selected urban communities

In the maternity cycle post natal period is a danger time, because maternal &amp; also new born deaths occur during this period, particularly just after the childbirth. So postnatal care in the first hour &amp; days after childbirth could stop the mass of these deaths. To find the knowledge about postnatal care use among mothers in selected urban communities. It was a descriptive type of cross sectional study conducted purposively in selected 200 mothers who completed their puerperium period and had child birth within 3 months. Data was collected by self administered questionnaire. The study was conducted in selected vaccination centers of Mohakhali, Dhanmondi and Mohammadpur. The total period of study was 1 year from January to December 2014. Among 200 respondents them mean age was 25.02(±SD 6.53) years. Majority 184(92 %) were literate and 67% were housewife. About 93(46.5%) had 3-4 members in their family. 170(85%) were Muslims. About 191 (95.5%) had knowledge about PNC and 187(93.5%) used PNC. 106(56.7%) were used PNC for routine follow up. The respondent who knew about PNC more used that care than who had no knowledge about that (p&lt;0.05). This study assessed the knowledge of mothers on their use of post natal care. The findings of the study indicated that postnatal service was quite satisfactory but still some intervention needed. Regular monitoring and supervision would certainly improve the quality of postnatal care service in Bangladesh.

GAMBARAN KONSELING YANG DIPEROLEH PADA KUNJUNGAN NIFAS KE-4 DI WILAYAH KERJA PUSKESMAS ROWOSARI 1 KABUPATEN KENDAL

The postpartum period is a transition period for the mother, baby and family physiologically, emotionally and socially. The low quality of health services can lead to low success in health promotion and early detection and adequate management of problems from diseases that arise in the postpartum period. The aim of the study was to described the counseling obtained by postpartum mother at the fourth postpartum visit. This study uses a descriptive method, with a survey approach. The population was all post-partum mothers who received the fourth postpartum attendance in the area in Public Health Care of Rowosari 0I. The number of samples was 34 respondents. The sampling technique used saturated samples. The results showed that the counseling was obtained at the fourth postpartum visit was still based on the complication history of the puerperium period which was still not good (76.47%), and based on family planning counseling that was still not good (79.41%). The midwives should assessing the mother complications and providing family planning counseling

Midwifery Care in the Postpartum Period with After Pains Discomfort at the Maternity Hospital

The puerperium period begins after giving birth and ends when the uterus returns to its pre-pregnancy condition, in which six weeks the process occurs. After pains are the sensation of heartburn and produce pain that lasts during the puerperium due to periodic contractions and relaxation of the uterus which usually lasts two to four days. The results showed that the incidence of after pains was 50% in the 26-30 year age group and 40% in the third parity group. The purpose of this study was to determine postpartum care with discomfort after pain. Case study method using descriptive method. The case study was carried out at PMB Dadang Ratih Jambangan Sidoarjo which was conducted on December 30, 2019. Midwifery care was carried out by history taking, physical examination, diagnostic analysis, management and evaluation. The care provided went well without a hitch and there were no complications. The development of the research obtained is based on the accumulation of data from anamnesis to evaluation.