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Referral and warning signs
When to refer
Transfer to PNC ward after stable period. Refer immediately if complications arise.
Red flags
- Maternal: Heavy bleeding, Boggy uterus, High BP/eclampsia signs, High fever, Resp distress, Altered consciousness.
- Neonatal: Not breathing/gasping, Hypothermia, Poor feeding/lethargy, Convulsions, Severe jaundice <24h.
Signs and symptoms
- Focus is on monitoring normal recovery and detecting complications.
- Maternal Monitoring Points: Vital signs, Uterine tone, Lochia, Perineum.
- Newborn Monitoring Points: Breathing, Warmth, HR, Activity, Colour, Cord, Feeding.
Risk factors
- Risk factors for PPH.
- Risk factors for neonatal compromise.
Diagnosis
Clinical assessment
Systematic monitoring of mother and baby.
Investigations
- Maternal vital signs.
- Uterine tone/bleeding assessment.
- Newborn assessment (breathing, warmth, activity).
Diagnostic criteria
Routine assessment for all mother-baby pairs.
Management
Non-pharmacological management
- Mother: Monitor vitals/uterus/bleeding Q15min x 2h, then hourly. Encourage urination, food/fluids. Comfort. Hygiene counseling.
- Baby: Keep warm (drying, skin-to-skin, wrap, hat). Clear airway (positioning, gentle suction if needed). Assess breathing/HR/tone (APGAR). Initiate breastfeeding (<1h). Cord care (Chlorhexidine gel daily). Eye care (Tetracycline ointment). ID tag. Weigh. Monitor temp/breathing/activity. Rooming-in.
Pharmacological treatment
- Mother: Analgesia (Paracetamol). Manage complications.
- Baby: Vitamin K 1mg IM.
Monitoring
Close monitoring mother (vitals, bleeding, uterus) and baby (breathing, warmth, feeding) for first 2-4 hours.
Complications
- Maternal: Primary PPH, Retained placenta, Tears, Eclampsia.
- Neonatal: Hypothermia, Hypoglycaemia, Respiratory distress, Birth trauma.
Prevention
- Skilled birth attendance.
- AMTSL.
- Essential Newborn Care.
Patient education
- Normal recovery.
- Self-care (hygiene, nutrition, rest).
- Perineal care.
- Breastfeeding support.
- Recognizing maternal/neonatal danger signs.
- PNC check-ups.
- Family planning.
Uganda-specific notes
High risk period. Close monitoring vital. Skin-to-skin/KMC for warmth. Chlorhexidine gel for cord care. Early BF crucial.
References
- Uganda Clinical Guidelines (UCG) 2023
Chapter 16, Section 16.4.8 (16.4.8.1 Mother, 16.4.8.2 Baby)
- Uganda Clinical Guidelines (UCG) 2023
Chapter 16, Section 16.5 (Essential Newborn Care sections)