On Day 3 postpartum Cindys fundus is in the midline, firm, and 1 cm below the umbilicus
D2. EXAMINE THE WOMAN IN LABOUR OR WITH RUPTURED MEMBRANESFirst do Rapid assessment and management B3-B7. Then use this chart to assess the woman's and fetal status and decide stage of labour.
Next: Perform vaginal examination and decide stage of labour D3. DECIDE STAGE OF LABOUR
Next: Respond to obstetrical problems on admission. D4-D5. RESPOND TO OBSTETRICAL PROBLEMS ON ADMISSIONUse this chart if abnormal findings on assessing pregnancy and fetal status D2-D3.
Next: Give supportive care throughout labour D6-D7. GIVE SUPPORTIVE CARE THROUGHOUT LABOURUse this chart to provide a supportive, encouraging atmosphere for birth, respectful of the woman's wishes. Communication
Cleanliness
Mobility
Urination
Eating, drinking
Breathing technique
Pain and discomfort relief
Birth companion
D8. FIRST STAGE OF LABOUR: NOT IN ACTIVE LABOURUse this chart for care of the woman when NOT IN ACTIVE LABOUR, when cervix dilated 0-3 cm and contractions are weak, less than 2 in 10 minutes.
D9. FIRST STAGE OF LABOUR: IN ACTIVE LABOURUse this chart when the woman is IN ACTIVE LABOUR, when cervix dilated 4 cm or more.
D10-D11. SECOND STAGE OF LABOUR: DELIVER THE BABY AND GIVE IMMEDIATE NEWBORN CAREUse this chart when cervix dilated 10 cm or bulging thin perineum and head visible.
D12-D13. THIRD STAGE OF LABOUR: DELIVER THE PLACENTAUse this chart for care of the woman between birth of the baby and delivery of placenta.
RESPOND TO PROBLEMS DURING LABOUR AND DELIVERYD14. IF FHR <120 OR >160bpm
Next: If prolapsed cord D15. IF PROLAPSED CORDThe cord is visible outside the vagina or can be felt in the vagina below the presenting part.
Next: If breech presentation D16. IF BREECH PRESENTATION
Next: If stuck shoulders D17. IF STUCK SHOULDERS (SHOULDER DYSTOCIA)
Next: If multiple births D18. IF MULTIPLE BIRTHS
Next: Care of the mother and newborn within first hour of delivery of placenta D19. CARE OF THE MOTHER AND NEWBORN WITHIN FIRST HOUR OF DELIVERY OF PLACENTAUse this chart for woman and newborn during the first hour after complete delivery of placenta.
D20. CARE OF THE MOTHER ONE HOUR AFTER DELIVERY OF PLACENTAUse this chart for continuous care of the mother until discharge. See J10 for care of the baby.
D21. ASSESS THE MOTHER AFTER DELIVERYAfter an uncomplicated vaginal birth in a health facility, healthy mothers and newborns should receive care in the facility for at least 24 hours after birth. Use this chart to examine the mother the first time after delivery (at 1 hour after delivery or later) and for discharge. For examining the newborn use the chart on J2-J8.
Next: Respond to problems immediately postpartum If no problems, go to page D25. D22-D24. RESPOND TO PROBLEMS IMMEDIATELY POSTPARTUM
Next: If elevated diastolic blood pressure IF ELEVATED DIASTOLIC BLOOD PRESSURE
Next: If pallor on screening, check for anaemia
Next: Give preventive measures D25. GIVE PREVENTIVE MEASURESEnsure that all are given before discharge.
D26. ADVISE ON POSTPARTUM CAREAdvise on postpartum care and hygiene
Counsel on nutrition
Counsel on Substance Abuse
D27. COUNSEL ON BIRTH SPACING AND FAMILY PLANNINGCounsel on the importance of family planning
Method options for the non-breastfeeding woman
Lactational amenorrhoea method (LAM)
Method options for the breastfeeding woman
D28. ADVISE ON WHEN TO RETURNUse this chart for advising on postnatal care after delivery in health facility on D21 or E2. For newborn babies see the schedule on K14. Encourage woman to bring her partner or family member to at least one visit. Routine postnatal contacts
Follow-up visits for problems
Advise on danger signsAdvise to go to a hospital or health centre immediately, day or night, WITHOUT WAITING, if any of the following signs:
Go to health centre as soon as possible if any of the following signs:
Discuss how to prepare for an emergency in postpartum
D29. HOME DELIVERY BY SKILLED ATTENDANTUse these instructions if you are attending delivery at home. Preparation for home delivery
Delivery care
Immediate postpartum care of mother
Postnatal care of newborn
For both
Where is the fundus located 3 days postpartum?The fundus is usually midway between the umbilicus and symphysis 1 to 2 hours after delivery, 1 cm above or at the level of the umbilicus 12 hours after delivery, and about 3 cm below the umbilicus by the third day after delivery.
Where should the fundus be 1 day after birth?Immediately after delivery, the upper portion of the uterus, known as the fundus, is midline and palpable halfway between the symphysis pubis and the umbilicus.
What level the Fundus of uterus on the 1 day after labor is found at?Immediately postpartum, the uterine fundus is palpable at or near the level of the maternal umbilicus.
Where should the fundus be 4 days postpartum?Therefore, 24 hours after birth the fundus should 1 cm (or one finger breadth) BELOW the belly button…… 48 hours it should be 2 cm below the belly button. At 7 days the fundus should be at the symphysis pubis. At 10-14 days the fundus should be back in the pelvic cavity and can't be palpated.
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