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Appearance = skin colour (blue all over / pink body + blue limbs / all pink)
Pulse = HR (0 / <100 / >100)
Grimace = reflex irritability on suction (none / grimace / cries, sneezes, or coughs)
Activity = muscle tone (absent or floppy + frog-like / limb flexion or some / active)
Respiratory effort (absent / irregular and slow / strong and crying)
Neonatal resuscitation
Breast and milk production Encourage feeding as soon as baby needs it. Lower
HPL and bHCG fall rapidly and becomes undetectable lip of baby below nipple so that it is drawn into
by day 10. Progesterone falls with delivery of mouth. This prevents insufficient milk, engorgement,
placenta. mastitis, and nipple trauma.
Contraindications
HIV+ mum in developed countries (use bottle
feeding).
Milk composition
70 kcal/ 100 mL
7% lactose and oligosaccharide
4% milk fat (via reverse pinocytosis)
1% proteins including sIgA, lysozyme (via
transcytosis).
0.2% minerals (via exocytosis and apical
transport).
Cells e.g. WBC, epithelial cells (via extravasation).
After delivery:
1. Mum and baby should not be separated. Ensure privacy.
2. Breastfeed.
3. Early mobilisation.
4. Check daily: lochia (sloughed off necrotic decidual layer + blood, 3-6 weeks), involution,
BP, To, pulse, perineal wound (heals by 4 weeks), and fluid balance.
5. Analgesia and pelvic floor exercises.
6. FBC before discharge (Fe + laxatives if needed).
7. MW/doctor who delivered should visit. GP alerted to any complications.
8. Contraception advice.
9. Psych.
Post-partum changes
1. Genital – uterus contraction (involution) to occlude blood vessels. Size decrease over 6
weeks (no longer palpable over by 10 days). Internal os close by day 3. Contractions and
after pain up to day 4. Lochia: blood-stained 4 weeks yellow-white. Menstruation is
delayed by lactation. If not lactating, return by 6 weeks.
2. Cardio – CO and plasma volume decreases within 1 week. Oedema resolution takes up to
6 weeks. BP back to normal in 6 weeks if elevated transiently).
3. Urinary – physiological dilation returns to normal over 3 months. GFR falls so urea +
electrolyte back to normal.
4. Haem – Hb + HCT increases with haemo-concentration. WCC fall. Platelet and clotting
factors increase (thrombosis risk).